How do you deal with the coronavirus epidemic in chronic skin conditions like atopic dermatitis, hand or contact eczema? Should I stop treatment? Is there a higher risk of coronavirus infection? Should we wear gloves to protect ourselves? The responses on this article.
Anyone with a chronic illness feels particularly vulnerable to a major health crisis like the one linked to the coronavirus epidemic. This is the case of the 2.5 million French people suffering from eczema, including 20% of children under the age of 7. Eczema is the second most common skin disease after acne. It can manifest as atopic dermatitis (atopic eczema), contact eczema or chronic hand eczema.
Are we more at risk of contracting covid-19 if we have eczema?
Yes and no, answers the ResoEczéma scientific and research committee. Patients receiving immunosuppressive therapy (ciclosporin, methotrexate, azathioprine, corticosteroids by mouth or injection) are considered to be more vulnerable to the risk of contracting Coronavirus infection, and must therefore comply in particular with the recommendations of the health authorities and the confinement. In contrast, patients on dupilumab and alitretinoin have no increased risk.
Should I suspend treatment?
The rule regularly reminded by the public authorities is the same for any chronic patient, with or without symptoms of coronavirus, and therefore applies in case of eczema: it is not recommended to stop treatment suddenly without medical advice.
Following on from these recommendations, the ResoEczéma scientific and research committee recommends:
- not to interrupt the following treatments without medical advice: systemic cortisone (oral or injectable) and systemic immunosuppressant (methotrexate, ciclosporin or azathioprine);
- continue treatment with alitretinoin in cases of severe chronic hand eczema, injections of dupilumab for severe forms of atopic dermatitis (biotherapy which does not cause an infectious risk), as well as tacrolimus.
- maintain in the same conditions the basic treatments based on inhaled corticosteroid, to avoid aggravation of the pathology;
- continue the same local treatments with topical corticosteroids (creams, ointments, lotions). They are safe.
Patients on treatment should not hesitate to contact their doctor to assess, on a case-by-case basis, the benefit / risk balance of continuing their treatment during the epidemic, and thus limit the risk of developing complications in the event of Covid disease 19.
Do you have to go to your doctor to renew your prescription?
No: pharmacies are exceptionally authorized until May 31, 2020 to dispense their drugs to patients on chronic treatment whose prescription has expired.
Can we benefit from a work stoppage during the epidemic?
People who meet the vulnerability criteria and who cannot telework could indeed request a work stoppage via the internet since mid-March, without going through the employer or the attending physician. People receiving immunosuppressive therapy are on this list of vulnerable patients. In the case of patients suffering from eczema, the measure therefore only concerns those on systemic immunosuppressants (methotrexate, ciclosporin, azathioprine), systemic cortisone (oral or injectable), or biotherapies (anti TNF alpha, anti IL12 / 23, anti IL17 and anti IL 23).
This system is evolving from May 1. The persons concerned will be placed in partial activity by their employer who will pay them compensation. If the employee has obtained his work stoppage via the declare.ameli.fr site, he will automatically receive from Medicare a certificate to be given to his employer. If the employee has obtained his work stoppage by a doctor, he must request him again to have an isolation certificate drawn up which he must give to his employer to be placed in partial activity.
What to do to avoid aggravating hand eczema due to frequent washing?
Regular hand washing with soap or hydroalcoholic gel is one of the barrier measures to be observed to limit the transmission of the virus. An essential gesture but which weakens even more dry skin bruised by eczema.
“For handwashing with soap, patients are recommended to use” soap-free “soaps, soaps suitable for atopic skin or washing oils, always favoring fragrance-free products. The hands should then be dried gently, without rubbing, ” said the French Eczema Association.
If the washing takes place with hydroalcoholic gel, it is strongly advised to rehydrate the skin after applying the gel, with emollient creams or non-allergenic “screen” creams.
Should you wear gloves or a scarf to protect yourself?
- No with regard to gloves, answers the French Eczema Association: wearing latex or vinyl gloves, especially in case of hand eczema has the effect of promoting perspiration and maceration of the skin.
- As for the scarf, which some patients adopt to protect the face due to the shortage of masks, it is also not recommended because it accentuates the friction on already dry skin. In addition to being ineffective, it can cause new patches on the face and neck and itching, with the risk of touching your face and contracting the virus from your hands.
Skin symptoms (frostbite, redness) have been associated with coronavirus. How to distinguish them from a flare of eczema?
The difference is not always easy indeed, underlines Dr Pierre-André Bécherel, dermatologist, member of Reso, because the cutaneous signs associated with covid are very heterogeneous. In eczema the lesions are very itchy, with small water vesicles on the sides of the toes, and scabs afterwards.
These characteristic symptoms of eczema cannot be confused with those of frostbite, of a darker or even purple color, with pains that are sometimes significant, hampering walking, without itching, without water vesicles. Toes affected by frostbite are cold to the touch, while in case of eczema the skin is warm. Do not hesitate to contact your doctor and send him a photo of the lesions via Zoom.