Skin damage is common in frontline healthcare workers managing COVID19 patients due to their prolonged use of personal protective equipment (PPE) and hand hygiene measures, Chinese researchers have shown.

A survey of 700 doctors and nurses working in Wuhan’s isolation wards and fever clinics found that 97% had skin damage due to the use of equipment such as N95 masks and double layer gloves.

Dryness/tightness and skin tenderness were the most common symptom and signs reported (70% and 57% respectively), according to doctors from the Department of Dermatology, Union Hospital, Tongji Medical College, Wuhan. Other common signs and symptoms from PPE were itching (53%) and burning/pain (38%). Desquamation (62%), erythema (49%) and maceration (40%) were the most common skin lesions reported

The most commonly affected skin areas were the nasal bridge, hands, cheek and forehead.

Skin damage was twice as common in healthcare workers who wore N95 masks and goggles for more than six hours (odds ratio 2.02 and 2.32 respectively). Skin irritation was also twice as common among healthcare workers who practiced hand hygiene more than 10 times a day.

The study authors said the skin damage was likely to be further increased when healthcare workers wore masks outside the work environment as a more general protective measure.

Skin damage contributed to doctors’ negative feelings about work and also to anxiety, they wrote in the Journal of the American College of Dermatology.

The findings of prolonged PPE use causing skin damage suggested that “the working time of first-line staff should be arranged reasonably [and] prophylactic dressings could be considered to alleviate the device-related pressure injuries,” they concluded.