Ask the Ecz-perts: the latest about COVID-19 and eczema

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.

In this edition, Amy Paller, MD, 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 answers questions about COVID-19.

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.

We’re looking for non-stinging or drying hand sanitizer to send to school that will protect against COVID. Any suggestions?

Dr. Paller: With respect to hand sanitizers, the issue is that only sanitizers with a 60% or greater alcohol content are effective. Some sanitizers add moisturizer or aloe to them, which can be helpful. The alternative is a good handwashing. Remember that soap-free cleansers are fine and that we don’t need irritating detergents to wash. Just do the gentle rubbing for 20 seconds, rinse, pat dry and then apply a good moisturizer.

Some people have chosen to wear gloves and change them frequently, applying sanitizers to the gloves. All of these techniques are more difficult to manage with children. If the hands get worse with the washing and sanitizing, be sure to talk with your doctor to get some effective treatment for the dermatitis. Perhaps you will need to ramp up the potency during this period.

When I’m outside of my home I use disposable food gloves to cover my hands and then throw them away once I’m back in my clean environment. If I’m not able to wash my hands due to a severe flare, is this effective for protecting myself from COVID-19?

Dr. Paller: Just as if you had hands without gloves, you can transfer from gloves to your face (don’t touch your face!) or transfer something you pick up to a doorknob, food, etc. That said, we are more worried these days about what we breathe in (wear that mask) and have contact our mucous membranes (mouth and nose). So, it’s fine to wear gloves as long as you wash them repeatedly like you would your hands and remember that they can have the virus on them.

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.

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.

What effect if any does Dupixent have on COVID-19?

Dr. Berger: 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.

Dr. Paller: Dupixent theoretically should not impair your ability to fight off COVID-19 (nor should having eczema). It works be suppressing a very specific arm of the immune system called TH2 immunity, which is only known to be helpful in handling parasite infection. We know of no issue in handling viral infections. As such, it may be the safest “systemic”/non-topical medicine out there during this pandemic.

In contrast, some of the oral or injectable “immunosuppressants” have broader effects on our immunity and could be an issue. Fortunately, to date, only taking steroids by mouth or injection appear to increase the risk, but we do not recommend these steroids anyway for treating eczema other than for very infrequent special situations (topical steroids are fine for limited amounts of time).

Any recommendations on masks for children with severe facial eczema if they are doing in-school learning?

Dr. Paller: Yes, these are big challenges. Although “N95s” and “procedural masks” are the best out there, the materials that they are made of are paper and rough. I think that soft cloth with a tight weave is among the softest and is fine for children. The other issue is the moisture from our breath that accumulates and can be irritating, in addition to the rubbing. So, I do recommend that the face be protected by a good moisturizer before putting on the mask.

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: 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: 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.