The need of an updated culture of “occupational” atopic hand dermatitis in children at the time of COVID-19 From two cases report to an update culture of atopic dermatitis

Main Article Content

Luca Pecoraro
Giovanni Chiaffoni
Giorgio Piacentini
Angelo Pietrobelli

Keywords

alcohol-based hand sanitizers, atopic dermatitis, occupational dermatitis, COVID-19, SARS-COV 2, school, children

Abstract

During the COVID-19 outbreak, handwashing emerged as an essential tool to prevent the spread of SARS-CoV-2 virus. It can put into practice using warm water and soap or, if not available, alcohol-based hand sanitizers (ABHS). Anyway, the use of warm water and soap is not always possible. On the contrary, ABHS are frequently used for their versatility, but can represent a risk factor for atopic dermatitis exacerbations in the pediatric age. At the same time, the Italian Ministry of Health established a school regulation, asking the students to periodically disinfect hands with sanitizing gel, or soap and water, especially before entering classrooms and laboratories, immediately after contact with everyday objects, after using the toilet, after throwing away the handkerchief and before and after eating. No rules have been personalized in this statement for children affected by atopic dermatitis attending the school. Based on this observation, we reported two case reports, involving children with a known diagnosis of atopic dermatitis, who attended our Pediatric Allergy Unit in Mantua, Italy. They experienced a worsening of symptoms related to AD on their hands in the last year for an intensive handwashing with ABHS before entering all classrooms and laboratories every day at school. Avoiding ABHS at school and washing their hands with a non-alcohol and additives soap and water solved their problem and brought their atopic dermatitis back to good control. So, it seems appropriate to consider ABHS as a “school trigger” and the low-controlled atopic dermatitis of these two patients as an “occupational dermatitis”. An adequate pediatric culture of atopic dermatitis at the time of COVID 19 is needed.

Abstract 457 | PDF Downloads 227

References

1) Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020 Aug 1;396(10247):345-360. doi: 10.1016/S0140-6736(20)31286-1. Erratum in: Lancet. 2020 Sep 12;396(10253):758. PMID: 32738956.
2) Rundle CW, Presley CL, Militello M, Barber C, Powell DL, Jacob SE, Atwater AR, Watsky KL, Yu J, Dunnick CA. Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society. J Am Acad Dermatol. 2020 Dec;83(6):1730-1737. doi: 10.1016/j.jaad.2020.07.057.
3) When and How to Wash Your Hands | Handwashing | CDC. https://www.cdc.gov/handwashing/when-how-handwashing.html (2022).
4) Borch L, Thorsteinsson K, Warner TC, Mikkelsen CS, Bjerring P, Lundbye-Christensen S, Arvesen K, Hagstroem S. COVID-19 reopening causes high risk of irritant contact dermatitis in children. Dan Med J. 2020 Aug 6;67(9):A05200357. PMID: 32800064.
5) Beiu C, Mihai M, Popa L, Cima L, Popescu MN. Frequent Hand Washing for COVID-19 Prevention Can Cause Hand Dermatitis: Management Tips. Cureus. 2020 Apr 2;12(4):e7506. doi: 10.7759/cureus.7506. PMID: 32373409; PMCID: PMC7195203.
6) Tasar R, Wiegand C, Elsner P. How irritant are n-propanol and isopropanol? - A systematic review. Contact Dermatitis. 2021 Jan;84(1):1-14. doi: 10.1111/cod.13722. Epub 2020 Nov 11. PMID: 33063847; PMCID: PMC7675697.
7) Simonsen AB, Ruge IF, Quaade AS, Johansen JD, Thyssen JP, Zachariae C. Increased occurrence of hand eczema in young children following the Danish hand hygiene recommendations during the COVID-19 pandemic. Contact Dermatitis. 2021 Mar;84(3):144-152. doi: 10.1111/cod.13727. Epub 2020 Nov 5. PMID: 33085086.
8) 8.https://www.miur.gov.it/documents/20182/0/m_pi.AOOGABMI.ATTI+del+Ministro%28R%29.0000021.14-08-2021.pdf/f2defe64-6a94-2676-f652-7c1ba87d304d?version=1.0&t=1629311928566
9) Cardinale F, Ciprandi G, Barberi S, Bernardini R, Caffarelli C, Calvani M, Cavagni G, Galli E, Minasi D, Del Giudice MM, Moschese V, Novembre E, Paravati F, Peroni DG, Tosca MA, Traina G, Tripodi S, Marseglia GL; and the SIAIP Task Force. Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic. Ital J Pediatr. 2020 Jun 16;46(1):84. doi: 10.1186/s13052-020-00843-2. PMID: 32546234; PMCID: PMC7296524.