Coronavirus SARS-CoV-2 and the protection of atopic dermatitis patients

We carried on with our lives as usual and suddenly, we’ve found ourselves in the midst of the coronavirus epidemics. We’ve been completely unprepared, thinking: “Oh, China’s far away, anyway.” However, in but a few weeks, the new coronavirus hit all the countries in the world. Because the virus jumped from animal to human host very quickly and is not well adapted to the human body, the symptoms of the infection are much more serious, especially for those at higher risk for severe illness.

What are coronaviruses?

 

Coronaviruses are a family of numerous viruses that infect the respiratory organs. The infections can vary in symptoms from the common cold to the severe acute respiratory syndrome (or SARS). The new coronavirus was named SARS-CoV-2 and the illness it causes, COVID-19. Coronavirus SARS-Cov-2 was unknown to us before it erupted in the Chinese province Wuhan, in December 2019. The symptoms of the illness include raised temperature, coughing and breathing difficulty, which are typical pneumonia symptoms. Because the virus is new to the scientific community, researcher are still looking for ways to prevent, treat and heal the illness.

What to pay attention to in order to prevent the infection with the new coronavirus?

 

  • Hand hygiene is the most important. It’s very important to wash your hands often and in the correct manner: rub them with soap for 20 seconds, in lukewarm water. Always wash your hands when you arrive at work and come home and before eating. Disinfect your hands with a disinfectant that should contain at least 60% of ethanol. It’s worth stressing that disinfectants used for surfaces aren’t meant for the disinfection of hands. We must also be careful when mixing homemade disinfectants. It often happens that people don’t understand the principles of dilution and end up making a disinfectant that contains less than the recommended 60% of ethanol (usually around 40%). Such a concoction won’t work as a disinfectant and won’t protect you. WHO published a recipe for a homemade disinfectant. I make my own disinfectant from 9 units of 70% ethanol and 1 unit of glycerol. You can also add a drop or two of an essential oil.
  • Proper cough hygiene. Cover your mouth and nose with a tissue or the upper part of the sleeves when coughing and sneezing. Dispose of the tissue in a bin. Maintain a 2-metre safety distance between yourself and the people who are coughing.
  • Avoid touching the eyes, nose and mouth.
  • Clean and disinfect items regularly. Keep the frequently touched objects clean. Such items definitely include keyes and mobile phones. Wash your clothes at 60 °C. The virus can “survive” up to 24 hours on cardboard and up to 3 days on plastic and metal.
  • If you experience the symptoms of the virus, consult your GP outside his or her working hours or visit the emergency ward. If necessary, remain in self-isolation.
  • Regularly monitor the information on the virus from the scientifically approved and reliable sources and follow the recommendation of health experts. In knowledge is power. By following reliable and useful instructions, we can fight together against panic, misinformation, ignorance and arrogance.

Hand hygiene for patients with atopic dermatitis

 

Hand hygiene in atopic dermatitis patients is even more important. The intense itch to which we often respond reflexively makes it almost impossible not to scratch our body and face. Thus, atopic dermatitis patients should give priority to hand washing and becoming conscious of their scratching. The washing itself and the use of soap (use the type that suits you most) can worsen the rash and provoke pain, but they are unavoidable in the current situation. After having washed your hands, dry them well and apply the type of skincare product that suits you. I advise the use of bamboo gloves because they’ll help you be more conscious of your scratching. Wash the gloves at 60 or 90 °C.

Am I more at risk for infection because of open wounds due to my atopic dermatitis?

 

Because the virus is new, it’s hard to say anything about it. It’s known that the coronavirus SARS-CoV-2 enters the body through the mucous membranes of the eyes, mouth and the airways, so it’s highly unlikely that damaged skin puts you at an increased risk.

What about disinfectants?

 

If your hands are free of wounds, disinfection is recommended. However, we have to keep in mind the fact that disinfectants dry the skin out strongly and can provoke a flare-up of atopic dermatitis on body parts where it wasn’t present before. Disinfectants are very aggressive to our skin and further damage the skin barrier.

When wounds are present on the palms, the use of disinfectants is unsuitable. You can protect yourself by using disposable gloves when going out and using your hands a lot (e.g. when shopping). When you clean and disinfect surfaces or objects that you use often, always put on gloves. Disinfectants for surfaces and objects are usually even more aggressive than hand disinfectants.

Atopic dermatitis patients taking the biological medicine

 

We asked the assistant dermatologist Vesna Breznik, MD, from the dermatological department at Maribor University Medical Centre about an opinion on what do do if you’re a patient with atopic dermatitis and taking the biological medicine. This is her answer:

On the basis of the current research, the biological medicine for patients with atopic dermatitis doesn’t increase the risk of infection. Patients can thus continue with their treatment. We stop the treatment if the patient has a confirmed infection with the new coronavirus. The same recommendations that apply for classic biological medicines, the ones blocking Th1-inflammation, also apply for the new biological medicine. Patients with atopic dermatitis who are taking the biological medicine during the new coronavirus pandemics should follow the instructions for the patients with psoriasis that can be found on the Maribor University Medical Centre webpage:

Assistant Vesna Breznik, MD, additionally stresses the following:

Regardless of whether or not atopic dermatitis patients are taking the biological medicine, they find themselves at an increased risk for infection with the new coronavirus because of the inflamed eyes and the consequent scratching and robbing. Patients should wash their hands consistently before applying healing and skincare products to eyelids or to the eyes.

What about other drugs?

 

Assistant Vesna Breznik, MD, advises:

None of the drugs taken by patients with psoriasis or atopic dermatitis are crucial for keeping the patient alive. Therefore, in accordance with the before-mentioned instructions, the biological medicine and classic immunosuppressants (cyclosporine A, methotrexat, azathioprine) can be discontinued until the patient is cured from the new coronavirus or until the pandemic passes. Patients restart their treatment by going to a medical check-up with their dermatologist.

The British Association of Dermatologists gave the following advice:

The British Association of Dermatologists is aware of the reluctance of patients to use drugs that affect the immune system, such as biological medicines and immunosuppressants. The association currently has no information that these patients would be at a higher risk for the infection with the coronavirus or experience a severer course of the illness. . . The British Association of Dermatologists advises that the creams recommended by dermatologists or GPs and used according to instructions probably won’t increase the risk of the coronavirus infection or trigger a severe course of the COVID-19 illness.

Even to this day, there are as of yet no health recommendations for people taking drugs that affect the immune system, such as biological medicines and immunosuppressants, although this may change in the future.

Bear in mind that it might be more difficult to access medical care in the coming few weeks or months. Follow the instructions issued to the public to minimise the risk for infection.

I wish you lots of health. Act responsibly and compassionately towards others. Stay home and, in this way, protect yourself, your loved ones, health workers, salespeople and all the others who have to go to work in spite of the pandemic.