COVID-19 hand washing advice

Hello – I’m Hywel Williams and I’m professor of dermatology at the Queen’s Medical Centre at the University of Nottingham. I have had a lifelong interest in eczema research and I have also had eczema all of my life.

Now many people with eczema or parents of children with eczema have been asking me for advice about hand washing during the coronavirus pandemic – some children and adults with eczema are getting very sore hands as a result of repeated washing with soap and water. Many healthcare professionals working on the front line have also developed dry and inflamed, red itchy hands as a result of constant hand washing.

Knowing what to advise is tricky as there is not a lot of good evidence about the best way to clean your hands of coronavirus for people with eczema and dry skin, so this advice is given to you in good faith and is based on clinical experience, previous studies from hand washing problems for health care professionals and from a scientific discussion with two of my colleagues, Professor Michael Cork from Sheffield and Professor Alan Irvine from Dublin. I should add that I have no commercial conflicts of interest.

So why is it such a tricky topic? Well, because normally, I would advise that people with eczema should be using a moisturiser or emollient instead of soap for washing. However, the UK Government advice is to wash your hands with soap and water for at least 20 seconds. Now the problem with frequent hand washing with soap and water is that it can make your hands very dry and even break out in eczema. And for people who already have eczema on their hands, soap and water can make the eczema much worse.

The main concern with using your emollient as a soap substitute is that it might not remove and kill the coronavirus that you could be carrying on your hands.

The UK Government has thought carefully about its advice, and soap and water for 20 secs seems to the best option to keep your hand free of virus (or sanitiser if no soap or water is available). And the reason is that soaps, detergents and alcohol gels help to penetrate the fatty outer coat of the coronavirus. Emollients don’t do this, and they might even trap and protect the virus on the skin surface and leave a moist residue on the skin – this is what they are supposed to do after all.

Yet there is a way to solve this balancing act between removing the virus and keeping your hands healthy.

I recommend that you should continue to follow the UK Government advice and use soap and water to wash your hands for 20 secs to clear your hands of virus. COVID-19 is a serious disease and it is important to reduce the spread as much as possible. After you have washed your hands and then rinsed them and dried them properly, what you then need to do is to apply plenty of emollient to your hands to replenish the precious oils on your skin - so that you keep your hands moisturised and supple. This means that you need to keep your emollient by your sink, and if you have to go out, you should take your emollient with you. Your emollient should be in a pump dispenser or tube. You should not put some in a small container as your fingers might contaminate the pot if you use it repeatedly.

Most people with dry skin and eczema will be fine using soap and water in this way providing you are strict about always applying your emollient afterwards.

Some people who already have eczema on their hands, will find that the above plan still makes their eczema worse. If this happens there are two things you can do. The first is that you wash for 20 seconds with soap and water to get rid of the virus. Then after rinsing the soap off, use your emollient soap substitute for a second wash to remove any irritating soap residues. Then rinse and dry and finally apply more emollient directly to your dried hands.

Second, if you find that your hand eczema is still playing up, then treat it properly with your anti-inflammatory cream which would normally be a medium to strong topical steroid. Remember that the skin on the hands is really tough and thick, so you should not be too timid about using stronger steroid creams or ointments there. So if your hands are in a state with eczema, then get control by giving them a blast of topical steroid once a day for say one week, then keep control by using the topical steroid to the troublespots every weekend (on a Sat and Sunday night). This is a very safe way of using topical steroids on the tough skin of the hands. And of course, you can apply your emollients on your hands as often as you like during the day.

So just to summarise, my advice to people with dry skin or eczema on their hands is to follow the normal UK Government advice but to make sure you put lots of emollient on your hands after rinsing and drying your hands.

For those people who find this is not enough to protect their skin, then you should still start with the soap and water for 20 secs, and then use emollient as a second soap wash, rinsing and drying your hands and following up with your emollient applied directly to your hands.

And if your hands are red raw with eczema, emollients by themselves will not be enough – you must treat the skin inflammation with your topical steroid to get control then keep control.

Thank you for your help in doing what you can to help reduce the spread of coronavirus whilst at the same time taking good care of your hands.

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