Prevention and Treatment of Skin Damage Caused by Personal Protective Equipment: Experience of the First-Line Clinicians Treating SARS-CoV-2 Infection

Kaur

et al. 2021

Advances in Wound Care

133

189

Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently a pandemic. Although pulmonary health has been the primary focus of studies during the early days of COVID-19, development of a comprehensive understanding of this emergent disease requires knowledge of all possible disease manifestations in affected patients. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant review focuses on cutaneous manifestations reported in COVID-19 patients. Approach: Literature review was conducted using the PubMed database to examine various cutaneous manifestations related to the SARS-CoV-2 infection. Published articles (n = 56) related to search criteria from the onset of the COVID-19 pandemic to June 30, 2020, were included. The primary literature articles included in this study were mainly from France, Spain, Italy, and the United Kingdom. Results: Unique to many other symptoms of COVID-19, its cutaneous manifestations have been found in people of all age groups, including children. The cutaneous manifestations of COVID-19 are varied and include maculopapular, chilblain-like, urticarial, vesicular, livedoid, and petechial lesions. In addition, rashes are common in multisystem inflammatory syndrome in children, a new and serious health condition that shares symptoms with Kawasaki disease and is likely related to COVID-19. In addition, personal protective equipmentrelated skin wounds are of serious concern since broken cutaneous barriers can create an opening for potential COVID-19 infections. Innovation and Conclusion: As this virus continues to spread silently, mainly through asymptomatic carriers, an accurate and rapid identification of these cutaneous manifestations may be vital to early diagnosis and lead to possible better prognosis in COVID-19 patients. This systematic review and photo atlas provide a detailed analysis of the skin pathologies related to COVID-19. Study of these cutaneous manifestations and their pathogenesis, as well their significance in human health will help define COVID-19 in its entirety, which is a prerequisite to its effective management.

Section: Discussionmentioning

confidence: 99%

Section: Incidences Of Ppe-associated Skin Rashes In Covid-19 Pandemicmentioning

confidence: 99%

Cutaneous Manifestations of COVID-19: A Systematic Review

Kaur

et al. 2021

Advances in Wound Care

133

189

“…Refreshment of PPE poses increased virus exposure risk and as such, medical staff wear their facial PPE for much longer than recommended. The recent global COVID-19 pandemic has highlighted that prolonged use of facial PPE can cause a range of skin issues, including irritation and injuries such as skin tears, pressure injuries and urticaria [3]. Maintaining skin health and preventing injury whilst using PPE has become an important aspect of advice to medical staff [4].…”

Section: Covid-19 Ppe and Skin Injurymentioning

confidence: 99%

Evaluating lubricant performance to reduce COVID-19 PPE-related skin injury

et al. 2020

Background Healthcare workers around the world are experiencing skin injury due to the extended use of personal protective equipment (PPE) during the COVID-19 pandemic. These injuries are the result of high shear stresses acting on the skin, caused by friction with the PPE. This study aims to provide a practical lubricating solution for frontline medical staff working a 4+ hours shift wearing PPE. Methods A literature review into skin friction and skin lubrication was conducted to identify products and substances that can reduce friction. We evaluated the lubricating performance of commercially available products in vivo using a custom-built tribometer. Findings Most lubricants provide a strong initial friction reduction, but only few products provide lubrication that lasts for four hours. The response of skin to friction is a complex interplay between the lubricating properties and durability of the film deposited on the surface and the response of skin to the lubricating substance, which include epidermal absorption, occlusion, and water retention. Interpretation Talcum powder, a petrolatum-lanolin mixture, and a coconut oil-cocoa butter-beeswax mixture showed excellent long-lasting low friction. Moisturising the skin results in excessive friction, and the use of products that are aimed at 'moisturising without leaving a non-greasy

“…8 Long-term disinfectant use also influences the microbiome and immune microenvironment on the skin surface, resulting in conditions such as eczema, fungal infection, bacterial infection, and allergic dermatitis. 14 Van der Meer et al recommended that hands should be washed in lukewarm water and dried thoroughly. 15 Using weak acidic or neutral detergents instead of alkaline ones are encouraged, and frequent application of barrier creams is recommended.…”

Section: Resultsmentioning

confidence: 99%

Cutaneous manifestations among health-care workers caring for COVID patients

et al. 2020

Background: Due to the high transmission ability of the SARS-CoV-2 virus, front-line healthcare workers (HCWs) are at a greater risk of contracting the infection during the management of COVID patients. As a result, prevention measures against COVID-19 disease transmission like personal protective equipment (PPE) and frequent hand washing have become a necessity. While these measures are effective against COVID-19 transmission, they have negative implications as well, one of which is their detrimental effects on the skin. The objective of the study was to understand the prevalence and pattern of cutaneous manifestations among HCWs caring for COVID patients.Methods: A descriptive study on HCWs caring for COVID-19 patients was conducted at a designated COVID hospital from September to October 2020. Data on protective measures taken and cutaneous examination findings were recorded and analyzed.Results: Among 310 HCWs in this study, 137 HCWs (44.19%) had skin rash. The highest incidence of cutaneous manifestations was seen among nurses (48.33%), followed by doctors (42.29%) and support staff (33.33%). Hand eczema (43.80%) was the most common manifestation, followed by acne (22.63%), hair fall (18.98%), sweat dermatitis (11.68%), pressure dermatitis (10.22%), irritant contact dermatitis (7.30%). Seborrhea capitis, pruritus, xerosis, hyperpigmentation, urticaria, tinea corporis, and eczema over legs were the other cutaneous manifestations seen in this study.Conclusions: Nearly half of the HCWs in this study had cutaneous manifestations. Hence, there is a need to educate the HCWs regarding best practices for the prevention of skin damage caused by PPE and frequent hand wash.