Treating Dermatitis in Healthcare Workers

In his session at Maui Derm Hawaii 2023, "Contact Dermatitis Update 2023", Matthew Zirwas, MD, FAAD, and founder of the Bexley Dermatology Research Clinic in Bexley, Ohio, revealed that hand dermatitis affects up to 50% of healthcare workers in the US. There are often multiple contributing causes to occupational contact dermatitis, as workers are exposed to both irritants and allergens, and they can usually be diagnosed as atopic contact dermatitis (ACD) or irritant contact dermatitis (ICD). While Zirwas said there is no definitive way to distinguish between ACD and ICD, there are observations that can be made to help determine a treatment path.

ACD, he said, tends to involve intense itch, and is typically limited to the palms. It tends to be more acute and more inflammatory than irritant dermatitis. ICD sufferers have less itch, but more pain and irritation. This variant of dermatitis spares the palm but presents on the back of the hand. Zirwas recommends patch testing for those symptoms to try to determine the allergen. “Remaining aware of the current trends in allergens may allow for earlier recognition, diagnosis, and treatment; subsequently helping our patients to work in healthier and safer environments”, he said.

Zirwas said patients can help relieve symptoms by using sanitizer as opposed to soap and water to cleanse, because it is less irritating than handwashing and less likely to cause hand dermatitis. He explained that soap and water are known to destroy the skin barrier, while sanitizer is much better at reducing bacteria. If there is no sanitizer available, Zirwas said the water temperature makes a significant difference. “The best thing you can do in terms of hand washing is not using a specific kind of soap or frequently washing hands. It’s the temperature of the water. Use cold water. We tell people not to take hot showers, but we don’t usually remind people not to wash hands in hot water”, he said.

 For patients who find the burn of alcohol based santizer too painful, Zirwas said he recommends benzalkonium chloride (BAC) sanitizer, which can be bought over-the-counter. BAC is a long-lasting bactericide that does not promote antibiotic resistance, and Zirwas said it is just as effective against COVID-19 and other viruses.

Reference

1. Zirwas, M. Contact Dermatitis Update 2023; Presented at Maui Derm Hawaii 2023; January 23-27, 2023; Maui, Hawaii.