Letter to the Editor
Response to: «Hand Eczema Due to Hygiene and Antisepsis Products: Not Only an Irritative Etiology»
Réplica a: « Productos de higiene, antisepsia y eccema de manos: no solo etiología irritativa»
Servicio de Dermatología, Complejo Hospitalario de Pontevedra, Spain
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García-Gavín, L. Pérez-Pérez, A. Zulaica" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "García-Gavín" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Pérez-Pérez" ] 2 => array:2 [ "nombre" => "A." 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Batalla, I. García-Doval" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Batalla" "email" => array:1 [ 0 => "anacebey@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "García-Doval" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario de Pontevedra, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Réplica a: « Productos de higiene, antisepsia y eccema de manos: no solo etiología irritativa»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We appreciate the comments made by García-Gavín et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> concerning the article “Products for Hand Hygiene and Antisepsis: Use by Health Professionals and Relationship With Hand Eczema.”<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The focus of the article in question was skin irritation in health care professionals caused by hygiene and antisepsis products, particularly alcohol-based sanitizers. Skin irritation is one of the main reasons for the scant use of these products in clinical practice. Alcohol-based hand rubs are better tolerated by the skin than soap and water, and the guidelines of the Centers for Disease Control and Prevention and the World Health Organization clearly recommend the use of these products over traditional handwashing.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It has been reported previously<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> that such irritation may be erroneously diagnosed by health professionals as an allergic reaction.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–8</span></a> That said, this does not mean that these products can never cause true allergies. Cases have been reported of allergic contact dermatitis associated with alcohol-based products. In addition to the published cases of allergy to isopropanol,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> there have also been reports of allergic contact dermatitis caused by ethanol, 1-propanol, and 2-propanol.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> However, given the large number of people using alcohol-based rubs today, the incidence of such allergies, while certainly not negligible and potentially considerable, is low, and in most cases the allergy is caused by impurities, contaminants, or additives.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5,8</span></a> Therefore, the possibility that a user may develop an allergy should not be an obstacle to recommending the use of these products. For example, in a study of 50 nurses who reported erythema, desquamation, blistering, itching, or stinging after using alcohol-based products, none had a positive reaction to ethanol, 1-propanol, or 2-propanol on patch testing.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> When, in the same study, the nurses underwent patch testing with the products they were using at the workplace, only 3 exhibited a mild positive reaction after application of 2 of the products (Desmanol and Sterillium). When the components of these products were tested separately in 2 of these patients, a positive reaction was observed to the cetearyl octanoate in Desmanol and no reactions were seen at 72<span class="elsevierStyleHsp" style=""></span>hours in the case of the components of Sterillium.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Moreover, we should not forget that the most common causes of allergic contact dermatitis in health care professionals are the substances found in gloves, such as latex, rubber, and starch, or the ingredients in antiseptic soaps, including glutaraldehyde, formaldehyde, and glyoxal.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As indicated in the management algorithm in our article on this topic, irritant contact dermatitis favors the development of allergic contact dermatitis. Thus, reducing irritation and preserving the integrity of the skin barrier will reduce the risk of sensitization.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We agree entirely that when there is a temporal relationship in the case of lesions that are persistent or are exacerbated by the use of alcohol-based products, patch tests should be performed to rule out the possibility of an allergy to the alcohol component of the product used or the additives it contains. As García-Gavín et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> point out, the repeated open application test is a quick, practical, and economical alternative diagnostic method.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, we believe that the possibility that certain patients may develop allergic contact dermatitis to alcohol-based products should not distract from the main message of our article<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>: hygiene is mandatory in health care and the use of alcohol-based sanitizers causes less irritation than handwashing with soap and water. Moreover, irritation should not be considered a limiting factor in the use of such products.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Batalla A, García-Doval I. 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| 2019 July | 4 | 3 | 7 |
| 2019 June | 6 | 10 | 16 |
| 2019 May | 4 | 19 | 23 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 2 | 5 | 7 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 4 | 0 | 4 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 6 | 0 | 6 |
| 2018 May | 0 | 1 | 1 |
| 2018 March | 15 | 2 | 17 |
| 2018 February | 21 | 8 | 29 |
| 2018 January | 22 | 5 | 27 |
| 2017 December | 37 | 6 | 43 |
| 2017 November | 18 | 7 | 25 |
| 2017 October | 23 | 9 | 32 |
| 2017 September | 33 | 12 | 45 |
| 2017 August | 22 | 9 | 31 |
| 2017 July | 33 | 14 | 47 |
| 2017 June | 35 | 13 | 48 |
| 2017 May | 21 | 16 | 37 |
| 2017 April | 23 | 10 | 33 |
| 2017 March | 24 | 13 | 37 |
| 2017 February | 31 | 4 | 35 |
| 2017 January | 21 | 10 | 31 |
| 2016 December | 35 | 10 | 45 |
| 2016 November | 47 | 11 | 58 |
| 2016 October | 35 | 14 | 49 |
| 2016 September | 33 | 7 | 40 |
| 2016 August | 44 | 13 | 57 |
| 2016 July | 39 | 12 | 51 |
| 2016 June | 12 | 11 | 23 |
| 2016 May | 4 | 7 | 11 |
| 2016 April | 6 | 1 | 7 |
| 2016 March | 12 | 9 | 21 |
| 2016 February | 10 | 9 | 19 |
| 2016 January | 8 | 6 | 14 |
| 2015 December | 8 | 4 | 12 |
| 2015 November | 16 | 0 | 16 |
| 2015 October | 19 | 3 | 22 |
| 2015 September | 4 | 5 | 9 |
| 2015 August | 10 | 4 | 14 |
| 2015 July | 44 | 6 | 50 |
| 2015 June | 56 | 7 | 63 |
| 2015 May | 62 | 9 | 71 |
| 2015 April | 70 | 11 | 81 |
| 2015 March | 47 | 6 | 53 |
| 2015 February | 32 | 8 | 40 |
| 2015 January | 43 | 10 | 53 |
| 2014 December | 47 | 4 | 51 |
| 2014 November | 42 | 15 | 57 |
| 2014 October | 22 | 8 | 30 |
| 2014 September | 18 | 5 | 23 |
| 2014 August | 16 | 5 | 21 |
| 2014 July | 15 | 8 | 23 |
| 2014 June | 26 | 5 | 31 |
| 2014 May | 26 | 6 | 32 |
| 2014 April | 17 | 3 | 20 |
| 2014 March | 25 | 12 | 37 |
| 2014 February | 18 | 11 | 29 |
| 2014 January | 22 | 9 | 31 |
| 2013 December | 33 | 5 | 38 |
| 2013 November | 16 | 9 | 25 |
| 2013 October | 10 | 9 | 19 |
| 2013 September | 7 | 14 | 21 |
| 2013 August | 9 | 12 | 21 |
| 2013 July | 10 | 9 | 19 |
| 2013 June | 4 | 15 | 19 |
| 2013 May | 11 | 10 | 21 |
| 2013 April | 17 | 10 | 27 |
| 2013 March | 13 | 8 | 21 |
| 2013 February | 24 | 5 | 29 |
| 2013 January | 19 | 3 | 22 |
| 2012 December | 15 | 5 | 20 |
Show all
