Eczema and COVID-19: Questions and answers
We appreciate that the coronavirus pandemic may present new challenges for managing your child's eczema. As there is still a lot not known about the virus, sources of information can be challenging to find, particularly that concerning eczema.
To help, dermatologist Professor Hywel Williams is answering questions submitted by parents on the topic of eczema and COVID-19.
If you'd like to ask a question, please contact us via twitter or email.
My daughter has eczema on her face and she is always touching her face, yet we are told to avoid touching the face near the eyes, mouth and nose. How can I help her?
“I think it is incredibly difficult for someone with eczema on their face to completely avoid touching their face. I also have eczema on my face and scalp and I have probably touched my face several times already typing this reply. There are techniques like registering the habit part of face touching and keeping your hands busy. The worst thing you can do is to tell your daughter “don’t scratch” as this will only make her more anxious and scratch more. Here is a good article on how to avoid touching your face https://www.bbc.com/future/article/20200317-how-to-stop-touching-your-face
Once at home, my honest view is that it is impractical to try and enforce your daughter not to touch her face. The reason why avoiding the eyes, nose and mouth is important is because they are a common route for the coronavirus to enter the body after contact from the hands. So the key thing is to make sure she washes her hands after outside contact and that she washes her face as well
, so that both face and hands are “decontaminated” and therefore safe in the home again to do what she likes. But remember, although soap and water is the best way to wash off and kill the virus from the hands and face, it will also dry out the skin a lot, so it is really important to put plenty of moisturiser on the hands and face after washing. And if your daughter’s facial eczema is not in good control, then get control of it again with your anti-inflammatory creams
I have developed sore hands (eczema?) from all this washing Should I bother the doctor with this? Will it spread to other parts of my body?
Sorry to hear that your hands are sore. It is difficult to say whether this is eczema without seeing your hands, but if they are red and itchy and sore as a result of frequent washing in soap and water, it could well be what we call irritant contact eczema. In other words, the soap and water has removed so much of the protective natural oils from your skin that it can’t take more. Tiny cracks appear that cause skin inflammation giving rise to dryness and red patches – usually starting in the finger webs, beneath a ring (if worn) and on the backs of the hands and wrists. If you have developed this for the first time, then I think it is worth having a telephone consultation with your doctor – sending them a photo if you can. Its sounds as if you definitely need a good emollients and if you have broken out in eczema, then you will need a topical steroid to get it under control again. Aggressive treatment of early hand eczema is important to avoid it getting a hold, and the most important thing is to apply plenty of emollient to your hands after washing – see the video that I did.
For more information, please see https://dermnetnz.org/topics/irritant-contact-dermatitis/
My child has eczema but has avoided inheriting asthma. Could COVID19 be a trigger to her developing this?
Good question, but probably not. Usually we use the term ”trigger” to describe something that sets of asthma in those that have already got asthma. Now there is evidence that viral infections can trigger worsening of asthma in someone who has already got it, but I could not find any evidence that a viral infection such as COVID-19 can start off asthma for the first time. There is a possible increase in asthma if your child had severe RSV infection in early life. The strongest risk factors for a child to develop asthma include parental asthma, environmental tobacco smoke before birth and prematurity.
For more information, see https://www.asthma.org.uk/advice/triggers/
Should we be raising fire warnings to all using alcohol hand sanitizer. How many are smoking, trying to relax with candles or cooking straight from applying to their hands?
Good point, as alcohol is flammable. Hand sanitizers use alcohol because it is very good at penetrating the outer lipid coat of COVID-19 and killing it. Although most of the alcohol content quickly evaporates from your warm hands, I would suggest keeping your hands away from naked flames such as a candle, cigarette or gas hob if you have just applied some.
Does hand sanitiser or washing hands with soap kill all the microbiome on the surface of hands, not just COVID-19? If so does the gap left leave more of an opportunity for COVID-19 to cover the newly cleaned hands
Washing the hands in soap and water and alcohol-based sanitizers certainly reduces the overall load and disrupts the natural balance of microbes on the skin surface (harmful ones and beneficial ones). Nearly all of our knowledge on the skin microbiome of the hands is based in bacteria rather than viruses like COVID-19. Unlike some bacteria, COVID-19 is not a natural organism that normally lives on the skin of our hands, so it is unlikely that it would somehow multiply on the skin surface and take up a position where some of the normal skin microbiome was lost. COVID-19 needs mucous membranes (linings of the lungs, nose and eyes and mouth) not skin in order to multiply. Hands that are damaged from repeated washing can carry higher bacterial counts, but the significance in terms of disease transmission is still unclear. My advice remains the same for hand washing during the coronavirus pandemic - soap and water or sanitisers are probably the best way to reduce the possibility of spreading the virus from our hands.
Hi Professor, my age 15 son is on 12.5mg of methotrexate once a week. He used to have chronic eczema before this medication. Been told he is fine to continue unless he shows any symptoms of covid 19. Would this be your advice? Thank you.
Yes, that would be exactly my advice. The issue of what to do about people who need to take medicines that suppress the immune system for their skin problem has been thought about a lot by dermatologists and also those working in other specialties like rheumatology and gastroenterology where medicines like methotrexate are used a lot. A group of us in dermatology, led by Dr. Nick Levell, put a lot of work into this issue and came up with a grid on who or who might not need shielding during the pandemic which you can find here
. It looks a bit complicated, but in a nutshell, as a young person on a single agent, your son does not need shielding unless there are other complicating factors such as diabetes, kidney disease or asthma. Your son should of course observe social distancing and observe good hygiene practices like everyone else. And if he did develop symptoms of COVID-19, he should stop his medication until well again. You can ask for a telephone consultation with your dermatologist or specialist nurse if needed. UK dermatologists would have by now looked through all their patients taking immunosuppressive medications and written to them if they were at increased risk. Some people might have had a similar letter from Public Health England. There is a useful list of frequently asked questions about skin patients taking immune suppressing medicines produced by the Guys and St. Thomas’ Hospital Dermatology team which you can find here
I have had a letter telling me to stay at home and self-isolate for 12 weeks because I am taking methotrexate for my eczema – is that right?
That does not sound quite right. If you are otherwise fit and well, and only taking just methotrexate, then shielding is not considered necessary as was specified in the recent British Association of Dermatology Guidelines, reinforced by a NICE rapid guideline. Given the rush to try and protect the vulnerable during the pandemic, some people have been contacted in error, so if you are in doubt about whether you should be shielding or just observing normal social distancing, just check with your hospital consultant or the specialist nurse that normally looks after you.
Some people with eczema have problems with the surface of their eyes, as well as the surface of their skin. This can leave them prone to getting bacterial and viral infections in their eye. Are these people more at risk from coronavirus - and should they wear eye protection?
I don’t think anybody knows if allergic conjunctivitis is a risk factor for infection, as none of the risk factor studies have collected this degree of detail to date. On an empirical basis, I would say that any breach of the conjunctival barrier (eg through allergic conjunctivitis) does make it easier for any pathogen to invade the mucous membrane (including staph aureus and viruses like herpes). But whether wearing eye protection decreases that risk is another unknown. I suspect that the dominant risk is failing to wash hand and then touching the eyes. Treating the underlying inflammation could also restore the conjunctival integrity to some degree. So great question but so many unknowns
Newspapers are saying that a skin rash could be the first sign you've got the coronavirus. Is that true? If it is, how do I know whether I'm having an eczema flare-up or getting sick with the virus?
It is true that some case reports from over the world suggest that a skin rash could be the first sign of COVID-19, although most reports suggest that COVID-19 associated rashes seem to start a few days after the infection has started. We don’t really know enough about the relationship between the various types of rash that have been suggested to be due to COVID-19 and the timing of the infection. What we do know is that the main types of rashes described don’t really look like eczema at all. So the commonest rash suggested to be associated with COVID-19 is a typical “viral” rash ie just non-itchy red blotches and little bumps on the skin, usually starting on the inside of both arms and legs and sides of the body. Some have reported a rash like hives (urticaria). Some have reported chilblain-like skin rashes too. But nobody has described a rash that looks like eczema or existing eczema worsening due to the virus. The rashes are almost always associated with other things like fever and/or new onset dry cough. Parents and young people are pretty good at recognising what eczema looks like and when it is getting worse, so I don’t think there is too much to worry about.
I have a question regarding covid19. Does having eczema (overactive immune system) put someone at risk for a fatal cytokine storm if they get covid19?
What a great question. COVID-19 is a new disease, so I am always cautious in coming out with dogmatic statements in the middle of learning more about it. The studies that have been published to date do not indicate that people with eczema are more at risk of contracting COVID-19, and there is no signal that they are more at risk of getting multi-organ failure and dying from the disease. So good news so far.
Does COVID-19 cause eczema to flare?
There is no evidence at present that COVID can cause eczema, or that it causes eczema to flare
in someone who already has eczema. That does not mean it could not, but nobody has noticed it across the world yet in a convincing way.. Eczema seems to go up and down of its own accord, so if other things are happening around the time of a flare, it is easy to blame them for the flare whereas in fact it is a just the immune system going up and down. And if your child does get a flare, make sure you get control with a one week blast of your safe topical steroid cream and plenty of moisturisers. Constant hand washing can cause a flare for people with hand eczema, or it can bring on hand eczema for the first time - but that is due to soap and water not COVID, and we give some advice about what to do for hand washing during the pandemic here