The problem is a common one in the healthcare industry: Prolonged wearing of personal protective equipment (PPE) creates heat, moisture and friction on the sensitive areas of the skin, leading to uncomfortable symptoms and even skin breakdown.1,2 In fact, findings from one report revealed that 97% of 542 front-line healthcare workers experienced symptoms such as burning, itching, stinging, erythema, papules, maceration and scaling due to extended PPE use.1

Reactions occur most often where the skin is thinner, with little underlying tissue, such as across the bridge of the nose, on the tops of cheeks and forehead, and behind the ears. Hand reactions are common as well due to prolonged glove wearing and excessive hand washing and sanitizing.2

Additionally, many cleansers leave the skin at a suboptimal acidity, when a pH of 4.7-5.0 is ideal. At this level, the stratum corneum is optimized, creating a thriving skin microbiome (the ecological community of commensal, symbiotic, and pathogenic microorganisms that exist within the stratum corneum). And when the skin’s microbiome thrives in this acidic, low-pH environment, it allows the stratum corneum to serve its critical, antimicrobial functions, significantly altering the availability of oxygen to tissues—a critical component in wound healing.3-8

Skin Breakdown Is More Than Uncomfortable. It’s Unsafe.
PPE-related skin injuries are frequently seen as mild irritations, so they are often overlooked or minimized. It must be noted that even small skin irritations can increase the risk to healthcare workers, potentially causing them to touch their faces (when not wearing PPE), inadvertently breaking PPE protocol.9

Plus, breaks in skin integrity can lead to an increased risk of breaching infection control policy (itching and premature removal of PPE), as well as a decrease in work productivity and absence from work.10

In a summary for Wound Management & Prevention, Dr. Amit Gefen, chair of the International Consensus Document on Device-Related Pressure Injuries, warned that “skin failure under a medical face mask will be a portal for the coronavirus to penetrate the body and also will allow other hospital-acquired bacterial, viral, or fungal infections access to the circulatory system.”11

How Theraworx Protect Can Help With PPE-Related Skin Breakdown
With soap and water not always available for frequent cleansing, and other hygiene products that may degrade the skin with frequent use, the need for an advanced hygiene and barrier solution like Theraworx Protect has never been more critical for healthcare workers.

Our clinically proven, non-toxic, no-rinse solution offers dual defense, helping protect both the hands and the face, particularly the T-zone (eyes, nose and mouth)—an area that leaves us most vulnerable to infection.

Unlike many soaps and antimicrobials on the market, Theraworx Protect supports healthy skin pH. Furthermore, the combination of surfactants in Theraworx Protect creates an invisible barrier against some shear and friction of PPE on the sensitive skin of the face and hands.

At home
Employees should do the following before leaving for work—about 1 to 2 hours before donning PPE:

  1. Following the instructions on the label, apply Theraworx Protect to cleanse the hands and T-zone (the area around the eyes, nose and mouth).
  2. Do not rinse. Allow to dry about 90 seconds, until no longer tacky.
  3. Apply moisturizer to face and hands until completely absorbed (avoid oil-based or petrolatum-based products).

At work
Employees should do the following 5 minutes before donning PPE:

  1. Apply Theraworx Protect as a cleanser and skin barrier to dry hands and face (forehead, around eyes, nose, cheeks, mouth and behind ears if needed). This will help reduce shearing, but not alleviate pressure, so it is important for PPE to have a good fit, but not be too tight.
  2. Do not rinse. Allow to dry about 90 seconds, until no longer tacky.
  3. Don PPE.
  4. Relieve pressure by removing PPE and repeating steps 1-3 every 4 hours, if possible, in accordance with your local policy and procedures.

Find out More
To inquire about our recent pandemic-related study data and learn more about how you can help protect your front-line healthcare workers by making Theraworx Protect part of your health and safety assessment and control plan, contact us. You can also purchase Theraworx Protect for your healthcare facility or for your household.


  1. Darlenski R, Tsankov N. Covid-19 pandemic and the skin: what should dermatologists know? [published online ahead of print, 2020 Mar 24]. Clin Dermatol. 2020. doi:10.1016/j.clindermatol.2020.03.012. Accessed July 6, 2020.
  2. Medscape website. A step-by-step guide to preventing PPE-related skin damage. Accessed July 6, 2020.
  3. Lambers H, Piessens S, Bloem A, et al. Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int J Cosmet Sci. 2006;28(5):359-370. doi:10.1111/j.1467-2494.2006.00344.x.
  4. Elias & Williams website. Atopic dermatitis: is it all about pH? Accessed July 6, 2020.
  5. Nakatsuji T, Teruaki RL. Antimicrobial peptides: old molecules with new ideas. J Invest Dermatol. 2012;132(3):887-895. doi: Accessed July 6, 2020.
  6. Grice EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011;9(4):244-253. doi:10.1038/nrmicro2537. Accessed July 6, 2020.
  7. Elias & Williams website. What are the layers of skin? Why are they important? Accessed July 6, 2020.
  8. Nagoba B, Suryawanshi N, Wadher B, et al. Acidic environment and wound healing: a review. Wounds. 2015;27(1):5-11. Accessed July 6, 2020.
  9. Kantor J. Behavioral considerations and impact on personal protective equipment use: early lessons from the coronavirus (COVID-19) pandemic. J Am Acad Dermatol. 2020;82:1087-1088. Accessed July 6, 2020.
  10. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for hand hygiene in all health care settings, 4th ed. April 2014. Toronto, ON: Queen’s Printer for Ontario. Accessed July 6, 2020.
  11. Gefen A. Skin tears, medical face masks, and coronavirus. Wound Manag Prev. 2020;66(4):6. Accessed July 6, 2020.