Prevention of Hand Dermatitis in Surgery/Procedural Specialties

[Full Metal IC]

I am not a surgeon. I am a rising interventional cardiology fellow. I have mild chronic atopic dermatitis, nowadays mostly confined to my hands. We mostly use alcohol-based solution (Sterillium) and non-latex gloves. I have noticed lately as I do more cases, I have started to develop some dermatitis on my hands.

There isn't too much about this topic online, a limited thread from a while ago, and I suspect that this is a fairly common issue particularly given the harsher scrubs you guys use in surgery.

For folks who have struggled with dermatologic issues related to scrubbing or gloves, what are your tips for maintaining hand/arm skin health?

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[akwho]

Use Avaguard and let it dry completely before putting on gloves. Or use a chlorahexadine scrub and pat dry with a sterile towel before putting on gloves. Some people have sensitivities to the rubber in the gloves that can cause rash issues. I had an attending special order her own gloves that were for sensitive skin and seemed to help her atopic dermatitis significantly. I would start there.

 

[LucidSplash]

I developed a sensitivity to chlorhexidine/avaguard in training. I can use it if absolutely necessary, but develop moderate to severe dermatitis if used repeatedly. If I use it for an emergency, I make sure to wash well after the case with soap and water and apply a fragrance free lotion.

Otherwise, I prefer PI or PCX for scrubbing into cases. Some of the alcohol based water-free surgical scrubs are very drying, but there are others with emollients which are better.

 

[cpants]

I actually find the sterillium to be much more mild than avaguard.

I find the most gentle is actually the old-fashioned povidone scrub brushes. Not a bad idea to get skin testing or just experiment with different gloves. If you could change out your gloves that would be an easy fix.

 

[DoctwoB]

I get pretty bad eczema on hands/elbows/knees. Its definitely worse with a lot of scrubbing/purell, but I haven't found one clear cause to cut out that makes it better. I think I am just prone to it and repeated washing/drying and our various chemical solutions make it worse without a specific hypersensitivity to one ingredient.

Was unimpressed with dupixent. Opzelura cream has been awesome, however.

 

[Full Metal IC]

To follow up on this issue for anyone else - my hands got pretty bad, I experimented with various gloves, and ultimately theorized that it was probably a sensitivity to rubber accelerators which are used in the manufacturing of most surgical gloves. I switched to an accelerator-free glove (Dermassure Green) and my dermatitis improved drastically. I still get some skin irritation after long cases but it is night and day. I have also adopted the moniker "Green Goblin" in the cath lab because of the green color of the gloves.