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." "apellidos" => "Zulaica" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012002621" "doi" => "10.1016/j.ad.2012.06.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012002621?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012002880?idApp=UINPBA000044" "url" => "/15782190/0000010300000009/v1_201304241357/S1578219012002880/v1_201304241357/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Response to: «Hand Eczema Due to Hygiene and Antisepsis Products: Not Only an Irritative Etiology»" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "846" "paginaFinal" => "847" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. 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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| 2020 Abril | 33 | 15 | 48 |
| 2020 Marzo | 24 | 12 | 36 |
| 2020 Febrero | 10 | 2 | 12 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 8 | 2 | 10 |
| 2019 Noviembre | 2 | 0 | 2 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 8 | 3 | 11 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 3 | 7 |
| 2019 Junio | 6 | 10 | 16 |
| 2019 Mayo | 4 | 19 | 23 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Marzo | 2 | 5 | 7 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Marzo | 15 | 2 | 17 |
| 2018 Febrero | 21 | 8 | 29 |
| 2018 Enero | 22 | 5 | 27 |
| 2017 Diciembre | 37 | 6 | 43 |
| 2017 Noviembre | 18 | 7 | 25 |
| 2017 Octubre | 23 | 9 | 32 |
| 2017 Septiembre | 33 | 12 | 45 |
| 2017 Agosto | 22 | 9 | 31 |
| 2017 Julio | 33 | 14 | 47 |
| 2017 Junio | 35 | 13 | 48 |
| 2017 Mayo | 21 | 16 | 37 |
| 2017 Abril | 23 | 10 | 33 |
| 2017 Marzo | 24 | 13 | 37 |
| 2017 Febrero | 31 | 4 | 35 |
| 2017 Enero | 21 | 10 | 31 |
| 2016 Diciembre | 35 | 10 | 45 |
| 2016 Noviembre | 47 | 11 | 58 |
| 2016 Octubre | 35 | 14 | 49 |
| 2016 Septiembre | 33 | 7 | 40 |
| 2016 Agosto | 44 | 13 | 57 |
| 2016 Julio | 39 | 12 | 51 |
| 2016 Junio | 12 | 11 | 23 |
| 2016 Mayo | 4 | 7 | 11 |
| 2016 Abril | 6 | 1 | 7 |
| 2016 Marzo | 12 | 9 | 21 |
| 2016 Febrero | 10 | 9 | 19 |
| 2016 Enero | 8 | 6 | 14 |
| 2015 Diciembre | 8 | 4 | 12 |
| 2015 Noviembre | 16 | 0 | 16 |
| 2015 Octubre | 19 | 3 | 22 |
| 2015 Septiembre | 4 | 5 | 9 |
| 2015 Agosto | 10 | 4 | 14 |
| 2015 Julio | 44 | 6 | 50 |
| 2015 Junio | 56 | 7 | 63 |
| 2015 Mayo | 62 | 9 | 71 |
| 2015 Abril | 70 | 11 | 81 |
| 2015 Marzo | 47 | 6 | 53 |
| 2015 Febrero | 32 | 8 | 40 |
| 2015 Enero | 43 | 10 | 53 |
| 2014 Diciembre | 47 | 4 | 51 |
| 2014 Noviembre | 42 | 15 | 57 |
| 2014 Octubre | 22 | 8 | 30 |
| 2014 Septiembre | 18 | 5 | 23 |
| 2014 Agosto | 16 | 5 | 21 |
| 2014 Julio | 15 | 8 | 23 |
| 2014 Junio | 26 | 5 | 31 |
| 2014 Mayo | 26 | 6 | 32 |
| 2014 Abril | 17 | 3 | 20 |
| 2014 Marzo | 25 | 12 | 37 |
| 2014 Febrero | 18 | 11 | 29 |
| 2014 Enero | 22 | 9 | 31 |
| 2013 Diciembre | 33 | 5 | 38 |
| 2013 Noviembre | 16 | 9 | 25 |
| 2013 Octubre | 10 | 9 | 19 |
| 2013 Septiembre | 7 | 14 | 21 |
| 2013 Agosto | 9 | 12 | 21 |
| 2013 Julio | 10 | 9 | 19 |
| 2013 Junio | 4 | 15 | 19 |
| 2013 Mayo | 11 | 10 | 21 |
| 2013 Abril | 17 | 10 | 27 |
| 2013 Marzo | 13 | 8 | 21 |
| 2013 Febrero | 24 | 5 | 29 |
| 2013 Enero | 19 | 3 | 22 |
| 2012 Diciembre | 15 | 5 | 20 |
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