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
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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 Julio | 24 | 65 | 89 |
| 2021 Junio | 26 | 57 | 83 |
| 2021 Mayo | 26 | 50 | 76 |
| 2021 Abril | 141 | 147 | 288 |
| 2021 Marzo | 77 | 90 | 167 |
| 2021 Febrero | 76 | 53 | 129 |
| 2021 Enero | 36 | 52 | 88 |
| 2020 Diciembre | 58 | 53 | 111 |
| 2020 Noviembre | 39 | 60 | 99 |
| 2020 Octubre | 25 | 54 | 79 |
| 2020 Septiembre | 26 | 26 | 52 |
| 2020 Agosto | 37 | 43 | 80 |
| 2020 Julio | 17 | 60 | 77 |
| 2020 Junio | 44 | 48 | 92 |
| 2020 Mayo | 23 | 48 | 71 |
| 2020 Abril | 30 | 68 | 98 |
| 2020 Marzo | 28 | 70 | 98 |
| 2020 Febrero | 8 | 24 | 32 |
| 2020 Enero | 4 | 9 | 13 |
| 2019 Diciembre | 4 | 14 | 18 |
| 2019 Noviembre | 4 | 7 | 11 |
| 2019 Octubre | 0 | 10 | 10 |
| 2019 Septiembre | 4 | 9 | 13 |
| 2019 Agosto | 4 | 4 | 8 |
| 2019 Julio | 4 | 17 | 21 |
| 2019 Junio | 3 | 16 | 19 |
| 2019 Mayo | 5 | 23 | 28 |
| 2019 Abril | 2 | 17 | 19 |
| 2019 Marzo | 0 | 5 | 5 |
| 2019 Febrero | 2 | 5 | 7 |
| 2019 Enero | 0 | 1 | 1 |
| 2018 Diciembre | 2 | 7 | 9 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Mayo | 0 | 11 | 11 |
| 2018 Abril | 0 | 5 | 5 |
| 2018 Marzo | 11 | 4 | 15 |
| 2018 Febrero | 55 | 7 | 62 |
| 2018 Enero | 37 | 10 | 47 |
| 2017 Diciembre | 66 | 4 | 70 |
| 2017 Noviembre | 25 | 9 | 34 |
| 2017 Octubre | 38 | 8 | 46 |
| 2017 Septiembre | 43 | 6 | 49 |
| 2017 Agosto | 31 | 24 | 55 |
| 2017 Julio | 39 | 10 | 49 |
| 2017 Junio | 37 | 15 | 52 |
| 2017 Mayo | 37 | 14 | 51 |
| 2017 Abril | 29 | 5 | 34 |
| 2017 Marzo | 23 | 34 | 57 |
| 2017 Febrero | 26 | 12 | 38 |
| 2017 Enero | 36 | 4 | 40 |
| 2016 Diciembre | 48 | 11 | 59 |
| 2016 Noviembre | 60 | 8 | 68 |
| 2016 Octubre | 39 | 15 | 54 |
| 2016 Septiembre | 64 | 19 | 83 |
| 2016 Agosto | 54 | 6 | 60 |
| 2016 Julio | 53 | 9 | 62 |
| 2016 Junio | 11 | 20 | 31 |
| 2016 Mayo | 9 | 12 | 21 |
| 2016 Abril | 6 | 2 | 8 |
| 2016 Marzo | 11 | 1 | 12 |
| 2016 Febrero | 5 | 3 | 8 |
| 2016 Enero | 2 | 2 | 4 |
| 2015 Diciembre | 5 | 1 | 6 |
| 2015 Noviembre | 10 | 1 | 11 |
| 2015 Octubre | 19 | 3 | 22 |
| 2015 Septiembre | 9 | 3 | 12 |
| 2015 Agosto | 18 | 6 | 24 |
| 2015 Julio | 55 | 11 | 66 |
| 2015 Junio | 79 | 13 | 92 |
| 2015 Mayo | 87 | 15 | 102 |
| 2015 Abril | 80 | 16 | 96 |
| 2015 Marzo | 66 | 4 | 70 |
| 2015 Febrero | 61 | 11 | 72 |
| 2015 Enero | 107 | 23 | 130 |
| 2014 Diciembre | 125 | 49 | 174 |
| 2014 Noviembre | 51 | 14 | 65 |
| 2014 Octubre | 27 | 5 | 32 |
| 2014 Septiembre | 18 | 4 | 22 |
| 2014 Agosto | 21 | 4 | 25 |
| 2014 Julio | 24 | 7 | 31 |
| 2014 Junio | 43 | 12 | 55 |
| 2014 Mayo | 58 | 12 | 70 |
| 2014 Abril | 42 | 6 | 48 |
| 2014 Marzo | 56 | 8 | 64 |
| 2014 Febrero | 27 | 11 | 38 |
| 2014 Enero | 35 | 8 | 43 |
| 2013 Diciembre | 53 | 13 | 66 |
| 2013 Noviembre | 25 | 10 | 35 |
| 2013 Octubre | 16 | 13 | 29 |
| 2013 Septiembre | 7 | 14 | 21 |
| 2013 Agosto | 11 | 23 | 34 |
| 2013 Julio | 14 | 19 | 33 |
| 2013 Junio | 13 | 20 | 33 |
| 2013 Mayo | 16 | 18 | 34 |
| 2013 Abril | 11 | 10 | 21 |
| 2013 Marzo | 10 | 18 | 28 |
| 2013 Febrero | 24 | 4 | 28 |
| 2013 Enero | 16 | 9 | 25 |
| 2012 Diciembre | 22 | 8 | 30 |
| 2012 Noviembre | 1 | 0 | 1 |
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