The coronavirus crisis poses new challenges for us all, including for the health of our skin. Being in isolation, with the accompanying stress, sanitizing measures, lack of fresh air and opportunities to exercise can result in a series of dermatological problems, such as dry skin, adult acne exacerbations, and flare-ups of other inflammatory skin conditions. The following details how being in lockdown can affect your skin, and what changes you can make to prevent it.

Your skin and quarantine

Help with your hands

Think of your hands as the frontline of your defense against Covid-19. Touching contaminated surfaces can transfer the virus to your hands; touching your face (especially your mouth, eyes, and nose) is then a gateway to infection.

Face-touching has been known to be a driver of viral transmission for decades. For this reason, proper hand hygiene is a crucial preventive measure to stop the spread of Covid-19. However, it can lead to severely dry skin on your hands.

Hand cleansing agents need not be complicated

The humble, conventional bar of soap is all that is needed for effective hand cleansing to prevent virus transmission. The coronavirus has a fatty membrane that dissolves when it meets soap molecules, causing it to breakdown and become inactive. There is no benefit in the use of antibacterial soaps and using these may do more harm by removing the good bacteria of our skin’s microbiome (the community of microorganisms that reside on our skin). If you are not near a basin, then hand sanitizers with more than 60% alcohol is recommended by the CDC.

Is handwashing drying your skin?

Rightfully, we are all taking hand hygiene seriously, so much so in fact, that there has been a dramatic rise in a type of eczema called irritant contact dermatitis. Research shows an increased incidence of hand eczema in the general population due to the zealous handwashing associated with the pandemic. Frequent hand cleansing with detergents (like soaps) leads to a gradual depletion of the fats in the superficial skin layers, and so the skin becomes less able to retain water. This disrupted skin barrier means that our hands may become dry, itchy, red, and cracked. Any break in the skin can allow bacteria and other germs in and so increase the risk of infection. It’s thus important to avoid or treat very dry skin.

How can we wash our hands frequently and still maintain a healthy skin barrier? To help curb these problems, moisturizers should be used directly after handwashing and throughout the day, especially if you are prone to eczema. It’s best to apply a moisturizer when hands are still damp from hand washing to lock in moisture, however, wait for your hands to dry completely if you are using a hand sanitizer. The optimal moisturizer is a thick fragrance-free cream with hydrating ingredients such as petroleum or glycerin. Ointments that may be too greasy for daytime can be applied at night under gloves. Troublesome hand eczema may need a prescription for a topical corticosteroid, to reduce inflammation. To avoid further irritation to your hands, it’s wise to use protective rubber gloves when washing dishes or clothes.

The effects of stress on your skin

Psychological stress, in varying degrees, has become part of our ‘new normal’.

As a result, people dealing with chronic skin conditions, such as eczema or rosacea, may experience flareups. Indeed, emotions are an important factor in many skin diseases. The answer lies in how the skin and brain communicate.

The brain-skin connection

Our skin is a complex organ that plays a crucial role in barrier and immune functions. Psychological stress is perceived by the brain which activates a stress response in the systems of the body. Through a sequence of events, your body releases cortisol – known as the primary stress hormone. Stress also induces the release of catecholamines, such as adrenaline, which is a crucial part of the ‘fight or flight’ response. The skin is an unexpected, yet an important target for these stress responses and the result is inflammation. In turn, inflammation impacts the skin’s immune system functioning and blood flow.

Adding to the issue, the skin itself produces the same mediators that further drive immune and inflammation responses. A wide range of skin conditions, including psoriasis, atopic eczema, acne, contact eczema, and itching, can be triggered, or worsened, by these stress responses.

Stress has also been shown to affect the barrier properties of the skin, which normally prevents loss of water from the skin cell layers. In a study of students, exam stress caused a decrease in the skin’s permeability barrier. This disruption of skin barrier function can lead to flaky or dry skin.

If you are experiencing a flare-up of adult acne while in isolation, you are not alone, and stress may be to blame. This is because some stress hormones stimulate sebaceous oil glands to produce more sebum, which contributes to acne.

“My hair is falling out – could that be stress-related too?”

It is true that stress can also play a role in hair loss. Stress responses can disrupt the hair growth cycle, leading to a type of hair loss called telogen effluvium. This happens when an abnormal number of hair follicles go into a resting and subsequent shedding phase. Fortunately, this kind of hair loss is considered temporary.

Taking care of your skin in stressful circumstances means keeping your skin-care simple. it’s a good idea to avoid potential skin irritants, such as fragrance. Moisturizers with hydrating ingredients like ceramides are helpful for dryness. For flares of chronic conditions that are not improving you may require prescription treatment.

Potential problems with PPE

The latest guidance from the National Department of Health urges the wearing of cloth masks in public. Masks can reduce the spread of droplets, however, prolonged wearing of masks may come with a host of unwelcome problems.

Masks can cause skin irritation from pressure and rubbing. The pressure on oil ducts as well as the build-up of sweat and make-up allows for acne breakouts. The term ‘maskne’ has been recently coined for the redness and pimples that people are experiencing due to PPE.

Talking and breathing creates a trap under the mask for humidity which may potentially cause bacterial overgrowth. This can result in infections such as folliculitis, a skin condition in which hair follicles become inflamed.

More serious skin problems from masks can be seen in healthcare workers who use N95 respirator masks as these can cause more pressure. A study in Singapore reported staff had acne (59.6%), facial itch (51.4%), rash (35.8%), and pigmentation (85) from N95 mask use.

Advice for skin conditions caused by wearing masks

Face masks are a daily, and vital, part of our wardrobe for the foreseeable future. So, here is some advice for now:

• If you are experiencing redness or irritation, try to avoid harsh cleansers or irritating ingredients in your skincare. The use of exfoliating hydroxy acids or scrubs will need to wait.
• Avoid synthetic materials in masks. Rather, opt for natural fibers, such as cotton, and remember to wash your mask with every use.
• Get into the habit of cleaning your face both before and after you remove your mask. Micellar water would be a good option here.
• Be sure to choose non-comedogenic make-up, which will not block pores and promote acne. Go lighter on your make-up, or better yet, make-up free under your mask.
• For acne breakouts, helpful ingredients are benzoyl peroxide, which kills acne-inducing bacteria and helps with inflammation. Salicylic acid containing cleansers can effectively reduce excess oil and dead skin cells that build up and block pores.
• Niacinamide (vitamin B3) in the form of a moisturizer or serum can be beneficial for acne and redness. It has anti-inflammatory properties and it enhances the skin barrier function. This is a great all-rounder!

If you are a healthcare worker then consider using a barrier protecting ointment in pressure areas. Good options include Vaseline or Eucerin Aquaphor, or a barrier cream with zinc oxide to restore the compromised skin barrier. For any eczema rash, a short duration of a topical corticosteroid treatment may be needed.

Why you should still use sunscreen in lockdown

Sunscreen is not just needed outdoors.

There are different types of UV rays that affect the skin. UVB rays can cause sunburn and eventually lead to skin cancer. UVA rays penetrate deeper into the skin and degrade collagen and elastin. It is, therefore, the main cause of photoaging, whilst also contributing to skin cancer. UVA rays can penetrate through windows, so sunscreen is needed if you are seated near windows or where there is sunlight indoors.

Are our phones and computer screens damaging our skin?

Lockdown has most people spending a longer time on their electronic devices. Group calls, webinars, and social media keep us connected, but we are getting significantly more blue light exposure in the process.

While the detrimental effects of exposure to the sun’s UV radiation are well known, we have only recently started to understand the effects of visible light on the skin. Visible light, of which blue light is a component, makes up almost half of the solar spectrum. It’s emitted from computer monitors, laptop and smartphone screens, as well as TVs and fluorescent bulbs.

Research is still on-going, but studies are showing that blue light can generate damaging free radicals that break down collagen, leading to premature aging. Blue light can also induce pigmentation which is longer-lasting compared to that induced by UV light.

When it comes to blue light protection, instead of reaching for any sunscreen, look for mineral blockers with iron oxide and added antioxidants. You can also use antioxidants in the form of vitamin C serums. These neutralize the damaging effects of free radicals from UV and visible light, as well as from pollution.

Conclusion

Covid-19 continues to disrupt our every-day lives and we are all still figuring out the changes needed to adapt to these unprecedented times. Perhaps now more than ever, we should make our health a priority, and this should extend to our skin.

Dr Tarryn Jacobs explains maskne in this informative video with Longevity Live. Click here:

References

1. Singh M, Pawar M, Bothra A, Choudhary N, Overzealous hand hygiene during COVID 19 pandemic causing increased incidence of hand eczema among general population, Journal of the American Academy of Dermatology (2020), doi:https://doi.org/10.1016/j.jaad.2020.04.047.

2. Garg A, Chren MM, Sands LP. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001 Jan;137(1):53-9 doi:10.1001/archderm.137.1.53

3. Foo CC, Goon AT, Leow YH, Goh CL. Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome–a descriptive study in Singapore. Contact Dermatitis. 2006 Nov;55(5):291-4. Doi:

4. Arck P, Slominski A, Theoharis C, Theoharides C. Neuroimmunology of Stress: Skin Takes Center Stage.J Invest Dermatol. 2006. August ; 126(8): 1697–1704.

5. Mahmoud BH, Ruvolo E, Hexsel CL, Liu Y. Impact of long-wavelength UVA and visible light on melanocompetent skin. J Invest Dermatol. 2010 Aug;130(8):2092-7. doi: 10.1038/jid.2010.95