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      Consensus of Chinese experts on protection of skin and mucous membrane barrier for health‐care workers fighting against coronavirus disease 2019

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          Abstract

          Health professions preventing and controlling Coronavirus Disease 2019 are prone to skin and mucous membrane injury, which may cause acute and chronic dermatitis, secondary infection and aggravation of underlying skin diseases. This is a consensus of Chinese experts on protective measures and advice on hand‐cleaning‐ and medical‐glove‐related hand protection, mask‐ and goggles‐related face protection, UV‐related protection, eye protection, nasal and oral mucosa protection, outer ear, and hair protection. It is necessary to strictly follow standards of wearing protective equipment and specification of sterilizing and cleaning. Insufficient and excessive protection will have adverse effects on the skin and mucous membrane barrier. At the same time, using moisturizing products is highly recommended to achieve better protection.

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          Most cited references16

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          2019-nCoV transmission through the ocular surface must not be ignored

          Chaolin Huang and colleagues 1 reported the epidemiology, symptoms, and treatment of patients infected by the 2019 novel coronavirus (2019-nCoV) in Wuhan, China. As ophthalmologists, we believe that transmission of 2019-nCoV through the eyes was ignored. On Jan 22, Guangfa Wang, a member of the national expert panel on pneumonia, reported that he was infected by 2019-nCoV during the inspection in Wuhan. 2 He wore an N95 mask but did not wear anything to protect his eyes. Several days before the onset of pneumonia, Wang complained of redness of the eyes. Unprotected exposure of the eyes to 2019-nCoV in the Wuhan Fever Clinic might have allowed the virus to infect the body. 2 Infectious droplets and body fluids can easily contaminate the human conjunctival epithelium. 3 Respiratory viruses are capable of inducing ocular complications in infected patients, which then leads to respiratory infection. 4 Severe acute respiratory syndrome coronavirus (SARS-CoV) is predominantly transmitted through direct or indirect contact with mucous membranes in the eyes, mouth, or nose. 5 The fact that exposed mucous membranes and unprotected eyes increased the risk of SARS-CoV transmission 4 suggests that exposure of unprotected eyes to 2019-nCoV could cause acute respiratory infection. Thus, Huang and colleagues 1 should have analysed conjunctival scrapings from both confirmed and suspected 2019-nCoV cases during the onset of symptoms. The respiratory tract is probably not the only transmission route for 2019-nCoV, and all ophthalmologists examining suspected cases should wear protective eyewear.
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            Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome – a descriptive study in Singapore

            Severe acute respiratory syndrome (SARS) was first recognized in February 2003. It is the first severe and readily transmissible new disease to emerge in the 21st century. Healthcare workers in affected countries were exposed to the regular use of personal protective equipment (PPE) such as the N95 mask, gloves, and gowns. Our aim was to study the prevalence of adverse skin reactions to PPE among healthcare workers in Singapore during the SARS outbreak. Healthcare staff in the National Skin Centre and Tan Tock Seng Hospital were surveyed using questionnaires. Of those asked to participate, 322 (94.7%) agreed. 14.3% of the respondents were doctors, 73.0% nurses, and 12.7% other ancillary staff. Mean age of respondents was 32.4 years, with the majority being women (85.7%) and Chinese (53.7%). 109 (35.5%) of the 307 staff who used masks regularly reported acne (59.6%), facial itch (51.4%), and rash (35.8%) from N95 mask use. 64 (21.4%) of the 299 who used gloves regularly reported dry skin (73.4%), itch (56.3%), and rash (37.5%). The use of PPE is associated with high rates of adverse skin reactions. There is a need to find suitable alternatives for affected staff and to encourage awareness among staff of the role of dermatologists in their care.
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              N95 acne

              Two women, aged 27 and 45 years, presented to the Dermatology Outpatient Clinic with acne vulgaris. Both had nodular acne in a similar distribution over the cheeks, chin, and perioral areas (Fig. 1). Each had a history of acne vulgaris as a teenager. Both were healthcare assistants working in the Singapore General Hospital throughout the severe acute respiratory syndrome (SARS) crisis, had worn N95 masks continuously for about 3 months whilst on the wards, and had suffered an outbreak of acne of the skin occluded by the mask. They were treated with topical retinoid and systemic antimicrobials, and both responded well. Figure 1 Twenty‐seven‐year‐old woman with acne papules and nodules on the face over the area occluded by the N95 mask
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                Author and article information

                Contributors
                lhengjin@163.com
                drlihang@126.com
                Journal
                Dermatol Ther
                Dermatol Ther
                10.1111/(ISSN)1529-8019
                DTH
                Dermatologic Therapy
                John Wiley & Sons, Inc. (Hoboken, USA )
                1396-0296
                1529-8019
                29 March 2020
                : e13310
                Affiliations
                [ 1 ] Department of Dermatology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses Xicheng District, Beijing China
                [ 2 ] Department of Dermatology, Tongji Hospital of Tongji Medical College Huazhong University of Science and Technology Hankou, Wuhan People's Republic of China
                [ 3 ] Department of Dermatology Wuhan No.1 Hospital Wuhan Hubei People's Republic of China
                [ 4 ] Department of Dermatology First Affiliated Hospital of Fujian Medical University Fuzhou Fujian People's Republic of China
                [ 5 ] Department of Dermatology West China Hospital of Sichuan University Wuhou District, Chengdu City Sichuan Province People's Republic of China
                [ 6 ] Department of Dermatology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan Hubei Province People's Republic of China
                [ 7 ] Department of Dermatology Chinese Medical University First Hospital Shenyang Liaoning Province People's Republic of China
                [ 8 ] Hospital for Skin Diseases Chinese Academy of Medical Sciences Nanjing Jiangsu Province People's Republic of China
                [ 9 ] Department of Dermatology First Affiliated Hospital of Kunming Medical University Wuhua District, Kunming Yunnan Province People's Republic of China
                [ 10 ] Department of Dermatology Peking Union Medical College Hospital Dongcheng District, Beijing China
                [ 11 ] Department of Dermatology The Third Affiliated Hospital, Sun Yat‐Sen University Tianhe District, Guangzhou Guangdong China
                [ 12 ] Department of Dermatology Renmin Hospital of Wuhan University Wuhan China
                [ 13 ] Department of Infection Control Peking University First Hospital Xicheng District, Beijing China
                [ 14 ] Department of Dermatology Air Force General Hospital of PLA Haidian District, Beijing People's Republic of China
                [ 15 ] Department of Dermatology The Second Xiangya Hospital of Central South University Changsha China
                [ 16 ] Department of Dermatology Zhongnan Hospital of Wuhan University Wuchang District, Wuhan Hubei Province China
                [ 17 ] Plastic Surgery Hospital, Chinese Academy of Medical Sciences Peking Union Medical College Shijingshan District, Beijing China
                [ 18 ] Department of Dermatology Xijing Hospital, Air Force Medical University of PLA Xi'an Shaanxi China
                [ 19 ] Department of Dermatology Huashan Hospital, Fudan University Shanghai China
                [ 20 ] Department of Dermatology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Yangpu District, Shanghai People's Republic of China
                [ 21 ] Shandong Academy of Medical Sciences Ji'nan Shandong Province People's Republic of China
                [ 22 ] Department of Dermatology Peking University People's Hospital Xicheng District, Beijing People's Republic of China
                [ 23 ] Department of Dermatology Hainan Hospital of PLA General Hospital Sanya Hainan Province China
                Author notes
                [*] [* ] Correspondence

                Hang Li, Department of Dermatology, Peking University First Hospital, No. 8 Xishiku St., Xicheng District, Beijing, China.

                Email: drlihang@ 123456126.com

                Hengjin Li, Department of Dermatology, Hainan Hospital of PLA General Hospital, Haitang Bay, Sanya, Hainan Province, China.

                Email: lhengjin@ 123456163.com

                As one of the original authors, she is responsible for the translation and revision of the English version.

                Author information
                https://orcid.org/0000-0002-9752-4761
                https://orcid.org/0000-0001-8809-8564
                https://orcid.org/0000-0002-5485-682X
                Article
                DTH13310
                10.1111/dth.13310
                7228211
                32170800
                bff4c5b8-19e9-4050-adad-fb435002fffe
                © 2020 Wiley Periodicals, Inc.

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 09 March 2020
                : 10 March 2020
                Page count
                Figures: 0, Tables: 0, Pages: 7, Words: 4625
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                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:16.04.2020

                covid‐19,healthcare workers,protect,sars‐cov‐2,skin and mucous membrane barrier

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