Handwashing Can Lead To Hand Eczema: How To Wash Your Hands Correctly And Protect Against Dry, Cracked Skin, Hand Rashes, And Hand Dermatitis
I know all about hand eczema. First, because I specialize in the treatment of hand eczema. Second, because I've had to deal with it myself for years. As a long-term germophobe who suffers from a tendency to hand dermatitis (also known as hand eczema), I've had to learn how to protect my hands. In fact, I'm known for babying my hands. And these techniques for preventing hand eczema are what l I focus on when treating my patients.
Rough, Dry, Red, Itchy, Cracking Skin
If you have sensitive skin, or are prone to eczema, you know how challenging it can be. Especially if it involves your hands. We constantly use our hands throughout the day. For patients with hand dermatitis, the redness, flaking, and itching of hand eczema can be a distraction at best, and unbearable at worst.
Overwashing Can Trigger Hand Eczema
Right now, we're in the midst of a spreading epidemic of coronavirus, and we're still making it through flu season. Many of my patients (and my friends) report that they’ve amped up their handwashing quite a bit in response. And they report that their skin is starting to suffer. This is why it’s so important to learn how to wash your hands correctly while still protecting your skin in the process. Because if you don’t use the right technique and the right products, your skin barrier WILL start to suffer. And once you start to damage your skin barrier, you become far more likely to develop chronic skin inflammation.
How To Wash Your Hands Correctly
Handwashing: we do it multiple times a day and yet rarely think about it much. Yet it's so important to get it right. First, you need to make sure that you’re getting rid of germs. Second, you need to make sure that in the process of getting rid of germs, you’re not getting rid of your skin barrier. The most effective way to wash your hands is to use soap and water. It's more effective if you wet your skin first, then lather up with soap, and then rub your hands as you're washing. Experts recommend at least 20 seconds of rubbing to effectively remove most germs. It's also important to rinse under running water and then carefully dry your skin. But there are several steps in this process where, if you’re not careful, you could really damage your skin barrier.
The Basics of Handwashing: Protecting Against Germs While Protecting Your Skin Barrier
1. Wash your hands the right way. Wet your hands first, then lather up and rub for 20 seconds. Rinse soap off thoroughly with running water.
2. Use the right water. While you would think that scalding hot water might be more effective in killing germs, research has shown that lukewarm water is just fine, and is much safer for your skin. 3. Use the right soap. Harsh soaps can strip away the skin’s natural oils and leave you more at risk for developing hand eczema. Other types of soaps contain irritating ingredients that can trigger allergic reactions. I don’t recommend soaps with fragrance, antibacterial ingredients, essential oils such as tea tree oil, or certain preservatives such as formaldehyde. Check below for a list of some of my recommended products. 4. Dry your hands the right way. If you’re washing your hands 20 times a day or more, like I frequently do, it’s important to pay just as much attention to how you're drying your hands as you do to how you're washing your hands. Especially if you’re using a rough paper towel, it's important to gently pat your hands instead of scrubbing them. If you're not using any hand creams, then it's important that you continue patting until your hands are dry. If you can, though, I recommend using hand cream as often as possible. Gently pat your hands until they’re almost dry, then apply hand cream while your skin is still slightly damp. Rub in the hand cream until it's absorbed. 5. Use the right kind of hand cream. In general, I recommend creams over lotions. Lotions have a high percentage of water, which means they just don’t hold moisture into your skin very well. Creams, on the other hand, are able to lock moisture into your skin more effectively because they're thicker. Ointments are the most effective at blocking water loss, but they're very greasy--and for many people they’re just too greasy for everyday use. However, I frequently use ointments on my hands at bedtime. Check below for a list of some of my recommended products. 6. Make sure you know the difference between cleansing wipes and disinfecting wipes. As the world rushes to protect itself against coronavirus, we’re seeing a lot more people using disinfecting wipes. These have strong chemicals that can kill the bacteria and viruses that may be found on the surface of objects such as doorknobs, desks, and tray tables. However, these should NEVER be used directly on your skin. The best way to “disinfect” your skin is by washing with soap and water. Wet wipes are not the same as washing with soap and water, but if you are using wet wipes for any reason (such as to help with sticky hands), make sure that you're only using wipes that are specifically formulated to be used directly on skin. 7. If you don’t have access to soap and water, hand sanitizer can be used instead, although it is not effective against all bacteria and viruses. Specifically, hand sanitizer is not as effective against norovirus or clostridium difficile, which can both cause diarrhea. However, hand sanitizers at concentrations of 60% alcohol or higher are effective against many bacteria and viruses. They can be used in place of soap and water if you don't have access to soap and water.
In terms of your skin’s health, these high concentrations of alcohol can be drying and irritating, and this is something to keep in mind if you're frequently using hand sanitizer. Be extra careful if you have cracks in your skin; the alcohol in hand sanitizer can be painful to use on cracked skin.
Use The Right Products: Avoid Soaps With Fragrance, Antibacterial Ingredients, And Highly Allergenic Preservatives
For my patients with hand eczema, I am very specific about which soaps and other skin care products that I recommend. That’s because there is not one single brand that I can recommend across-the-board.
For example, some of the major brands sell 20 different versions of just their soaps alone.
Here is a short list of some of the cleansers, creams, and wipes that I recommend to my patients.
Liquid cleansers:
Aveeno baby cleansing therapy wash fragrance-free
Cetaphil gentle skin cleanser (liquid only) [P,PG]
Cerave hydrating cleanser [P]
Cerave foaming cleanser [P,PG]
Free and Clear liquid cleanser
Neutrogena ultra gentle hydrating cleanser (creamy formula only)
Vanicream gentle facial cleanser
Bar soaps:
Aveeno fragrance-free bar soap
Cerave hydrating cleanser bar
Neutrogena fragrance-free bar soap [TR]
Vanicream bar soap [PG]
Hand Creams:
Cerave moisturizing cream [P]
Cleure Day Cream [V] (www.cleure.com)
Aveeno Eczema Therapy cream [BCL]
Theraplex eczema therapy with oatmeal (www.theraplex.com)
Neutrogena Norwegian Formula Hand Cream fragrance-free [P]
Vanicream cream [PG]
Cerave healing ointment [V]
Theraplex emollient for severely dry skin
Vaniply ointment
Pure Vaseline petroleum jelly (no added fragrance or flavoring)
Wet Wipes (best for removing crumbs or stickiness, not germs)
Sani-Hands Instant Hand Sanitizing Wipes [PG, V]
Seventh Generation chlorine-free baby wipes [Benzoic acid]
Simple Cleansing Facial Wipes [Benzoic acid, V]
CVS Health Instant Hand Sanitizing Wipes [PG, V]
How Did I Choose These Particular Products?
There are a few rules I emphasize when choosing soaps (and other skin care products). These rules are especially important if you're washing frequently, have sensitive skin, or are prone to eczema.
That's because if you have an impaired skin barrier, you're more likely to develop allergic reactions to anything that you use on top of that skin barrier.
How do you know if you have an impaired skin barrier? Some common conditions can indicate that your skin barrier isn't functioning well and may be considered impaired. For example, dry skin, red skin, cracked skin, or a rash can all indicate an impaired skin barrier.
When choosing cleansers, it’s important to stay away from those with heavy fragrances. That added fragrance doesn't add anything to the effectiveness of the product. It’s purely there for your enjoyment. If you don’t have sensitive skin, feel free to use these every now and then. But for those with sensitive skin, I recommend staying away from any added fragrance.
I also recommend staying away from antibacterial cleansers. Research has shown that they're not necessary. Regular soaps are formulated in such a way that they are able to effectively remove germs from the surface of the skin. Antibacterial ingredients aren't necessary, and in fact may contribute to antibiotic resistance. Also, some of my patients have become allergic to certain antibacterial ingredients after using them on inflamed skin. The bottom line is that antibacterial cleansers don't add much, and they may cause problems, so I no longer recommend them for regular handwashing. Along the same lines, I don’t recommend routinely using "natural" antibacterial ingredients. For example, some of my patients have turned to tea tree oil cleansers in the hope that this "natural antibacterial" ingredient may be helpful. However, the tea tree oil isn't necessary for cleansing. And I'm seeing a lot of allergic reactions to tea tree oil, especially in those with sensitive skin or those who are using it on top of an impaired skin barrier.
I also recommend avoiding certain preservatives and ingredients that are more likely to trigger allergic skin reactions. That’s why none of the cleansers that I recommend contain formaldehyde-related preservatives or methylisothiazolinone.
Use The Right Hand Moisturizers: Choose Creams Over Lotions, And Avoid Fragrance, Formaldehyde, And Methylisothiazolinone
I recommend hand creams for those who wash their hands frequently, because it’s really important to replenish the skin barrier. The products above are examples of some that I recommend to my patients (note that there are many other good options.) I recommend these specific products because they are truly fragrance-free. They also do NOT contain any of the highly allergenic preservatives that I avoid at all costs, including formaldehyde and methylisothiazolinone. As I mentioned earlier, I prefer creams over lotions. Creams are more moisturizing and they help your skin retain water better. Because lotions are formulated with a higher water content, they don’t help your skin retain water as effectively as a cream. Ointments are actually the best at blocking water loss, but they are greasy.
Disinfecting Wipes: Great For Doorknobs But Dangerous For Your Skin
The disinfectants that we use for doorknobs and desks and other surfaces make use of chemicals that are very irritating to the skin. Do not ever use these on the skin and don’t get them on the skin. This includes chemicals such as sodium hypochlorite, also known as bleach, as well as glutaraldehyde. Chemical disinfecting wipes can also be extremely irritating. If you’re using them on surfaces, try not to get them on your hands, and make sure that the disinfectant dries before you touch that surface.
The Bottom Line: Handwashing is one of the most important things we can do to protect ourselves from contagious illnesses. However, if you’re not careful, all of that handwashing can start to strip away your skin barrier. And that can leave you prone to irritated skin, hand eczema, and allergic reactions of the skin.
That’s why, when it comes to protecting your hands, the right technique and the right skin care products are so important.