Allergic Contact Dermatitis to Chlorhexidine-Containing Antiseptics in Infants and Children: The Origin of Sensitization and The Role of The Excipients in This Sensitization (A Series of Ten Cases).
Main Article Content
Abstract
The recent COVID-19 pandemic provoked an outstanding increase of infection-control measures, with chlorhexidine becoming an extensively used antiseptic. Allergic contact dermatitis (ACD) to chlorhexidine is considered as a rare event in children, is often difficult to identify, and its diagnosis is often misdiagnosed as other skin diseases.
Thus, we aimed to explore the sensitization to chlorhexidine-containing antiseptics (CCA) in infants and children to determine the origin of their sensitization and the role of the excipients in their dermatosis.
We performed patch tests (PT) with chlorhexidine digluconate 0.5%, benzalkonium chloride 0.1%, benzyl alcohol 10%, 5% and 1% in ten children (1-16.5-year-old, including six children with a personal history of atopy) with severe contact reactions to chlorhexidine-based antiseptics (Biseptine®) and cosmetics. We also performed PT with sodium benzoate 5% in four of the children. Results were measured according to criteria recommended by the International Contact Dermatitis Research Group (ICDRG). Patch test reactions revealed that most children were sensitized to at least two components of CCA (chlorhexidine, benzyl alcohol and/or benzalkonium chloride).
To explore the origin of the sensitization, we searched for umbilical cord care (UCC) with CCA and the use of cosmetics and drugs containing chlorhexidine and excipients of CCA. Most parents reported prior disinfection of umbilical cord with CCA, but this was not always the case.
Allergic contact dermatosis to chlorhexidine, benzyl alcohol and benzalkonium chloride should be considered in infants and children with severe eczema and concomitant allergies. The regular use of cosmetics and drugs containing chlorhexidine, benzyl alcohol, benzalkonium chloride or sodium benzoate should probably be cautioned or avoided in children with severe eczema or pre-existing allergies.
Early suspicion and allergology exploration of ACD to CCA and their excipients is of paramount importance to help prevent severe allergic reactions to topical antiseptics and numerous cosmetics.
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