Hand sanitizer's second act: What physicians say about risk of overuse

Amid the pandemic, hand sanitizer has become a fixture in Americans' daily lives, but it's not without risk, two physicians told The Boston Globe.

Overall, the near-ubiquitous nature of hand sanitizer is a good thing, the physicians said. 

"The great benefit is the ease of use, and the demonstrated efficacy of killing viruses, bacteria, etc.," said Gregory Poland, MD, infectious diseases physician at Rochester, Minn.-based Mayo Clinic. 

However, there are several risks associated with hand sanitizer overuse. Below are five possible risks:

1. The vapors of hand sanitizer, when used in excess, may irritate people with hyperreactive airway disease, Dr. Poland said.

2. The high concentration of alcohol in sanitizer can also damage the skin's outer layer, said Abigail Waldman, MD, a dermatologist at Boston-based Brigham and Women's Hospital. The damage causes dry skin prone to itching and cracking, thereby increasing the risk of bacterial infections. Healthcare providers accustomed to frequent use of hand sanitizer compensate with Vaseline and Aquaphor, Dr. Waldman said.

3. People who regularly use hand sanitizer may develop a resistance to the sanitizer being used, though resistance is more common with antimicrobial agents, Dr. Waldman said.  

4. Hand sanitizers may also disrupt the microbiome. They wipe out bad bacteria and viruses, but also wipe out good bacteria and viruses, Dr. Waldman said. "We just don’t know what the implications of that are. More and more, we're realizing that your normal skin flora actually maybe has some purpose in protecting you."

5. Ethanol and isopropanol are safe and effective sanitizer ingredients, though methanol — a hand sanitizer ingredient used in many countries — is not. It's banned in the U.S. but allowed in certain countries that sell the product online, prompting several FDA warnings last year. Ingesting methanol may lead to blindness and death, according to the CDC, which reported 15 cases in two states last summer.

Bottom line

"What's clear is that sanitizer is inferior to soap and water, which allows for a more thorough wash," Dr. Poland said, noting that hand sanitizer can't penetrate mucus, dirt, blood or other solid particles. However, when soap and water isn't available, hand sanitizer is the next best option.

"I think the benefits far outweigh the risks when it's an approved hand sanitizer, used properly, and soap and water isn't available or not a feasible option," Dr. Poland told the Globe.


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