Hand Washing: Good for Infection Control, Bad for Skin Cancer Treatment

Sometimes my dermatology problems are so complicated that it takes me a while to summarize them in an email in between appointments. COVID-19, the new coronavirus, and the stipulation to wash our hands for 20 seconds has made my hands worse, and therefore the explanation of the problem more difficult.

Skin cancer and hand washing

Obviously good hand washing is not a new thing, but the fear of infection is so great that we’re doing it more. And I have to admit that when washing my hands for 20 seconds I’ve realized that I didn’t do it long enough before. In any case, the handwashing, although good for infection control, is bad for an ongoing problem with my hands. And treating a relatively new problem, a tiny squamous cell cancer on the knuckle of my thumb is harder.

Efudex application and hand washing

This all coincided with treating my hands with a combination of calcipotriene and 5-fluorouracil (Efudex). The spots that reacted to the treatment were not happy about all the washing. They were supposed to get red and sore. They formed scabs that came off. But this left exposed spots of skin that did not heal. So that’s the story of my left hand.

The right hand is the one with the spot on my thumb. At night, I applied the two creams and went to sleep in exam gloves. I also applied the cream to some spots on my wrist. Those spots looked more like they had gotten infected rather than reacting in the proper way. The cream needs to be applied twice a day. There is no way it’s going to stay on during the day with the hand washing. The spot on my thumb doesn’t look like it is doing anything.

Asking for professional advice

I took photos of the problem areas on both hands and tried to summarize in an email to the Mohs surgery department, with a copy to one of my dermatologists, like so:

“I treated hands and wrist for about 10 days with the combo cream. (I think I had a Mohs on the wrist). It didn’t react the way they usually do and it looks almost infected to me. Should I put antibiotic cream on it? The thumb with the squamous cell on it didn’t react. I wore gloves but with all the hand washing it’s hard to keep any cream on during the day. The photos on top are the right hand. Spots on the left hand reacted. The skin peeled off and now I have raw red areas made worse by hand washing. Anything to recommend? Maybe sleep in gloves with Vaseline? Thanks and I’m sure you have more important things to worry about but I said I’d keep you up to date.”

By the way, one of the things that adds time to these emails is each time, looking up the spelling of calcipotriene. Usually, a nurse calls me back pretty quickly with advice, but with so many people working from home, I have no idea if anyone even saw it. If it was a more pressing question I would have called. I might call tomorrow.

Hand washing songs

Tired of singing “Happy Birthday” twice to get to 20 seconds or singing “Baby Shark” until you get to Daddy Shark? The Today Show reported on other hand washing songs. The story featured a freelance journalist, Jen Monnier, who wrote on Twitter, “I'm tired of singing Happy Birthday and you probably are too, so I've done the very important public service of compiling other songs with roughly 20-sec choruses to sing.”

The top 15 are:

• "Love On Top" by Beyoncé
• "Truth Hurts" by Lizzo
• "Jolene" by Dolly Parton
• "Somewhere Over the Rainbow" from the Wizard of Oz
• "The Sound of Music" from The Sound of Music
• "My Shot" from Hamilton
• "Hands Clean" by Alanis Morisette
• "Karma Chameleon" by Culture Club
• "Stayin' Alive" by The BeeGees (also a favorite song for performing CPR)
• "Toxic" by Britney Spears
• "Livin' On a Prayer" by Bon Jovi
• "No Scrubs" by TLC
• "Raspberry Beret" by Prince
• "Landslide" by Fleetwood Mac
• "Love Shack" by The B-52's

Note: This article was written on April 13, 2020. Further developments in what we know about the Coronavirus are continuously emerging.