Allergic Reactions to Hand Washing

We teach children at an early age that hand washing is an important part of daily hygiene. We ask our children to wash their hands before meals, after using the restroom, and any time we think their hands might be dirty, such as after playing outside. We also hear from healthcare experts (including our own doctors) that frequent hand washing can help reduce the spread of germs, especially during the cold and flu season.

Hand washing certainly has benefits to reduce the transmission of infections and should be encouraged. However, many people who wash their hands multiple times a day, such as with healthcare workers, develop rashes on their hands. In fact, up to 30% of healthcare workers develop hand rashes as a result of repetitive hand washing.

People who get rashes from repetitive hand washing may experience symptoms of redness, flaking, blister formation, cracking, and chronic skin thickening. Pain and itching may also occur. These skin changes usually occur on the back of the hands as well as the spaces between the fingers. The skin on the palms is much thicker and therefore more resistant to irritants and allergic rashes. These hand rashes may occur throughout the year, but are worse during the dry, cold winter months, possibly as a result of warm or hot water being used, which contributes to the irritant effect on the skin.

For people who wash their hands multiple times a day, hand rashes are usually caused by an irritant effect. In fact, in a study examining 1,300 people with hand rashes, 35% were caused by skin irritation. Nearly 20% had atopic dermatitis while only 19% had allergic contact dermatitis. While many people blame hand rashes on alcohol-based hand cleansers, these agents rarely cause contact dermatitis. Alcohol-based hand cleansers may cause burning and stinging but this is usually due to the skin already being broken and irritated.

Other causes of hand rashes that could worsen with hand washing include contact dermatitis caused by chemicals in soaps and moisturizers (such as parabens) and atopic dermatitis limited to the hands and feet. The diagnosis of contact dermatitis is made with the use of patch testing while people with atopic dermatitis are often diagnosed with atopic dermatitis in childhood. Another form of eczema that may worsen with hand washing is dyshidrotic eczema (or pompholyx) which occurs on the palms and fingers and can be related to allergies or stress. Dyshidrotic eczema often has the classic finding of small bumps and blisters along the sides of the fingers, as well as the palms, which resembles tapioca pudding.

The prevention of hand rashes includes reducing the irritant effects of repetitive hand washing. While this may seem difficult, or even impossible, for people who need to wash their hands frequently, the solution is to increase the use of alcohol-based hand cleansers as an alternative. Hand washing with soap and water needs to occur when the hands are visibly dirty, and should not be used simply to disinfect the hands. Alcohol-based cleansers should be used when disinfection is the goal, as they cause less irritation on the skin than the repetitive use of soap and water.

Treatment of hand washing rashes includes aggressive moisturizing, such as at the end of a work shift and before bed. Ointment-based moisturizers, such as Aquaphor, work the best in my opinion, and other similar brands can be found over-the-counter, often specifically labeled as being for dry hands. Topical corticosteroid creams and ointments may also be used, especially if contact dermatitis, atopic dermatitis, or dyshidrotic dermatitis is the diagnosis.