Ask the Ecz-perts: Coronavirus (COVID-19)

COVID-19 coronavirus
Ask the Ecz-perts

By Kathryn Jones

Published On: Mar 13, 2020

Last Updated On: Sep 22, 2020

In December 2019, an outbreak of respiratory disease caused by a novel (new) coronavirus was detected and has since spread globally. The virus has been named “SARS-CoV-2,” and the disease it causes has been named “coronavirus disease 2019” (abbreviated COVID-19).

Information about COVID-19 is changing minute by minute. The most reliable, up-to-date information available to the public can be found through the Centers for Disease Control and Prevention and the World Health Organization (WHO).

We’ll continue to update this article with more information as available.

If you’d like to submit a question to the Ecz-perts, send us an email.

MEET THE ECZ-PERTS

  • Timothy Berger, MD, is a dermatologist practicing at the University of California, San Francisco.
  • Peter Lio, MD, is assistant professor of clinical dermatology and pediatrics dermatology at Northwestern University Feinberg School of Medicine and founding director of the Chicago Integrative Eczema Center.
  • Amy Paller, MD, is chair of the department of dermatology at Northwestern University Feinberg School of Medicine and pediatric dermatologist at the Ann and Robert H Lurie Children’s Hospital of Chicago.
  • JiaDe (Jeff) Yu, MD, is a pediatric dermatologist at Massachusetts General Hospital.

Q: What are the recommendations for keeping hands clean without triggering and/or exacerbating my eczema? Does soap need to be antibacterial? Are there hand sanitizers formulated for eczema?

Dr. Paller: We know regular handwashing is the most important way to keep from contracting and spreading infection, and this means a thorough wash with soap for at least 20 seconds, including tops and palms of the hands, wrists and between the fingers. Warm water is fine – hot water offers no advantage and can aggravate eczema. After washing and rinsing well, the hands should be patted dry and a good moisturizer applied.

An antibacterial soap is not necessary and soap-free cleansers can be used. That said, frequent handwashing will dry out the skin and strip the natural oils, which can cause eczema to flare.

There are some steps to ease the discomfort, such as selecting soaps for sensitive skin like those bearing the NEA Seal of Acceptance, and moisturizing after each washing is essential.

If soap is unavailable, hand sanitizers (with at least 60% alcohol) are the next best thing for preventing the spread of infection, though they may sting skin with eczema. While there are not hand sanitizers formulated specifically for people with eczema, there are some with emollients/moisturizers in them that are fairly well tolerated if hands are dry. If eczema occurs or is exacerbated, be sure to use an anti-inflammatory topical regularly.

Q: I have facial eczema and find it very difficult to avoid touching my face, as currently advised. Are there any tips?

NEA: Most people touch their face much more than they realize, but it can be especially true for those with eczema. Distraction techniques can be effective in lessening the habit or compulsion to touch and scratch the face. This might include playing handheld video games, arts and crafts, or playing a musical instrument.

Similar to distraction is the idea of “competing responses” where you replace a behavior you don’t want with another behavior. For instance, when you have an urge to touch your face, you might do something else like place your hand firmly on your leg or make a fist. Also effective can be a competing sensory experience, such as a cool shower or an ice pack, which blocks the itchy messages going to the brain with other messages, like the cool sensation of the ice pack.

If you do need to deliberately touch your face, wash your hands first; avoid the nose, eyes and mouth; and perhaps use a clean cloth or Kleenex.

Q: If I have open cracks or lesions in my skin due to eczema, do I have an increased risk of getting the coronavirus?

Dr. Lio: This is an important question, and I have to preface it by saying that we don’t really know for sure at this point. However, because the coronavirus seems to be transmitted through contact transmission with the mouth, eye and airway mucosa – either directly or indirectly – it seems to be unlikely that damaged skin increases the risk.

Of course, bacterial infections are much more likely in compromised skin as are certain viral infections such as Herpes Simplex Virus (HSV), but with this (coronavirus) type of respiratory infection, my thinking is that there is not a significantly increased risk.

Q: I read that certain people with compromised immune systems are more susceptible to coronavirus. Is this risk greater for people with eczema as well? What if I am taking an immunosuppressant medication for my eczema?

Dr. Lio: The general thinking seems to be that in those with immunocompromised status (and that includes older people in general where the immune system is not as robust as it may be in younger patients) the risks are greater for COVID-19.

However, my sense is that even in severe eczema, the immune system is disordered but not actually compromised. In fact, we think of it as being an over-exuberant immune response rather than a compromised state. So just having eczema alone is probably not a significant risk factor for getting sick with or having a more severe case of COVID-19. 

Dr. Berger: That said, if a patient with eczema is on oral immunosuppression there is some possibility that they are at increased risk, although this is not fully known. If someone with eczema is on the following medications: prednisone, cyclosporine, methotrexate, azathioprine (Imuran), mycophenolate (Cellcept), they need to take every precaution and consider staying home, limiting their interpersonal contact (no groups or crowds over 50 people) and avoiding unnecessary travel.

There is insufficient data to determine if biologic treatment alters the risk to acquire COVID-19, or of a more severe infection, and implications may differ from medication to medication.

Q: I also have asthma in addition to eczema.  Are people with asthma more vulnerable to coronavirus?

NEA: The Asthma and Allergy Foundation of America and the CDC can provide the best, most up-to-date information on COVID-19 and asthma.

Q: If/when I am instructed to wear a face mask, how can I prevent it from causing my eczema to flare?

Dr. Yu: If you are advised to wear a mask, you can take precautions to keep the mask from irritating your eczema. I recommend first cleaning the skin with a gentle face wash (see NEA’s SOA product directory for options that are suitable for people with eczema) and drying the skin completely.

Next, apply a thin layer of a non-comedogenic face lotion or cream to the entire face – the cream or lotion will provide a barrier layer between the mask and your skin to prevent direct contact. Finally, put the mask on.

Allergic reactions to mask material can also occur. Some masks include a glue strip along the nose and cheek area which can trigger a reaction. Some masks also contain a metal wire to allow you to mold it to your face. This wire may be made out of nickel, a common contact allergen. Even through a thin fabric such as a cotton liner, it can cause allergic reactions. I recommend attaching a soft fabric layer between the mask and your skin to prevent the nickel from touching your skin or finding a mask that does not have the metal wire.

Q: What advice do you have for mitigating stress and anxiety around COVID-19?

NEA: Relaxation techniques, such as mindful meditation and guided imagery, help reduce the physiological effects of stress by loosening muscles, deepening breaths and decreasing heart rate. Other common relaxation techniques include deep or relaxed breathing (taking slow, even breaths in through the nose and out through the mouth) and progressive muscle relaxation (tensing and then relaxing different muscle groups throughout the body).

The Disaster Distress Helpline is a toll-free, multilingual, 24/7, 365-day-a-year, national hotline that provides immediate crisis counseling for people in the U.S. and its territories who are experiencing emotional distress related to traumatic events and incidents of community unrest including infectious disease outbreaks. Call 1.800.985.5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.