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Dry chapped hands

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Photo: Wix

Why do hands get dry and rough due to hand sanitizer and washing?



Our skin is not smooth like a wall- it’s more like a cobblestone street. The skin cells make up the bricks and the mortar that holds them together is made up of lipids, ceramides, wax esters, and other proteins that serve to protect our skin. Hand sanitizers have a significant amount of alcohol and hand soaps have surfactants that dry out our skin by breaking down this barrier. As natural oils, fats and proteins are pulled away from our skin, it leaves our hands feeling cracked and dried.

Cooler temperatures do not help as there is less moisture in the environment compared to hot humid times of the year. This only serves to dry our skin out further. Once our skin dries out and the barrier function it serves starts to break apart, our skin becomes inflamed and the immune cells in our skin become more prevalent attempting to protect us from infection and allergens.





Tips for keeping your hands hydrated- what to do and why it works!



Given the concerns today for viral spread, the incidence of hand dermatitis has definitely increased. More people are using hand sanitizers and washing more than ever! For people like me and the volume of patients, I see daily, I can honestly say I have learned to avoid the dry cracked skin that these products can cause in spite of washing my hands several times daily.

  • Every time you wash your hands, try to apply a moisturizer to replace natural oils and moisture that is lost with hand washing.

  • Wear gloves outside when it’s cold. When it is cold out, it is natural to put on a coat or add some layers. Gloves are not always worn unless the cold is excessive. It may be for practical reasons of needing our fingers free for phones and keys. However, when you are outside with cold temperatures, the cold will pull away moisture from your skin which will dry and crack it further. Try to protect your skin from the elements to avoid this breakdown.

  • Avoid using hand wipes or baby wipes to clean your hands. These are easy to use when in a bind, like right before a meal or while traveling, however, these wipes have added preservatives designed to keep them moist in the packet. I have seen lots of sensitivities and allergies on patch testing to the preservatives in wipes. I tend to prefer to stick with traditional hand sanitizers, soap, and water for hands for most hand-cleaning needs.

  • Avoid hand soaps and sanitizers with added fragrances if using them for frequent hand washing. The more you wash your hands, the harder it is to keep up with rehydrating them. If you use scented products, your skin may develop added sensitivities to the fragrance that make it harder to heal. These products are great for occasional use. If your hands are in the trenches or repeated hand washing, they are not so great.

  • If your hands are always exposed to cleaning agents, solvents, glues, dyes, resins, cooking, and gardening - wear gloves! Your hands are well designed to have thicker skin over the palms and fingertips to let you work with some harsh products occasionally. However, if you are working with products that can further dry out or inflame your skin routinely, then your skin has to work in an uphill battle to stay hydrated. Help them out and recognize when certain products routinely aggravate your skin and think about using gloves.


I have a lot of patients who tell me that they often wear vaseline or thick moisturizers with cotton gloves at night to help restore their skin. This is not unreasonable if you are in the early stages of drying out your skin. If you already note that your skin is red, inflamed, sore, or uncomfortable with cracks or fissures in your skin, see your dermatologist. This often means that you may need a prescription topical steroid or nonsteroidal cream to help heal your skin so that moisturizers will work again. Truthfully, after 20 years of washing my hands several times daily, I have never had to resort to wearing gloves to bed with petrolatum-based products. I find if you approach this the right way you may not have to!


 


 

How much alcohol is in hand sanitizers?



Alcohol-based hand sanitizers generally use ethanol or isopropanol as their active ingredient. Ethanol is ideally in a 60-85% concentration while isopropanol should be in a minimum concentration of 70%. Given the shortages of hand sanitizers in recent years, I found some patients “diluting” the sanitizers they did have access to by mixing them with moisturizers or adding aloe. By altering or changing the concentration of the alcohol in the product, there is a possibility that the resulting product is less effective at serving its purpose of sanitizing the skin.

Studies have evaluated the effectiveness of alcohol-based hand sanitizers for visibly soiled hands as well as “clean” hands for the potential to kill microbes. The presence of dirt or oil on the hands does not seem to impair hand sanitizers from achieving hand hygiene.
In recent years there were recalls on hand sanitizers and warnings issued by the FDA for products that used methanol as either a listed or “unlisted” active ingredient. Methanol or methyl alcohol has a significant risk of toxicity. It can be absorbed through the skin as a matter of fact. Signs of methanol poisoning include headache, nausea, blurry vision, vomiting, seizures, and even blindness.

 

 

What are best practices with hand sanitizers to balance their effectiveness while avoiding the side effects of excess dryness?


Alcohol-based hand sanitizers must be allowed to dry on the skin in order to be effective. The process of alcohol drying on the skin allows it to be most toxic to viruses and microorganisms. Applying then wiping with a paper towel for example can clearly make it less effective.

Avoid leaving your hand sanitizer in the sun or a hot car can cause the alcohol in the product to evaporate. This can make it potentially less effective.
Over-applying hand sanitizer has its own problems. The ambitious use of hand sanitizers can lead to excessively dry cracked and inflamed skin. Our skin is a barrier that protects our body from exposure to harmful bacteria, viruses, and outside allergens. Breaking down this barrier with excess hand sanitizer use can ironically leave us more vulnerable to exposure to infectious agents.

Is it better to make my own hand sanitizer?



Making your own hand sanitizer is not necessarily a problem if you carefully ensure the right concentration of alcohol in your product. I have found that it can be hard to create a product that is homogeneous. The alcohol tends to be lighter weight and separate to move to the top of the compound. When pumping, mostly aloe or moisturizer is pumped out and less alcohol is clearly less effective.


Are there recipes for DIY hand sanitizers to consider?


At-home hand sanitizer is not necessarily a bad idea and not that difficult to make overall. The key is to not complicate recipes or try to become a chemist by mixing cleaning agents as the risk of harm is higher when doing so. The other important note is to ensure that the final concentration of alcohol is at least 60 % ethanol or 70% isopropyl alcohol to be effective. I strongly recommend when at home focus on hand washing with soap and water. This is more effective and readily available at home. Hand sanitizer is truly only for specific situations when hand washing is not as easy to find.



DIY hand sanitizer recipe


2 parts isopropyl alcohol (91%) 1 part aloe Vera gel 10-15 drops of essential oil such as tea tree oil, lavender, etc



The challenge is also in mixing this enough to create a solution that has the ingredients evenly distributed. I have actually even tried placing the bottles for brief periods of time in our ultrasonic instrument cleaner to shake them enough to make a solution that does not separate easily as this separation can impact the concentration of alcohol in each pump. Too much alcohol can dry and crack your hands, too little won’t be effective.




Another DIY recipe is for sanitizing wipes

6 parts isopropyl alcohol (91%) 1 part hot water 0.5 part aloe Vera Dry wipes, or a paper towel roll



Mix the alcohol, water, and aloe Vera together. Place the paper towels in a zip lock bag or Tupperware. Pour the mixture over the wipes or towels. These can be used to wipe countertops and clean surfaces.



Are there any risks with hand sanitizers?


Hand sanitizers may tend to accumulate under rings and other jewelry. This leads to prolonged exposure to products with a high alcohol content that breaks down the skin under jewelry. The raw, eroded plaques that can result are uncomfortable and unsightly! It is important to move jewelry around to completely rub in the sanitizer and avoid leaving excess product built up on the skin.
Try to avoid touching your face and eyes with hand sanitizer. The high concentration of alcohol in these products can be particularly irritating to thin-skinned areas of the eyes and face.



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