The Impact of SARs-CoV-2 on Occupational Skin Disease Found in Physicians

Occupational contact dermatitis (OCD) makes up 95% of all occupational skin-related disease (Lampel & Powell, 2019). Contact dermatitis (CD), which includes both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD), is an inflammatory reaction of the skin in response to contact with an allergen or irritant, respectively.

ICD comprises 80% of all OCD (Lampel & Powell, 2019). Among the populations of individuals most affected by OCD are health care workers (HCWs). Disease prevalence among HCWs is 22% in contrast to that of the general working population which is 20% (Lampel & Powell, 2019). However, some studies suggest a higher range of 20% to 30% of HCWs have OCD secondary to under reporting and under recognition of the disease (Holness, 2019).

The American Contact Dermatitis Society (ACDS) warns against the rising prevalence of OCD in response to the SARs-CoV-2 (COVID-19) pandemic. Protecting medical professionals and reducing transmission of the virus by physicians who come into contact with COVID-19-positive patients requires stringent hand hygiene. This includes excess wet work, frictional work (i.e., glove handling), and frequent use of disinfectants.

Close to one half of patients with OCD that is located on the hands report finger and joint restriction (Holness, 2019). Thirty-one percent of individuals claiming restriction of use also report a decline >10% in work productivity (Holness, 2019), while one half of these workers claim to have requested sick leave or job change due to the condition (Nicholson et al., 2010). In addition, individuals with OCD report positive anxiety and depressions scores (20% and 14%, respectively) with one half indicating the disease has a direct negative impact on their quality of life (Holness, 2019; Nicholson et al., 2010).

OCD remains a significant burden to medical professionals and is a rising threat in the climate of COVID-19. Treatment of OCD requires avoidance of the allergen or irritant. In occupations in which this is not possible, such as the medical field, primary prevention is key. Primary prevention requires a multidisciplinary approach. The following recommendations on safe practices may reduce the rate of OCD and bring awareness to safe practices for the workplace. The ACDS and Centers for Disease Control and Prevention recommend alcohol-based hand sanitizers (ABHS) with moisturizers to reduce the onset of OCD. ABHS containing >60% ethanol or >70% isopropanol are appropriate for COVID-19 and do not require handwashing pre- or post-use. For individuals that prefer to use soap and water, cold or lukewarm water is recommended. To prevent glove breakdown, moisturizers with an aqueous based solution should be applied prior to glove use. Individuals who react to rubber accelerators in gloves should use cotton or plastic liners or use vinyl gloves in place of latex and non-latex gloves.

For occupational health nurses caring for workers with OCD, identify the causative irritant or allergen by taking a detailed medical history of exposures and symptoms. If the irritant or allergen remains unknown, recommend patch testing. Encourage patients to avoid or minimize exposure to the causative agent. If symptoms persist, recommend that the patient avoid scratching, apply cool compress, and soak the area in oatmeal baths. Workers can also use calamine lotion to relieve itching. Additional therapies include topical anti-inflammatories such as corticosteroids, calcineurin inhibitors, and phototherapy. The ACDS (www.contactderm.com) has additional information on how to manage patients with OCD.