Impact of Hand Hygiene and Mask-Wearing Practices on Hand Eczema and Facial Acne Incidence in Healthcare Workers during COVID-19 Outbreak.

Dear Editor: In response to the COVID-19 outbreak, Singapore raised the Disease Outbreak Response System Condition (DORSCON) from Yellow to Orange on 7th February 2020. All healthcare professionals (HCP) in Singapore were mandated to wear masks and strict hand hygiene was reinforced. Frequent mask-wearing may contribute to an occlusive form of acne, while frequent handwashing contributes to occupational hand dermatitis. In this cross-sectional study, we distributed electronic surveys to HCP with direct patient contact in the National University Hospital, Singapore between 14 April 2020 and 21 May 2020. Univariable and multivariable logistic regression were performed to identify factors associated with worsening hand eczema or new hand eczema-related symptoms, and worsening acne or new acne-related symptoms. Statistical analysis was performed using SPSS version 21.0 (IBM Corp.). A p-value <0.05 was considered to be statistically significant. Approval from the National Health Group Domain Specific Review Board Singapore (Reference number 2020/00267) was obtained before commencement of study. Waiver of consent was obtained as data collected was anonymized and participation in the study was voluntary. No identifying information is included in this manuscript. A total of 515 HCP took part in the survey. Results reflected changing hand hygiene practices after DORSCON Orange. The number of participants washing hands less than 15 times a day at work decreased from 177 (34.4%) to 80 (15.5%), while the number washing hands more than 40 times at work increased from 106 (20.6%) to 191 (37.1%). Hand hygiene frequency outside work similarly increased, with 472 (91.7%) participants washing hands more than 6 times a day from just 314 (61.0%) previously. Wilcoxon signed-rank test showed a statistically significant increase in frequency of handwashing at work (Z=-15.1, p<0.001) and outside work (Z=-15.6, p<0.001). Of 88 participants with existing hand eczema, 49 (55.7%) reported worsening symptoms. New hand eczemarelated symptoms (dryness, itching, redness, scaling, vesicles, or skin cracks) were observed in 242 (46.9%) participants without previous eczema. Of 165 participants with existing acne, 111 (67.3%) expressed worsening, of whom 102 (91.9%) reported worsening in mask covered areas, while 212 participants without prior acne reported new acne-related symptoms (oiliness, comedones or pimples). Results for the univariable and multivariable logistic regression for factors associated with worsening hand eczema or new hand eczema-related symptoms and worsening acne or new acne-related symptoms are shown in Table 1, 2 respectively. Being female and more frequent handwashing at work were associated with worsening hand eczema or new hand eczema-related symptoms (multivariable analysis, female: odds-ratio [OR], 1.71, 95% confidence interval [CI], 1.02~2.88,