Patch Testing to Chlorhexidine Digluconate, 1% Aqueous: North American Contact Dermatitis Group Experience, 2015-2020

Erin M. Warshaw, From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.
Joohee Han, From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.
Sara A. Kullberg, From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.
Joel G. DeKoven, Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
Brandon L. Adler, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Jonathan I. Silverberg, Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Marie-Claude Houle, Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada.
Melanie D. Pratt, Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.
Donald V. Belsito, Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA.
Jiade Yu, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Nina C. Botto, Department of Dermatology, University of California, San Francisco, California, USA.
Margo J. Reeder, Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
James S. Taylor, Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.
Amber R. Atwater, Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA.
Cory A. Dunnick, Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Vincent A. DeLeo, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Chris M. Mowad, Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA.

Document Type

Journal Article

Publication Date

6-6-2023

Journal

Dermatitis : contact, atopic, occupational, drug

DOI

10.1089/derm.2023.0077

Abstract

Chlorhexidine is an antiseptic that may cause allergic contact dermatitis. To describe the epidemiology of chlorhexidine allergy and characterize positive patch test reactions. This retrospective study analyzed patients patch tested to chlorhexidine digluconate 1% aqueous by the North American Contact Dermatitis Group, 2015-2020. Of 14,731 patients tested to chlorhexidine digluconate, 107 (0.7%) had an allergic reaction; of these, 56 (52.3%) reactions were currently clinically relevant. Most (59%) reactions were mild (+), followed by strong (++, 18.7%) and very strong (+++, 6.5%). Common primary dermatitis anatomic sites in chlorhexidine-positive patients were hands (26.4%), face (24.5%), and scattered/generalized distribution (17.9%). Compared with negative patients, chlorhexidine-positive patients were significantly more likely to have dermatitis involving the trunk (11.3% vs 5.1%;  = 0.0036). The most commonly identified source category was skin/health care products (n = 41, 38.3%). Only 11 (10.3%) chlorhexidine reactions were occupationally related; of these, 81.8% were in health care workers. Chlorhexidine digluconate allergy is uncommon, but often clinically relevant. Involvement of the hands, face, and scattered generalized patterns was frequent. Occupationally related reactions were found predominantly in health care workers.

Department

Dermatology

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