Multiple cases of sensitization to an antiseptic containing chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol with different profiles of sensitization in adults and children

Abstract

Background An aqueous antiseptic containing “chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol” (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL‐GERDA) has collected many cases in the last few years. Objectives To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB. Methods We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB. Results A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components. Conclusion CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children.

Allergic contact dermatitis to chlorhexidine‐containing antiseptics and their excipients in children: A series of six cases

“…As chlorhexidine‐related allergic contact dermatitis remains very rare, despite its widespread use, chlorhexidine‐induced dermatitis is often undiagnosed and mistaken for other skin diseases 8 . Diagnosis of allergic contact dermatitis is based on delayed‐reading skin tests (usually PT), and on (repeated) open application tests when the results of PT are difficult to interpret and/or when the substances to be tested are complex 9,10 . The children in our cases reported severe and persistent reactions (facial edema, severe eczema), often unresponsive to topical corticosteroids and skin emollients.…”

“…8 Diagnosis of allergic contact dermatitis is based on delayed-reading skin tests (usually PT), and on (repeated) open application tests when the results of PT are difficult to interpret and/or when the substances to be tested are complex. 9,10 The children in our cases reported severe and persistent reactions (facial edema, severe eczema), often unresponsive to topical corticosteroids and skin emollients. Thus, we and the parents feared severe relapses or exacerbations of the reactions.…”

It is not always chlorhexidine: Identification of benzoxonium chloride and lauramine oxide as culprit allergens in a popular antiseptic in Switzerland

“…17 retrospective study on patients with contact dermatitis to CBB-an aqueous antiseptic widely used in France containing the mixture chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol. 18 In their series, approximately 1/3 of patients were polysensitised (to two or even all three components) and 2/3 were mono sensitised. As in our series, most positive reactions were not caused by chlorhexidine digluconate.…”

“…Contact‐allergic reactions to antiseptics are not always due to the main antiseptic agent present. Recently, Beaumont et al published a retrospective study on patients with contact dermatitis to CBB—an aqueous antiseptic widely used in France containing the mixture chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol 18 . In their series, approximately 1/3 of patients were polysensitised (to two or even all three components) and 2/3 were mono sensitised.…”

Allergic contact dermatitis from benzyl alcohol mimicking acute generalized exanthematous pustulosis

“…When considering these results, the initial eruption remained unexplained. With benzyl alcohol as a likely culprit in mind, we questioned the patient about the use of Biseptine (chlorhexidine digluconate + benzalkonium chloride + benzyl alcohol; Bayer Heathcare), an antiseptic solution commonly used in France, and specifically associated with benzyl alcohol contact allergy 2 . She had indeed applied this particular product to her inguinal folds a few days before the onset of the initial rash; an additional patch test to Biseptine lotion was positive (++) (Figure 1G).…”