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Vol. 114. Núm. 2.
Páginas 176-178 (Febrero 2023)
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Vol. 114. Núm. 2.
Páginas 176-178 (Febrero 2023)
Case and Research Letter
Open Access
Contact Dermatitis From Amplified Hand Hygiene Practices in the COVID-19 Pandemic Among Medical Students: Frequency, Knowledge, and Attitude
Dermatitis de contacto debido al incremento de las prácticas sobre higiene de manos durante la pandemia de COVID-19 entre los estudiantes de Medicina: frecuencia, conocimiento y actitud
Mahdi B.M.
Consultant Clinical Immunology, University of Baghdad, Al-Kindy College of Medicine, Head of HLA Research Unit, Department of Microbiology, Baghdad, Iraq
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To the Editor:

Coronavirus disease-2019 pandemic continues to spread across the globe. Frequent use of detergents leads to skin allergic reaction due to the release of inflammatory mediators. Repeated itching leads to scratching at the affected area and secondary bacterial infection.1 Medical students are an important younger sector in the community that can influence the health status. These hygiene recommendations advance during COVID-19 and changing practices among individuals.2 This leads to a rise in unfavorable skin diseases and contact dermatitis from prolonged irritant detergents exposures and widespread use of antimicrobials disinfectants that are used to decrease infection with COVID-19.3,4

The purposes of this study are highlight the frequency, knowledge, and attitude of contact dermatitis development with repeated exposures to detergents and disinfectants among medical students during this pandemic.

Patients and methods

A cross-sectional study was conducted during January 2021 to assess the frequency of contact dermatitis among Medical students during the COVID-19 pandemic. A total of 700 medical students from Al-Kindy Medical College, University of Baghdad participated in this survey using a Google questionnaire from an online platform was sent to the students online because face-to-face interviews were not applicable during this pandemic. The study protocol was reviewed by the Scientific and Ethical Committee of Al-Kindy Medical College without funding. The final form link was distributed among the medical students via Google platforms. The inclusion criteria were all medical students who had been studying in this college from different stages for the study period. The exclusion criteria were Staff, lecturers, teachers, and other administrators in the college were excluded. An online questionnaire by Google forms was used to collect the data and utilized as a screening instrument examining the frequency of contact dermatitis (supplementary material).

Sampling method

Medical students were selected randomly from online Google platforms. Using Morgans’ table to calculate sample size and considering the total number of students were 10000 with 99% CI and 5% margin of error; the sample size calculated was 622 while our study gets many responses and collected about 700 participants. All surveys were completed in their answers.

Statistical analysis

The data were analyzed using SPSS-version- 25. Descriptive statistics including frequencies, percentages, Independent-Sample Chi-Square Test, were used. P-value <0.05 was considered statically significant.


The sociodemographic characteristics of the 700 medical students at Al-Kindy College of Medicine were shown in Table 1. Of the 700 who participated in the study, all of them (100%) were single undergraduate students, 80% of them were Clinical stages and the rest were preclinical stages. Sex distribution was 55% female and males were 45%. Their age was 61.42% ≥20 years (20.2±0.12). More than half of them (84.28%) lived in Baghdad. The frequency of CD among medical students during COVID-19 Pandemic was (26.42%) with a significant (P=0.0000) higher percentage among females students (150) (38.96%). Regarding males’ students, only 35 of them (11.11) had CD and the rest did not have CD.

Table 1.

Sociodemographic characteristics of medical students.

Characters  Categories  No. (%)  Total 
Age (years)≥20  430 (61.42)  700 
<20  270 (38.57)   
SexMales  315 (45.00)  700 
Females  385 (55.00)   
EducationPostgraduate  0.00 (00.00)  700 
Undergraduate  700 (100.0)   
Pre clinical stages (1, 2, 3)  140 (20.00)  700 
Clinical stages (4, 5, 6)  560 (80.00)   
AddressBaghdad  590 (84.28)  700 
Others  110 (15.71)   
Marital statusSingle  700 (100.0)  700 
Married  0.00 (00.00)   

Regarding the knowledge of medical students about CD as shown in Table 2. Almost all students (98.42%) agreed that this disease had a relation with COVID-19. About 82.71% of them did not agree that CD is a contagious disease. Nearly half of them (61.42%) know signs and symptoms. Students who used antiseptics frequently were (90%) and alcohol was mostly used (75%) and the rest were used Soap(25%). Table 3 illustrates the attitude of medical students about CD. A majority (93.71%) believed that CD increased with COVID-19, 90.28% agreed that its life-long disease. A proportion of students (67%) refused the idea of avoiding wearing masks, gloves, and detergent usage.

Table 2.

Knowledge of the medical students about CD and COVID-19.

Item  YesNo. (%)  NoNo. (%) 
Cause of CD  500 (71.42)  200 (28.57) 
Signs and symptoms  430 (61.42)  270 (38.57) 
Treatment  238 (34.00)  462 (66.00) 
Type of antiseptic used
Alcohol  525 (75.00)  175 (25.00) 
Soap  175 (25.00)  525 (75.00) 
Frequency of using detergent
Not frequent  70 (10.00)  630 (90.00) 
Frequent  630 (90.00)  70 (10.00) 
Complication  295 (42.14)  405 (57.85) 
Type IV hypersensitivity  346 (49.42)  354 (50.57) 
CD is a Contagious disease  121 (17.28)  579 (82.71) 
Relation with COVID-19  687 (98.42)  13 (1.85) 
Table 3.

Attitudes of the medical students about CD and COVID-19.

Item  YesNo. (%)  NoNo. (%) 
CD is a serious disease  327 (46.71)  373 (53.28) 
Life-long disease  632 (90.28)  68 (9.71) 
Preventable disease  435 (62.14)  265 (37.85) 
Increased with COVID-19  656 (93.71)  44 (6.28) 
Health education prevents CD  567 (81.00)  133 (19.00) 
Treated at home  643 (91.85)  57 (8.14) 
Avoid wearing masks and gloves  231 (33.00)  469 (67.00) 

In response to the COVID-19 pandemic outbreak, It was recommended proper and frequent handwashing with soap and using 70% alcohol. These recommendations have increased the incidence of hand eczema and contact dermatitis5 Frequent usage of gloves and masks will affect the function of epidermal barrier of the skin in medical workers.6 This study was in agreement with other study that demonstrated a high percentage (90.4%) of hand dermatitis among health care workers and (14.9%) of them had eczema (contact dermatitis).7 In Wuhan city; the hospitals of contact dermatitis among medical staff in university hospital was 74.5%.8 This difference may be due to type of workplace of sample selection, age of selected samples, differences in sample size, disparities in the characteristics of study participants and method of data collection. Daily using hand hygiene with alcohol demonstrated the lowest rates of skin barrier disruption and the highest reduction of colony forming unit.9 Other studies showed CD more affecting females which is comparable to our study like Saudi Arabia (46.4%) which might be due to similarities in socioeconomic characteristics of study sample.10 In spite of hand hygiene is important measure to prevent COVID-19 but skin barrier disruption can provide a site entry and viral attached to angiotensin converting enzyme receptor that presents in hair follicles, epidermis, and blood vessels of the skin.


This study showed that medical student's consideration contact dermatitis increased with frequent use of detergents during the COVID-19 pandemic. This may be due to frequent use of alcohol-based detergent. The educational level is an important factor for knowledge and attitude about this disease.

Conflict of interest

The author declares not to have any conflict of interest.

Appendix A
Supplementary data

The following are the supplementary data to this article:

M. Peiser, T. Tralau, J. Heidler, A.M. Api, J.H.E. Arts, D.A. Basketter, et al.
Allergic contact dermatitis: epidemiology, molecular mechanisms, in vitro methods and regulatory aspects. Current knowledge assembled at an international workshop at BfR, Germany.
Cell Mol Life Sci, 69 (2012), pp. 763-781
J. Allawi, H. Abbas, J. Rasheed, T. Sulaiman, A. Gatea, F. Al-Lami, et al.
The first 40-days experience and clinical outcomes in the management of coronavirus covid-19 crisis. Single center preliminary study.
B. Galib.
SARS-CoV-2 (COVID-19).
N.K. Alwan, S.A. Shakir, H.H. Waheeb.
Epidemiology of skin diseases among displaced people in Diyala Province.
J Fac Med Bagdad, 60 (2018), pp. 52-56
T. Montero-Vilchez, C. Cuenca-Barrales, A. Martinez-Lopez, A. Molina-Leyva, S. Arias-Santiago.
Skin adverse events related to personal protective equipment: a systematic review and meta-analysis.
J Eur Acad Dermatol Venereol, 35 (2021), pp. 1994-2006
T. Montero-Vilchez, A. Martinez-Lopez, C. Cuenca-Barrales, A. Rodriguez-Tejero, A. Molina-Leyva, S. Arias-Santiago.
Impact of gloves and mask use on epidermal barrier function in health care workers.
Dermatitis, 32 (2021), pp. 57-62
A. Guertler, N. Moellhoff, T.L. Schenck, C.S. Hagen, B. Kendziora, R.E. Giunta, et al.
Onset of occupational hand eczema among healthcare workers during the SARS-CoV-2 pandemic: comparing a single surgical site with a COVID-19 intensive care unit.
Contact Dermatitis, 83 (2020), pp. 108-114
P. Lin, S. Zhu, Y. Huang, L. Li, J. Tao, T. Lei, et al.
Adverse skin reactions among healthcare workers during the coronavirus disease 2019 outbreak: a survey in Wuhan and its surrounding regions.
Br J Dermatol, 183 (2020), pp. 190-192
T. Montero-Vilchez, A. Martinez-Lopez, C. Cuenca-Barrales, M.I. Quiñones-Vico, A. Sierra-Sanchez, A. Molina-Leyva, et al.
Assessment of hand hygiene strategies on skin barrier function during COVID-19 pandemic: a randomized clinical trial.
Contact Dermatitis, 86 (2022), pp. 276-285
O.B. Alluhayyan, B.K. Alshahri, A.M. Farhat, S. Alsugair, J.J. Siddiqui, K. Alghabawy, et al.
Occupational-related contact dermatitis: prevalence and risk factors among healthcare workers in the Al’Qassim Region, Saudi Arabia during the COVID-19 pandemic.
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