The COVID-19 pandemic is a stark reminder to the fact that one of the most effective ways to stop the spread of the virus is also one of the simplest: Hand hygiene.

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Amid the pandemic, washing hands and maintaining hand hygiene has become all the more important. As per experts, it is the first line of defence against coronavirus till the time a vaccine is developed. However, excess of everything has its repercussions. Dermatologists have observed an influx of cases coming with adverse effects of following excessive hand hygiene.

Nandini Barua, a senior consultant in the department of dermatology at Paras Hospital, Gurugram, said that people have developed an obsessive-compulsive disorder (OCD) for rigorous hand hygiene, suffering several skin ailments as a result. "The adverse effects of excessive hand washing can cause are mild rashes, dermatitis, and in extreme cases, dry eczema and psoriasis. Hand wash and frequent use of alcohol-based hand sanitisers cause severe skin conditions. While effective in killing germs and bacteria, hand sanitisers, when used in excess, can cause severe hand dermatitis," she cautioned. "All antiseptic soaps contain harsh chemicals, while alcohol-based sanitisers suck skin moisture. To avoid this situation, any mild soap can be used, also frequent use of moisturisers are recommended during the COVID times to keep the hand hydrated. However, a 20-second hand wash is necessary because the layer of coronovirus has to be destroyed," Barua advised.

Devendra Niranjan, clinical microbiologist and infection control officer at the Regency Super-speciality Hospital, Lucknow, said that excessive hand washing for individuals with particularly dry skin or skin conditions -- such as eczema or psoriasis -- could result in further skin damage and sore hands. "Even for people with healthy skin, excessive hand washing with soaps and hand sanitisers can cause the skin to dry out and crack. Repetitive hand washing or using hand sanitisers can shred the proteins in the top skin layer. Use of hand sanitisers can also lead to breaking the skin barrier and increase the risk of infection. In fact, water itself has a drying effect on the skin by reducing the skin's natural oils when it evaporates," Niranjan said. "To combat this, the first thing you should do is to dry your hands after washing, as infections transmit easily through wet hands. After drying your hands, apply moisturiser to avoid dryness. You can also use lather-based moisturisers to wash your hands," he added.

Mansak Shishak, a dermatologist at the Indian Spinal Injuries Centre (ISIC), New Delhi, said those who are diabetic and those who are occupationally exposed to irritants are prone to developing complications if they follow the routine of rigorous hand washing. "The skin is an important immune system organ and this balance is maintained delicately by specialised cells and substances within its different layers. Excessive washing, especially with irritant or harsh agents and antiseptics, predisposes the hands to get cracked, fissured, scaly, swollen and painful, sometimes impacting the nails and nail folds as well. "Those who are already diabetic and those who are occupationally exposed to a lot of irritants (cement factory, hairdressers, nurses etc) have a heightened risk of developing complications due to rigorous hand washing," Shishak explained.

Upali Nanda, head of preventive health and consultant-medicine at the Medeor Hospital in New Delhi, listed out a few cautions and precautions that people need to watch out for while maintaining hand hygiene:

• Tap water may contain microorganisms growing as a slimy layer in water storage tanks
• Washed hands may require further decontamination with antiseptic hand rubs, especially in areas where water quality is poor
• Wet hands can more readily acquire and spread microorganisms. Therefore proper drying of hands is an integral part of routine hand washing
• Reusing or sharing towels to dry hands should be avoided because of the risk of cross-infection
• Ideally, hands should be dried with either individual paper towels or hand dryers
• The skin should be gently dried with towels to avoid any cracking or excoriation as it can lead to further local and then bloodstream infection
• Don't forget to moisturize your hands after drying to prevent excessive dryness.