Starting surgical residency with really bad eczema?

[NewSurgeon]

Hello,

So I will be starting as a surgical intern this July and I am really worried about my skin. I have a history of REALLY BAD eczema that is triggered by hot water and scrubbing (both the act of hand washing and the chlorhexidane and betadine chemicals) among other things. I have been away from the OR for the last 6 months and have finally got my eczema under control with high potency topical steroids, moisturizing my hands after each hand washing, and using Purell instead of soap and water when seeign patients (unless soap and water is required). My eczema flares up quickly and badly if I do not adhere to my strict regimen. After a few days of scrubbing in, my skin (from fingertips to elbows) breaks out, is incredibly itchy, and begins to fissure, resulting in easy bleeding. I really enjoy surgery, but I am really worried about starting this July because of this. Does anyone have any tips? Any other surgeons out there with eczema who have come up with a method of minimizing/ eliminating flares despite scrubbing in for the OR daily? Any advice would be very much appreciated. Thanks for your time!

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[Dr.LeoSpaceman]

Unfortunately, I think you're going to be in a tough spot. Have you tried the waterless, no-scrub washes that are alcohol-based (like Avagard)? You would still have to do the normal water/brush scrub before the first case, but it would limit your exposure. I know of some attendings who have had success with using Ansell DermaPrene gloves, and then having the scrub tech place sterile mineral oil in it before gloving. Not sure if it was for eczema specifically, though.

 

[st0w]

It's doable, but different for everybody I'm sure. We have a couple residents at our program that have skin issues with their hands. They walk around carrying various creams and gels, and use special gloves in the OR. They make do.

You'll have to find something that works for you. I would hope you've already got some kind of plan in mind. It sounds like it's taken six months away from the OR to get things under control, which isn't a viable option during residency.

I'd try Avagard, as already mentioned, or one of the other alternatives. One thing you might consider is doing your first wash of the day as a full, regular scrub (many hospitals require that) and then doing whatever care your hands require after washing, and the using Avagard it whatever you use. This is what I do (but not for skin, for other reasons) and it works well. I still get my hands clean and scrubbed.

The other things worth looking into are alternatives to Avagard. We had an attending whose hands couldn't handle it, so he got his own sterilizing solution that the hospital accepted. As a resident, the hospital will be willing to work with you.

 

[Dr.LeoSpaceman]

As a resident, the hospital will be willing to work with you.

Unfortunately, the hospital/OR admin isn't going to be the most annoying part to deal with. If you have to do anything that's "out of the norm", I suspect you'll work with at least one or two attendings who take issue with doing what you have to do.

 

[Asperphys]

Is it bad enough that you might consider seeing a dermatologist for it? That have an impressive armamentarium against severe skin conditions and hypersensitivity that non-specialists might not have considered.

 

[MediCane2006]

I'll chime in as I had a severe glove hypersensitivity develop during surgical residency, which at one point was so bad my hands were blistered and bleeding at the end of the day.

1. SEE A DERMATOLOGIST prior to the start of residency. You need to get your skin optimized before beginning, and they may prescribe you a steroid cream for flares.
2. Talk to your program early about getting some hypo-allergenic gloves (I use the ansell/gammex gloves another poster mentioned.a lot of the biogel or neu-thera gloves have propellants that can irritate sensitive skin.
3. Avoid using chlorhexidine scrubs. If you need to scrub (first scrub of the day) use betadine and rinse well. Otherwise stick to Avagard or other no-scrub washes.
4. Depending on the case, and the attendings, you may be able to get away with only Avagard-ing on some days (colon cases for example) and only scrub when absolutely necessary.

 

[DermViser]

Is it bad enough that you might consider seeing a dermatologist for it? That have an impressive armamentarium against severe skin conditions and hypersensitivity that non-specialists might not have considered.

And yes, we do have an impressive armamentarium: http://www.merriam-webster.com/dictionary/armamentarium

 

[NewSurgeon]

Thank you to everyone who took the time to reply. I saw a dermatologist about a year ago and he did prescribe high-potency topical steroids for flares and ceramide cream for after hand washes. The only thing is that just a week of scrubbing in the OR can cause my skin to become so bad (really horrible pruritis, fissures, weeping lesions) that it becomes a game of catch up again to try and get the inflammation down with steroids. I think an optimal solution would be if I could somehow moisturize my skin after scrubbing but before putting my gloves on as constant moisturizing seems to be the best preventative measure in my experience. I am planning on getting allergy testing as well to see if that contributes to my skin sensitivity to the scrubbing chemicals. Who should I speak to in my program about this first? My PD? I am kind of worried about bringing it up because it will make it seem like I am looking for special treatment and I am just starting out. Don't want to get off on the wrong foot...

 

[Kahreek]

i would not go along using the steroid cream forever ( need dermviser back up on this ), it would be better to find gloves and asseptics that work with your hands.
Mind that there is difference between allergic eczema and irritative eczema. You need to know yours.
Try different brands of the same stuff, it could be specific excipient substances causing it.

 

[Gobanana]

I'll chime in as I had a severe glove hypersensitivity develop during surgical residency, which at one point was so bad my hands were blistered and bleeding at the end of the day.

1. SEE A DERMATOLOGIST prior to the start of residency. You need to get your skin optimized before beginning, and they may prescribe you a steroid cream for flares.
2. Talk to your program early about getting some hypo-allergenic gloves (I use the ansell/gammex gloves another poster mentioned.a lot of the biogel or neu-thera gloves have propellants that can irritate sensitive skin.
3. Avoid using chlorhexidine scrubs. If you need to scrub (first scrub of the day) use betadine and rinse well. Otherwise stick to Avagard or other no-scrub washes.
4. Depending on the case, and the attendings, you may be able to get away with only Avagard-ing on some days (colon cases for example) and only scrub when absolutely necessary.

That's great advice MediCane. I'd try to avoid any chlorehexidine scrubs... But Avagard contains chlorehexidine gluconate- so I'd avoid that as well if you're allergic to chlorehexidine. If available, after your first scrub, try Sterillium (if available) or another no-scrub wash instead of Avagard. Good luck!

 

[neusu]

Have the scrub open a xeroform and rub your hands down after you scrub but before you gown/glove.

 

[Winged Scapula]

Have the scrub open a xeroform and rub your hands down after you scrub but before you gown/glove.

Hmmm...not a bad idea for those with skin problems.