Observations and recommendations
Extended length gloves are not necessary when providing care to suspected or confirmed COVID-19 patients. They are not specifically recommended, except for activities with increased risk, such as submerging hands into a solution. For standard procedures, it is sufficient to cover the cuff (wrist) of the gown while donning.[1], [2], [3], [4]
Another common measure that is no longer recommended is “double gloving,” except for surgical procedures that carry a high risk of disrupting the integrity of the glove. Double gloving seems to increase the incidence of dermatologic side effects, from irritation and overhydration to induction of latex allergy. The increase of skin damage as the consequence of overzealous PPD use and hand hygiene is an emergent consequence of the COVID-19 handling.[10], [11], [12]
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About 74.5% of front-line COVID-19 HCWs developed hand dermatitis in the Chinese experience.13 A questionnaire-based study suggested that 88.5% of skin reactions on the hands are associated with the use of latex gloves.14 Three types of adverse events might occur: latex allergy, talcum powder reactions, and irritant dermatitis. Excluding latex allergy and powder within the gloves, the problem of excessive dryness and pruritus, associated with irritant dermatitis, may be aggravated by occlusion, leading to sweating and/or overhydration. This then may increase the permeability to sanitizers or detergents, creating a vicious cycle, plus aggravation of hand dermatitis.12
A peculiar pattern of hand dermatitis has been recognized, characterized by erythema and fine scaling on the palms and web spaces.15 This may be attributed to the depletion of surface lipids, resulting in deeper penetration of detergents, and progressive damage of skin layers is a major pathogenetic mechanism. Irritant contact dermatitis is more commonly found with iodophors, chlorhexidine, chloroxylenol, triclosan, and alcohol-based products, whereas allergic contact dermatitis develops due to quaternary ammonium compounds, iodine or iodophors, chlorhexidine, triclosan, chloroxylenol, and alcohol sensitization.
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To date, there have been no verified reports of COVID-19 infection as direct consequence of skin damage. Angiotensin-converting enzyme 2 (ACE2), which is the main cell receptor for SARS-CoV-2 entry, can be expressed in the basal layer of the epidermis, hair follicles, and eccrine glands, as well as on skin blood vessels.16
Basic skincare measures should be taken to avoid the risk of SARS-CoV-2 entry through the skin.[10], [11], [12], [13], [14], [15] Careful hand skin drying and hypoallergenic hand cream/emollients may be employed to prevent trapping sanitizers in the web spaces. Emollients may also be applied at other times to correct any residual dryness and scaling, or with the occurrence of hand dermatitis, topical corticosteroids are indicated.
A final consideration is the generation of massive amount of medical waste, caused in part by the extensive use of PPDs.17 HCWs, together with the general population, are using more gloves than ever before, whereas it should be limited to very essential preventive measures.
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