A Dermatologist's Tips for Keeping Overly-Washed Hands Soft and Healthy

With the rapid spread of the novel coronavirus (COVID-19), a respiratory virus that we don’t yet have treatment or a vaccine for, public health efforts have focused on two key messages: social distancing (thanks to the virus particles traveling in air) and hand washing (thanks to the virus particles’ ability to stay alive for hours to days on surfaces).

Why Hand Washing Matters

Hand washing is a simple yet incredibly effective way to combat the spread of this virus.  One significant way the virus spreads is through droplets (from a sneeze, cough, or even just talking) that may either be inhaled if standing too close to someone, or land on a nearby surface. Another person then goes and touches that surface, and then without thinking touches their face, rubs their eyes, bites their nails, or any other potentially harmful behavior, and now has virus particles in their body.

How exactly does handwashing work to combat the spread? We’ll try to keep it from getting too science-heavy, but in short, hand soap has the ability to break apart lipids, and the virus itself has a lipid membrane that protects it (think of the virus being protected by an oily layer); soap destroys that layer, and then we rinse away the naked dying virus particles down the sink. Experts recommend washing hands for 20 seconds (the time it takes to sing happy birthday twice), followed by completely rinsing and drying hands.

Hand Dermatitis Related to Over-Washing

All of this hand washing, though, has started to come with a side effect dermatologists were expecting–hand dermatitis (often called hand eczema). That’s because soap not only destroys lipid or oil on viral membranes, it also strips away the oils in our own skin that help make up our skin barrier. Repeated use of hand soaps can lead to a breakdown of that barrier, eventually leading to dry, flaky skin, with the potential for painful cracks and fissures. For some more sensitive patients, it can also lead to an itchy rash with similar dry, cracking skin or patches of scaly red or dark brown skin. Not only is hand dermatitis uncomfortable, it also puts us at risk for bacterial infection since the barrier is compromised.

Experts say hand sanitizer is not as good as hand washing when it comes to killing viruses, but it is certainly better than nothing when soap and a sink are not available. Are hand sanitizers any better for skin or preventing hand dermatitis? Most of the time, the answer is resounding no. In order for a hand sanitizer to be effective at killing germs, it needs to contain at least 60% alcohol (usually ethyl alcohol). This alcohol in sanitizers has the same oil-stripping effect on the hands. They also frequently have solvents in addition to alcohol that are even harder on hands. So, stick with the hand washing when possible. 

How to Best Take Care of Hands

So, what are we to do? Thankfully, we have lots of options when it comes to keeping hands clean and taking care of our skin. Here are a few tips for hand care:

• Use cool or lukewarm, not hot, water when washing hands. 
  While data suggests that the virus can be killed by higher temperatures, hot water isn’t actually necessary to do the job, and in fact just leads to more stripping of oil from the skin. Soap and water alone will take care of it, so use cool or lukewarm water.
• Pick a gentle, unscented soap for washing hands. 
  While it’s certainly true that we want antibacterial/antiviral written on our house cleaners and sanitizing wipes, we actually don’t need that in our hand soap. According to the FDA, there is no extra benefit to using antibacterial soap, and there’s a chance that the added chemicals can lead to more irritation. Fragrances are another ingredient to avoid, as these often have many chemicals that can potentially aggravate sensitive skin. A creamy formulation will be more moisturizing and still get the job done.
• Avoid hand dryers. 
  There are two reasons for this. For one (and most important when trying to cut down on virus transmission), it can spread viral particles. From a hand care standpoint, the dry, hot air can dry out hands even more and lead to worsening hand eczema. Instead, pat hands dry with a paper towel (rubbing can irritate them more). Follow up immediately with a hand moisturizer.
• Moisturize after washing hands. 
  We can’t stop soap from stripping oils from our hands, but we can add those oils and moisture back after washing. 
  Pick hand creams that are thick but fast-absorbing so you can continue with your day. It’s important if you’re already experiencing dry hands to reach for a cream formulation instead of a lotion. Creams are formulated with more oils (which is what we’re trying to replace, after all), while lotions are formulated with more water. While lotions are fine for healthy skin, in skin that is already dry, lotions can potentially lead to more dryness when the water in them evaporates. 
  Oils and butters act as occlusives (as do ingredients like petrolatum) that seal moisture in instead of allowing it to evaporate. At home, keep a pump bottle of hand cream right at the sink where you wash your hands, and keep a pocket-sized moisturizing cream with you when you’re out (which should be limited now, but many of us work jobs that still require us to show up)! If you are using a pocket-sized moisturizer, make sure to periodically wipe down the tube with a sanitizing wipe (just like our cell phones and other things we touch often)!
• Pamper hands at night. 
  If you’re already suffering from dry, cracked hands, take advantage of bedtime to really show them some TLC. After washing and patting dry, slather on a thick moisturizer (either a cream or even ointment formulation, which have the highest oil content). Follow up by covering with cotton gloves and sleeping with them on. Use the same pair nightly. Your hands will thank you after a few days!
• Consider a humidifier for home. 
  A humidifier at home will add more moisture to the air and means less moisture will evaporate from your skin. These also can help with congestion and dried-up noses.
• Protect hands when you can. 
  If you can, wear gloves when washing dishes or cleaning around the house. The same for if you may be doing food work, like cutting citrus. This will prevent further irritation from other cleaning agents or acids that can worsen hand dermatitis.
• Treat inflamed hands with hydrocortisone. 
  If you’ve developed itching and burning with dry skin, it’s time to add an over-the-counter hydrocortisone cream to the mix. After washing, apply this cream, followed by your thicker moisturizing cream. At night, apply the hydrocortisone after washing, then follow with a thick ointment and your cotton gloves.

If you try all of these tips and still suffer from dry, cracked skin, call your primary care doctor or dermatologist. While these strategies will help a majority of people suffering through hand dermatitis, there are some who may have other conditions like contact dermatitis or psoriasis and need prescription-strength creams to address the issue and calm down inflammation. Don’t wait until it’s too severe to reach out for help!