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Due to COVID-19, extended use of PPE introduced an increased risk of dermatological 
conditions among health care workers.  Many essential workers experience adverse skin 
reactions (ASRs) to the hands and face.1 Additionally, increased hygiene measures, such as 
utilization of 60% alcohol based hand sanitizers lead to the disruption of skin flora and 
natural protections of the skin barrier.2 Subsequently, bacteria, fungi, and viruses, such as the 
coronavirus, can penetrate through the skin into the bloodstream causing additional 
comorbidities.3 

Though 90% of healthcare workers experience symptoms associated with hand eczema 
less than 15% recognize the symptoms as onset of disease.2 

Introduction

54 year old female essential worker with a history of atopic dermatitis presents with a 6 week 
worsening of hand dermatitis due to frequent job related hand washing and sanitizing 
(~20x/day).  Hand dermatitis is unresponsive to previously effective long term atopic 
dermatitis treatment plan:

Case Report Information

OTC cleanser (Cetaphil® PRO) twice daily

OTC moisturizer (Cetaphil® PRO Eczema) 
twice daily and as needed
Desoximetasone (Topicort®) ointment 0.05% 
twice daily for flares

Loratadine (Claritin®)10mg daily
Adult multivitamin daily

Exam Signs and Symptoms

      Pruritis, pain 

      Papules 

      Erythematous plaques and scaling

      Excoriation 

      Fingertip fissures 

Results

Intervention/ Treatment

Initial Visit 2 Week Visit

Prescribe physiologically balanced lipid skin barrier repair emulsion  
(EpiCeram®) twice daily and as needed

Continued OTC cleanser (Cetaphil® PRO) twice daily
Continued desoximetasone (Topicort®) ointment 0.05% twice daily for flares
Continued loratadine (Claritin®) 10mg daily
Continued adult multivitamin daily

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Discussion

This case study demonstrates that a focus on proper barrier repair, which includes 
physiologically balanced lipids in a 3:1:1 ratio (ceramide:free fatty acid:cholesterol) delivered 
over time, is an important treatment option for ASRs due to frequent PPE use and hand 
washing/sanitizing not adequately responding to current treatment measures inclusive of 
topical steroids and over the counter moisturizers. 

Conclusion

Due to the COVID-19 pandemic essential workers are at increased risk of developing various 
cutaneous conditions. Utilizing a 3:1:1 prescription skin barrier repair emulsion that 
delivers physiologic lipids is an option for quick and sustained resolution of dermatoses.

References
1. Hu K, Fan J, Li X, Gou X, Li X, Zhou X. The adverse skin reactions of health care workers 
using personal protective equipment for COVID-19. Medicine (Baltimore). 2020;99(24):e20603. 
doi:10.1097/MD.0000000000020603 2. Guertler A, Moellhoff N, Schenck TL, et al. Onset of 
occupational hand eczema among healthcare workers during the SARS-CoV-2 pandemic: 
Comparing a single surgical site with a COVID-19 intensive care unit. Contact Dermatitis. 
2020;83(2):108-114. doi:10.1111/cod.13618 3. Baldwin H, Aguh C, Andriessen A, et al. Atopic 
Dermatitis and the Role of the Skin Microbiome in Choosing Prevention, Treatment, and Main-
tenance Options. J Drugs Dermatol. 2020;19(10):935-940. doi:10.36849/JDD.2020.10.36849/
JDD.2020.5393

COVID-19 Pandemic and Personal Protection Equipment (PPE): 
A Focus on Treatment of Essential Workers with Hand Dermatitis

Heather Roebuck, DNP, FNP-BC, FAANP RoebuckDERM, West Bloomfield, MI

Initial Visit 2 Week Visit

The author wishes to thank Dr. Christina Cognata Smith for her editorial assistance and 
support throughout this educational endeavor.