Occupational dermatoses during the second wave of the COVID-19 pandemic: a UK prospective study of 805 healthcare workers.

dear editor, The use of personal protective equipment (PPE) and frequent hand washing practice during the COVID‐19 pandemic has led to an emergence of related occupational dermatoses. During the first wave of the COVID‐19 pandemic high rates of hand irritant contact dermatitis (ICD), facial pressure damage from FFP3 masks, facial dermatitis and acne were seen in healthcare workers (HCWs). , Building on the published experience of dermatology units, we rapidly devised and set up a package of dermatology care to educate, support and treat our HCWs.

Between 18 January and 31 March 2021, 805 HCWs were seen and treated in ‘pop‐up’ occupational dermatosis clinics. Of those, 401 were seen in the first 3 weeks. The clinics were announced via weekly email bulletins, which were sent to all trust staff. The clinics were also advertised on the trust intranet and on posters across the trust. At the peak of the second wave in January 2021, Barts Health NHS Trust employed 12 975 HCWs doing COVID‐19 work with 835 COVID‐positive inpatients. This means 6·2% of all HCWs used our services. Questionnaires were completed for each consultation (summarized in Table 1). In total, 805 HCWs were assessed: 677 female and 127 male (one with sex not documented), mean (SD) age 35·3 (11·1) years. This reflects the workforce demographic, as 72% of the workforce are female. The most frequently seen occupation was nurses, followed by doctors. On average, staff spent a mean (SD) 9·3 (2·9) h in PPE per shift. We offered fee‐free prescriptions and emollient samples and produced educational material.

Table 1

Staff demographics and diagnoses presenting to occupational dermatology clinics during the second wave of the COVID‐19 pandemic at Barts Health NHS Trust. Data were obtained by questionnaire and diagnosis was made by a dermatologist at the time of consultation

Staff demographics	N = 805a
Female, n (%)	677 (84·1)
Male, n (%)	127 (15·8)
Age (years), mean (SD)	35·3 (11·1)
Hours in PPE per shift, mean (SD)	9·3 (2·9)
Staff occupation, n (%)
Nurse	258 (32·0)
Doctor	126 (15·7)
Healthcare assistant	67 (8·3)
Pharmacist	54 (6·7)
Radiographer	47 (5·8)
Physiotherapist	27 (3·4)
Administrative	22 (2·7)
Diagnosis, n (%)
Irritant contact dermatitis of the hands	391 (48·6)
Requiring potent topical steroidsb	62 (15·9)
Acne	363 (45·1)
Requiring oral antibioticsb	22 (6·1)
Facial eczema	112 (13·9)
Facial pressure injury	50 (6·2)
Dry skin	33 (4·1)
Hyperpigmentation	23 (2·9)
Psoriasis	19 (2·4)
Seborrheic dermatitis	7 (0·9)
Urticaria	4 (0·5)
Allergic contact dermatitis	3 (0·4)
More than one diagnosis	392 (48·7)

PPE, personal protective equipment. aSex not documented in 1 healthcare worker. bPercentage of those with irritant contact dermatitis or acne.

The most common diagnosis made in the 805 HCWs seen in the clinics was ICD of the hands (48·6%), followed by acne (45·1%). Facial eczema (13·9%) and facial pressure injury (6·2%) were less common. Diagnoses were made after history taking and examination by the dermatologists running the clinic. In particular, ICD of the hands was diagnosed when the pattern of the disease was consistent, namely inflammation involving web spaces and predilection for the dorsum of hands. ICD was distinguished from dry skin by the presence of erythema and inflammation. Overall, 392 HCWs had more than one skin problem. Three HCWs had suspected allergic contact dermatitis clinically to rubber accelerators, but due to COVID restrictions patch testing was unavailable during this time. Fourteen HCWs required formal referral to dermatology. Twelve HCWs required time off work, with a total of 114 lost working days. Of these 12, none had prior dermatology input and all experienced improvement after their consultation. The educational material created, including leaflets and videos, was available on the trust intranet and was accessed 6352 times.

Our data are consistent with existing literature, with the most common diagnosis in the current study being ICD (48·6% – almost half of our cohort). There was significantly increased incidence of acne (45·1%) compared with the first wave, where the reported incidence was 17% in a multicentre study. In contrast to other groups, we found acne was the most common facial skin problem – more than facial eczema and facial pressure injury from PPE. Hyperpigmentation was an issue in at least 2·9% of our cohort and this may be under‐recognized. Postinflammatory dyspigmentation is a major concern in people with more pigmented skin, who often are unable to tolerate benzoyl peroxide and topical retinoids due to irritation. This is important as 56% of our trust workforce are from black, Asian or minority ethnic backgrounds.

We saw significant numbers of facial pressure injury (6·2%) and facial eczema (13·9%), which were higher than in previous UK studies. , Atopy was seen in 26·5% of HCWs, compared with an estimated prevalence in the UK adult population of 8·3%. This supports previous studies showing that atopic eczema is more likely to present with healthcare‐related occupational dermatoses.

Limitations of this study include it being a single‐centre study and descriptive. Diagnoses were made clinically without tests, and the absence of patch testing was a significant drawback. The clinics were staffed by 10 dermatologists and within this there may be interexaminer variability. The majority of HCWs presenting to the clinic were not formally followed up.

Our data confirm there was a large unmet need in HCWs with skin problems during the second wave of the COVID‐19 pandemic. We highlight the sheer scale of the issue with 805 HCWs presenting for dermatological assessment in only 10 weeks in one trust, making this the largest cohort reported in the world. We describe the success of an outreach occupational dermatology clinic, which was convenient for HCWs. Compared with experience during the first wave, acne exacerbated or precipitated by masks is increasingly common.

Author Contribution

Jing Gao: Conceptualization (equal); Data curation (equal); Formal analysis (equal); Investigation (equal); Methodology (equal); Project administration (equal); Resources (equal); Validation (equal); Visualization (equal); Writing‐original draft (lead); Writing‐review & editing (lead). Rebeca Goiriz: Conceptualization (equal); Data curation (equal); Formal analysis (equal); Investigation (equal); Methodology (equal); Project administration (equal); Resources (equal); Supervision (equal); Writing‐original draft (equal); Writing‐review & editing (equal). Shefali Rajpopat: Conceptualization (equal); Data curation (equal); Formal analysis (equal); Investigation (equal); Methodology (equal); Project administration (equal); Resources (equal); Writing‐original draft (equal); Writing‐review & editing (equal). Portia Goldsmith: Conceptualization (equal); Data curation (equal); Formal analysis (equal); Investigation (equal); Methodology (equal); Project administration (equal); Supervision (equal); Validation (equal); Visualization (equal); Writing‐original draft (equal); Writing‐review & editing (lead).