‘Occupational dermatoses from Personal Protective Equipment during the COVID‐19 pandemic in the tropics – A Review’

Abstract

The COVID‐19 pandemic has enveloped the world and there has been a high incidence of occupational dermatoses related to Personal Protective Equipment (PPE) amongst healthcare workers (HCWs) during this period. Prevention and management of these conditions will not only improve staff morale and quality of life, but will also minimize the risk of breaching PPE protocol due to such symptoms. The tropical climate in Singapore predisposes HCWs to more skin damage and pruritus due to intense heat, high humidity and sun exposure. The effects of friction, occlusion, hyperhidrosis and overheating on the skin in the tropics should not be neglected. Preventive measures can be taken based on our recommendations, and the working environment can be made more conducive for frontline HCWs. We review the literature and discuss various preventive and management strategies for these occupational skin diseases for our frontline HCWs, especially those working in less controlled working environments beyond the hospital in Singapore. Shorter shifts and frequent breaks from PPE are recommended. Duration of continuous PPE‐usage should not exceed 6 h, with breaks in non‐contaminated areas every 2–3 h to hydrate and mitigate the risk of skin reactions. Other strategies, such as teledermatology, should be considered so that consultations can remain accessible, while ensuring the safety and well‐being of our clinical staff.

Adverse Skin Reactions Among Frontline Personnel Due To Personal Protective Equipment Against COVID-19

“…Second, to reduce hand dryness and itchiness, simple measures can be used such as avoiding washing hands with hot water, using powderfree, reduced protein, hypoallergenic gloves, and applying skin moisturizers, especially those containing ceramide. 16,19 Also, using alcohol gel formulation when the hand is not visibly contaminated can cause minor skin damage in comparison to soap and water. 22 Moreover, facial cleansers containing salicylic acid (SA) and benzoyl peroxide can be used to reduce acne.…”

“…22 Moreover, facial cleansers containing salicylic acid (SA) and benzoyl peroxide can be used to reduce acne. 16 Also, topical antibiotics may be warranted for papules and a low concentration of topical retinoid for comedones. 16 Nevertheless, pressure injuries from N95 masks are a common problem.…”

“…13,15 One possible explanation for hand dermatitis is excessive hand washing, rubbing without using proper hand moisturizers. 16 Another explanation reported by the literature is prolonged usage of PPE, and as suggested by other studies wearing double gloves is a potential risk factor. [16][17][18][19] As predicted, most participants in this study who used double gloves experienced adverse skin reactions, 58 out of 78 (74.4%).…”

“…16 Another explanation reported by the literature is prolonged usage of PPE, and as suggested by other studies wearing double gloves is a potential risk factor. [16][17][18][19] As predicted, most participants in this study who used double gloves experienced adverse skin reactions, 58 out of 78 (74.4%). The hot climate and excessive humidity may also influence this in the Kingdom of Bahrain.…”

“…10 The second most affected site was the nasal bridge, as it a vulnerable area for pressure injuries and lacerations, especially when using N95 masks too tightly or wearing the goggles for a long duration. 16,21 Acne and pimples were the third most familiar complaint, and cheeks were the third commonest affected site. This can be expected since the most prevalent chronic skin condition in the study participants is acne.…”