Letter to the Editor
Hand Eczema Due to Hygiene and Antisepsis Products: Not Only an Irritative Etiology
Productos de higiene, antisepsia y eccema de manos: no solo etiología irritativa
J. García-Gavín
, L. Pérez-Pérez, A. Zulaica
Corresponding author
Unidad de Alergia Cutánea y Fotoparche, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
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García-Gavín, L. Pérez-Pérez, A. Zulaica" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "García-Gavín" "email" => array:1 [ 0 => "juangavin@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Pérez-Pérez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Zulaica" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Alergia Cutánea y Fotoparche, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Productos de higiene, antisepsia y eccema de manos: no solo etiología irritativa" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the recent article by Batalla et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on the use of hand hygiene and antisepsis products among health care professionals and the relationship between these products and hand eczema. While we are in full agreement with the central message of the article and the authors’ algorithm for the management of patients with intolerance to alcohol-based products, we would like to add the following points.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Since 2009, when the World Health Organization published its guidelines on hand hygiene for health care professionals,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> there has been a marked upswing in the distribution and use of alcohol-based products because of the numerous advantages they offer over traditional handwashing.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The hand rubs that have achieved the greatest commercial success (e.g., Sterillium and Manorapid r.f.u.) are those that contain isopropyl alcohol (Chemical Abstract Service number 67-63-0).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Before these products were developed, isopropyl alcohol was rarely used in medical or cosmetic preparations. Type IV hypersensitivity reactions were, therefore, rare<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> leading some authors to even doubt whether isopropyl alcohol was in fact an allergen in humans.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However, the marked increase in the use of products containing isopropyl alcohol has led to a substantial increase in exposure. At the same time, it has been found that isopropyl alcohol is potentially an important allergen, especially when used directly on the skin although also in the case of occupational exposure.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In Europe, there are already numerous reports of health professionals who have been diagnosed with contact allergy to this substance, especially nurses and nursing assistants working in highly specialized units where frequent hand sanitizing is required (An Goossens, personal communication). In fact, in our own department we have diagnosed 2 young nurses with allergic contact dermatitis to isopropyl alcohol.</p><p id="par0035" class="elsevierStylePara elsevierViewall">It is important to remember that, in addition to isopropyl alcohol, commercial alcohol-based hand rubs may contain other ingredients, such as emulsifiers, additives (lanolin, propylene glycol, bisabolol), and perfumes, and that the allergenic potential of these components may be even greater than that of the alcohol.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">For all these reasons—and as Batalla et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> clearly indicate in their algorithm—the role of allergic contact dermatitis should not be overlooked when patients who habitually use alcohol-based sanitizers present with hand eczema. Consequently, patch testing is recommended in the case of persistent and clearly associated lesions. A practical alternative diagnostic technique available to any specialist is a repeated open application test with the actual product used by the patient.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It is very possible that the cause is allergic if the patient develops lesions after twice-daily application (morning and evening) on an area of approximately 5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> on the anterior forearm, for at least 2 weeks.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally, we would like to thank the authors of this excellent review on a very current issue of great relevance to dermatologists, who must be aware of the issues involved and up to date on the methods for diagnosing and treating these patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: García-Gavín J, et al. Productos de higiene, antisepsia y eccema de manos: no solo etiología irritativa. Actas Dermosifiliogr. 2012;103:848-9.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Productos de higiene y antisepsia de manos: su empleo y relación con el eccema de manos en profesionales sanitarios" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Batalla" 1 => "I. 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| 2021 January | 36 | 52 | 88 |
| 2020 December | 58 | 53 | 111 |
| 2020 November | 39 | 60 | 99 |
| 2020 October | 25 | 54 | 79 |
| 2020 September | 26 | 26 | 52 |
| 2020 August | 37 | 43 | 80 |
| 2020 July | 17 | 60 | 77 |
| 2020 June | 44 | 48 | 92 |
| 2020 May | 23 | 48 | 71 |
| 2020 April | 30 | 68 | 98 |
| 2020 March | 28 | 70 | 98 |
| 2020 February | 8 | 24 | 32 |
| 2020 January | 4 | 9 | 13 |
| 2019 December | 4 | 14 | 18 |
| 2019 November | 4 | 7 | 11 |
| 2019 October | 0 | 10 | 10 |
| 2019 September | 4 | 9 | 13 |
| 2019 August | 4 | 4 | 8 |
| 2019 July | 4 | 17 | 21 |
| 2019 June | 3 | 16 | 19 |
| 2019 May | 5 | 23 | 28 |
| 2019 April | 2 | 17 | 19 |
| 2019 March | 0 | 5 | 5 |
| 2019 February | 2 | 5 | 7 |
| 2019 January | 0 | 1 | 1 |
| 2018 December | 2 | 7 | 9 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 3 | 0 | 3 |
| 2018 May | 0 | 11 | 11 |
| 2018 April | 0 | 5 | 5 |
| 2018 March | 11 | 4 | 15 |
| 2018 February | 55 | 7 | 62 |
| 2018 January | 37 | 10 | 47 |
| 2017 December | 66 | 4 | 70 |
| 2017 November | 25 | 9 | 34 |
| 2017 October | 38 | 8 | 46 |
| 2017 September | 43 | 6 | 49 |
| 2017 August | 31 | 24 | 55 |
| 2017 July | 39 | 10 | 49 |
| 2017 June | 37 | 15 | 52 |
| 2017 May | 37 | 14 | 51 |
| 2017 April | 29 | 5 | 34 |
| 2017 March | 23 | 34 | 57 |
| 2017 February | 26 | 12 | 38 |
| 2017 January | 36 | 4 | 40 |
| 2016 December | 48 | 11 | 59 |
| 2016 November | 60 | 8 | 68 |
| 2016 October | 39 | 15 | 54 |
| 2016 September | 64 | 19 | 83 |
| 2016 August | 54 | 6 | 60 |
| 2016 July | 53 | 9 | 62 |
| 2016 June | 11 | 20 | 31 |
| 2016 May | 9 | 12 | 21 |
| 2016 April | 6 | 2 | 8 |
| 2016 March | 11 | 1 | 12 |
| 2016 February | 5 | 3 | 8 |
| 2016 January | 2 | 2 | 4 |
| 2015 December | 5 | 1 | 6 |
| 2015 November | 10 | 1 | 11 |
| 2015 October | 19 | 3 | 22 |
| 2015 September | 9 | 3 | 12 |
| 2015 August | 18 | 6 | 24 |
| 2015 July | 55 | 11 | 66 |
| 2015 June | 79 | 13 | 92 |
| 2015 May | 87 | 15 | 102 |
| 2015 April | 80 | 16 | 96 |
| 2015 March | 66 | 4 | 70 |
| 2015 February | 61 | 11 | 72 |
| 2015 January | 107 | 23 | 130 |
| 2014 December | 125 | 49 | 174 |
| 2014 November | 51 | 14 | 65 |
| 2014 October | 27 | 5 | 32 |
| 2014 September | 18 | 4 | 22 |
| 2014 August | 21 | 4 | 25 |
| 2014 July | 24 | 7 | 31 |
| 2014 June | 43 | 12 | 55 |
| 2014 May | 58 | 12 | 70 |
| 2014 April | 42 | 6 | 48 |
| 2014 March | 56 | 8 | 64 |
| 2014 February | 27 | 11 | 38 |
| 2014 January | 35 | 8 | 43 |
| 2013 December | 53 | 13 | 66 |
| 2013 November | 25 | 10 | 35 |
| 2013 October | 16 | 13 | 29 |
| 2013 September | 7 | 14 | 21 |
| 2013 August | 11 | 23 | 34 |
| 2013 July | 14 | 19 | 33 |
| 2013 June | 13 | 20 | 33 |
| 2013 May | 16 | 18 | 34 |
| 2013 April | 11 | 10 | 21 |
| 2013 March | 10 | 18 | 28 |
| 2013 February | 24 | 4 | 28 |
| 2013 January | 16 | 9 | 25 |
| 2012 December | 22 | 8 | 30 |
| 2012 November | 1 | 0 | 1 |
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