Allergic contact dermatitis to chlorhexidine in pediatric patients

Abstract

Chlorhexidine is one of the most widely used antiseptics in our environment. Allergic contact dermatitis to chlorhexidine is common in adults, but is quite rare in the pediatric population. Its diagnosis is important because it can mimic other dermatoses common during childhood, and it can also lead to acute immediate hypersensitivity | 541 Pediatric Dermatology BRIEF REPORT undiagnosed. 1 Only 4 cases have been reported of ACD to chlorhexidine in pediatric patients without underlying AD. 3-5 Darrigade et al reported the largest case series of pediatric patients with ACD to chlorhexidine. Epicutaneous patch testing for chlorhexidine digluconate was positive in 7 of 14 patients tested, whereas 8 of them exhibited positivity to benzyl alcohol and positivity to both allergens in 4 cases. 1Our work showcases the role of chlorhexidine as a cause for ACD in the pediatric population, especially, but not exclusively, among patients with AD. It is worth noting that a history of surgery at an early age was identified in one patient suggesting the possibility that sensitization had occurred then. We emphasize the clinical utility of ROAT as a simple initial diagnostic approach during the initial evaluation of a patient presenting with symptoms suggestive of ACD to chlorhexidine. The different commercial formulations of this antiseptic must be taken into account, as some regularly used excipients, such as benzyl alcohol, which can also cause ACD. 1 Furthermore, we must inform parents that chlorhexidine is not only present in antiseptic products but also as a component of cosmetics. 2 Last but not least, it is imperative to rule out immediate hypersensitivity reactions, as even mild cases of ACD can indicate a potential risk of acute hypersensitivity reactions following successive exposures to chlorhexidine. 6

The infectious complications of atopic dermatitis

“…A potential adverse effect of this antimicrobial agent is allergic contact dermatitis. 54 The Infectious Diseases Society of America published guidelines for the management of recurrent SSTI because of MRSA in 2011. 55 Similar principles apply to the management of recurrent SSTI in AD.…”

Contact dermatitis apparently triggered by meningococcal and polyvalent vaccines: A case of allergic contact dermatitis due to chlorhexidine

“…In Europe, one of the most widely employed antiseptics is chlorhexidine digluconate, both in aqueous and alcohol solutions. It is also used as an antimicrobic compound in numerous drugs and cosmetics 1‐3 . Allergic contact dermatitis (or ACD) in response to chlorhexidine is common in adults, with a prevalence of about 1%, but is rare in pediatric patients 3,4 …”

“…Anaphylaxis has been reported as a severe immediate immunoglobulin E (IgE)–mediated reaction to chlorhexidine after medical operations 5,6 . Although the incidence of ACD in response to chlorhexidine in the pediatric population is considered very low, some studies demonstrated that the prevalence of chlorhexidine sensitization occurs in about 2.9% in patients younger than 16 years of age with atopic predisposition 1,3 . Early use of chlorhexidine (particularly during surgery) could determine sensitization during the first years of life.…”

“…Allergic contact dermatitis in response to chlorhexidine is common in adults but is rare in pediatric patients. Its manifestations can resemble other common dermatoses of childhood 1,2 . We describe a case of a 1‐year‐old male patient who developed an eczematous rash on both upper limbs after vaccinations, mimicking a case of rash triggered by vaccinations 1 …”

Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic

“…During house cleaning, the use of nitrile gloves and a proper rinse of the contact surfaces may be useful. In case of worsening or suspicion of superinfection, it is advisable to contact the family doctor for further therapies [19][20][21][22][23].…”