key: cord-0787979-jrb2tlhj
authors: Yüksel, Yasemin Topal; Nørreslet, Line Brok; Flachs, Esben Meulengracht; Ebbehøj, Niels Erik; Agner, Tove
title: Hand eczema, wet work exposure, and quality of life in healthcare workers in Denmark during the COVID-19 pandemic
date: 2022-03-07
journal: JAAD Int
DOI: 10.1016/j.jdin.2022.02.009
sha: f8721eb72051fbe1dcb3ace35cf0a8a784dbddc2
doc_id: 787979
cord_uid: jrb2tlhj

Background The focus on hand hygiene during the pandemic has been reported to increase the hand eczema (HE) prevalence in healthcare workers (HCWs), however, detailed prospective data is missing. Objectives to evaluate changes in HE prevalence, exposures, and health-related quality of life (HR-QoL) among HCWs during the pandemic. Methods In this prospective cohort study, HCWs employed at hospitals in Copenhagen responded to a digital questionnaire at the beginning of the pandemic and again 10 months later. Results Seven-hundred-and-ninety-five HCWs responded to both questionnaires (83.4% females). The calculated one-year HE prevalence decreased from 16.0% at baseline to 13.0% at follow-up. Number of hand washings decreased significantly, while use of alcohol-based hand rubs (ABHR) on wet skin increased significantly. In a logistic regression model, increased use of ABHR on wet skin was associated with HE at follow-up (OR 1.78, 95%CI [1.11-2.87]). HR-QoL worsened slightly at follow-up, with HE severity and frequent flares being risk factors for a reduced HR-QoL. Limitations Sample size Conclusion In contrast to previous studies undertaken during the pandemic, we found a relatively low and stable HE prevalence. Our findings suggest that the interaction between changed exposures and HE is complex and cannot be linked to a single factor.

J o u r n a l P r e -p r o o f and provided an e-mail address (Figure 1 ). For inclusion in the study, the HCWs were required to 86 be actively employed during the study period (Figure 1 ). 87 The participants were nurses, auxiliary nurses, physicians and a mixed group of biotechnicians, The prevalence of HE at follow-up was self-reported ('Have you had HE since 1 st of March gloves on wet skin, respectively) were reported at both baseline and follow-up, and a change in 110 exposure levels was coded into new variables: 'increased', 'decreased' or 'unchanged'.

None of the included clinical departments were exclusively for COVID-19 patients, since most 112 departments were exposed to COVID-19 patients to some degree. Therefore, we decided to code the 113 departments into 'high exposure departments' and 'low exposure departments' based on 114 hospitalisation rates of COVID-19 patients during the study period.

The total QOLHEQ score was divided into four categories (minimal impairment, ≤8; slight 116 impairment, 9-25; moderate impairment, 26-58; severe impairment, 59-80) 20 .

Confounders 118 History of atopic dermatitis was self-reported at follow-up ('Have you ever had childhood 119 eczema?') 21 together with data on perceived stress ('How often do you feel stressed?') 22 .

Timing of the study 121 The study was conducted during the pandemic with the baseline survey in the beginning of the 122 pandemic, where the hospitalisation of COVID-19 patients was at its highest (in March and April 123 2020), and the follow-up questionnaire was sent just after the second wave in Denmark. dermatitis were evenly distributed between respondents and non-respondents. The respondents were 145 significantly older than the non-respondents, and with an even distribution between males and 146 females (Table 1) .

The calculated one-year prevalence was 16.0% at baseline and 13.0% at follow-up. At baseline, the 149 point-prevalence was 6.4% and 6.9% at follow-up. The HE severity was 1.7 and 3.0 at baseline and 150 follow-up, respectively (p<0.001). When comparing the HE prevalence at baseline with follow-up 151 grouped by sex, age, profession and departments, no overall differences were found (Table S1) .

A reduced HR-QoL was associated with increasing self-reported severity and frequent flares at 183 follow-up (Table 3) . In this cohort study, the one-year HE prevalence declined from 16.0% at baseline, one month since 187 the start of the pandemic, to 13.0% at follow-up 10 months later. During this period, the number of The observed decrease in the prevalence during the study period likely reflects the change of 202 exposures reported in our study. The reduced number of hand washings may have contributed to the 203 lower HE prevalence since it is a well-known risk factor for HE 10,23 . At the same time, however, the 204 exposure to ABHR on wet skin increased markedly and was significantly associated with HE at 205 follow-up, which is in alignment with an experimental study indicating that ABHR may induce a skin barrier disruption when applied on wet or moist skin 11 , as opposed to findings on ABHR on 207 dry skin 10 . Thus, it can be anticipated that the risk of applying ABHR on wet skin increases with the 208 increased use of ABHR. Moreover, the change in the exposures reflects the efficacy of hand J o u r n a l P r e -p r o o f 

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