Case and Research Letters
Allergic Contact Dermatitis Due to Chlorhexidine in 2 Pediatric Patient
Dermatitis alérgica de contacto a clorhexidina en dos pacientes pediátricos
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Patch test with progesterone, which was negative at 96<span class="elsevierStyleHsp" style=""></span>hours, and with NorLevo in petrolatum and Progeffik applied directly on the area of the lesion and on healthy skin (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Oscoz-Jaime, M. Larrea-García, M.J. Mitxelena-Eceiza, N. Abián-Franco" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Oscoz-Jaime" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Larrea-García" ] 2 => array:2 [ "nombre" => "M.J." "apellidos" => "Mitxelena-Eceiza" ] 3 => array:2 [ "nombre" => "N." "apellidos" => "Abián-Franco" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018300887" "doi" => "10.1016/j.ad.2017.11.016" "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/S0001731018300887?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018304153?idApp=UINPBA000044" "url" => "/15782190/0000011000000001/v1_201901030631/S1578219018304153/v1_201901030631/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018304086" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.11.010" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1915" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:74-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Treatment of a Refractory Venous Ulcer With Terminal Interruption of the Reflux Source" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "74" "paginaFinal" => "75" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de úlcera venosa refractaria mediante la «interrupción terminal de la fuente de reflujo»" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 878 "Ancho" => 1309 "Tamanyo" => 192054 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Venous ulcer before treatment. B, Complete resolution 4 weeks after beginning treatment, with evident improvement of the surrounding skin.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Mendieta-Eckert, J.L. Azpiazu-Macho, N. Landa-Gundin" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Mendieta-Eckert" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Azpiazu-Macho" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Landa-Gundin" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018300772" "doi" => "10.1016/j.ad.2017.10.024" "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/S0001731018300772?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018304086?idApp=UINPBA000044" "url" => "/15782190/0000011000000001/v1_201901030631/S1578219018304086/v1_201901030631/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Allergic Contact Dermatitis Due to Chlorhexidine in 2 Pediatric Patient" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "76" "paginaFinal" => "77" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Córdoba, T. Sanz-Sánchez, E. Mohedano-Vicente, J. Borbujo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Córdoba" "email" => array:1 [ 0 => "scordoba.hflr@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "T." "apellidos" => "Sanz-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Mohedano-Vicente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Borbujo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Alergia, Hospital Universitario de Fuenlabrada, Madrid, España" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis alérgica de contacto a clorhexidina en dos pacientes pediátricos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1088 "Ancho" => 800 "Tamanyo" => 101767 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Exudative, vesicular lesions on the knee (Patient 1).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Allergic contact dermatitis has become more and more frequent in children in recent years.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This increase seems to be the result of greater exposure to allergens at younger ages, changes in cosmetic usage habits, and greater diagnostic suspicion, together with the increasingly frequent use of patch tests in this population.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patient 1</span>. A 5-year-old girl with no history of atopy presented with a flare of vesiculobullous, erythematous, pruriginous lesions on her right knee 24<span class="elsevierStyleHsp" style=""></span>hours after application of alcohol-based Cristalmina (chlorhexidine digluconate, benzyl alcohol, and polysorbate 80) as an antiseptic to treat a wound (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Her parents denied having applied other topical products or any type of dressing and reported that similar lesions had appeared on several occasions during the previous 2 years when they had used the same antiseptic. She was prescribed topical betamethasone and fusidic acid, and her lesions disappeared after a few days. One week after the lesions resolved the patient presented with a reactivation at the same site, coinciding with sun exposure at the beach and with no previous application of any product.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Open and semiocclusive tests performed with Cristalmina both yielded a positive result at 96<span class="elsevierStyleHsp" style=""></span>hours (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patch tests were performed with the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea [GEIDAC]) and the individual components of Cristalmina (chlorhexidine 0.5% in petrolatum [pet], benzyl alcohol 1% pet, and polysorbate 80 10% pet). The results were only positive for chlorhexidine 0.5% pet at 96<span class="elsevierStyleHsp" style=""></span>hours. The result of the prick test with chlorhexidine 0.5% and 2% was negative, and an that of an intradermal test with chlorhexidine 0.5% diluted 1/1000 was positive at the immediate reading and at the delayed reading (1 week). The results of intradermal tests in 3 control patients were negative. Given the final diagnosis of allergic contact dermatitis caused by Cristalmina with immediate and delayed sensitization to chlorhexidine, the parents decided not to complete the study using patch tests to evaluate possible worsening of the condition by sunlight.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patient 2</span>. A 2-year-old boy with congenital hypothyroidism and no history of atopy presented with flares of papular, erythematous, pruriginous lesions at an injection site that had first appeared 24<span class="elsevierStyleHsp" style=""></span>hours after the procedure and resolved spontaneously during the following days (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Clorhexidina Lainco, an aqueous solution of chlorhexidine digluconate 2%, was applied as an antiseptic before blood sampling. The results of open and semiocclusive tests with Clorhexidina Lainco were positive at 48<span class="elsevierStyleHsp" style=""></span>hours. Subsequent patch testing with isopropyl alcohol 2.5%, 5%, and 10% in water and chlorhexidine 0.5% in water yielded positive results to chlorhexidine at 48 and 96<span class="elsevierStyleHsp" style=""></span>hours. When antiseptic with chlorhexidine was suspended, the patient did not develop further lesions. The parents decided not to continue with the study.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Chlorhexidine is a topical fungicidal and bacterial antiseptic that has been widely used in health care since 1954, generally in the form of digluconate, aqueous solutions, or alcohol-based solutions.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> It is used for hand washing, hygiene of hospitalized patients, presurgical antiseptic baths, and disinfection of the surgical area. It is also applied before placement and care of catheters and may be used to impregnate medical devices (eg, cannulas, dressings, catheters).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Furthermore, in recent years, chlorhexidine has been increasingly used as a biocide in all types of cosmetic products.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Chlorhexidine can lead to local irritation. Other adverse effects, such as tooth discoloration<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and fixed drug eruption,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> are less common. In addition, chlorhexidine can potentially cause allergic contact dermatitis, photosensitivity,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> urticaria, and anaphylaxis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Some patients experience both immediate and delayed hypersensitivity reactions; therefore, even mild to moderate allergic dermatitis may indicate a potential risk of severe immediate-type reactions during subsequent exposure to chlorhexidine in this population.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However, the sensitizing capacity of chlorhexidine is poor despite the frequency of its use. Series of patients assessed using patch tests show that between 0.5<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> and 13.1%<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> are sensitized to chlorhexidine, although in Europe, 1% is a more realistic prevalence.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The appropriate concentration for testing chlorhexidine has not been established. A concentration of 0.5% is probably more appropriate than 1%, since it leads to fewer irritant reactions.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We report the cases of 2 children with allergic contact dermatitis to chlorhexidine, in 1 of whom sensitization was shown to be immediate. In patients with a positive patch test result to chlorhexidine, the workup should be completed with skin tests in order to assess the possibility of immediate-type allergic reaction. Furthermore, in the case of a patient with urticaria or anaphylaxis during medical or dental treatments, chlorhexidine should be considered a possible trigger, alongside latex, anesthetics, and other drugs.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Córdoba S, Sanz-Sánchez T, Mohedano-Vicente E, Borbujo J. Dermatitis alérgica de contacto a clorhexidina en dos pacientes pediátricos. Actas Dermosifiliogr. 2019;110:75–77.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1088 "Ancho" => 800 "Tamanyo" => 101767 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Exudative, vesicular lesions on the knee (Patient 1).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1199 "Ancho" => 800 "Tamanyo" => 72739 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Positive results in an open test (upper) and semiocclusive test (lower) (Patient 1).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 694 "Ancho" => 900 "Tamanyo" => 43469 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Erythematous papules at the injection site (Patient 2).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatitis alérgica de contacto pediátrica Estudio clínico-epidemiológico en un hospital terciario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.M. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 16 | 10 | 26 |
| 2024 Octubre | 111 | 54 | 165 |
| 2024 Septiembre | 162 | 19 | 181 |
| 2024 Agosto | 179 | 65 | 244 |
| 2024 Julio | 121 | 50 | 171 |
| 2024 Junio | 99 | 55 | 154 |
| 2024 Mayo | 103 | 40 | 143 |
| 2024 Abril | 109 | 30 | 139 |
| 2024 Marzo | 163 | 42 | 205 |
| 2024 Febrero | 182 | 37 | 219 |
| 2024 Enero | 88 | 34 | 122 |
| 2023 Diciembre | 96 | 20 | 116 |
| 2023 Noviembre | 132 | 34 | 166 |
| 2023 Octubre | 127 | 45 | 172 |
| 2023 Septiembre | 96 | 40 | 136 |
| 2023 Agosto | 81 | 16 | 97 |
| 2023 Julio | 108 | 33 | 141 |
| 2023 Junio | 84 | 25 | 109 |
| 2023 Mayo | 144 | 30 | 174 |
| 2023 Abril | 95 | 27 | 122 |
| 2023 Marzo | 114 | 27 | 141 |
| 2023 Febrero | 91 | 24 | 115 |
| 2023 Enero | 71 | 35 | 106 |
| 2022 Diciembre | 68 | 32 | 100 |
| 2022 Noviembre | 56 | 33 | 89 |
| 2022 Octubre | 52 | 25 | 77 |
| 2022 Septiembre | 40 | 44 | 84 |
| 2022 Agosto | 48 | 41 | 89 |
| 2022 Julio | 35 | 49 | 84 |
| 2022 Junio | 24 | 27 | 51 |
| 2022 Mayo | 79 | 49 | 128 |
| 2022 Abril | 143 | 36 | 179 |
| 2022 Marzo | 113 | 50 | 163 |
| 2022 Febrero | 107 | 33 | 140 |
| 2022 Enero | 140 | 49 | 189 |
| 2021 Diciembre | 88 | 42 | 130 |
| 2021 Noviembre | 77 | 46 | 123 |
| 2021 Octubre | 85 | 75 | 160 |
| 2021 Septiembre | 74 | 44 | 118 |
| 2021 Agosto | 60 | 35 | 95 |
| 2021 Julio | 52 | 22 | 74 |
| 2021 Junio | 57 | 29 | 86 |
| 2021 Mayo | 59 | 36 | 95 |
| 2021 Abril | 139 | 65 | 204 |
| 2021 Marzo | 75 | 35 | 110 |
| 2021 Febrero | 86 | 24 | 110 |
| 2021 Enero | 60 | 19 | 79 |
| 2020 Diciembre | 43 | 24 | 67 |
| 2020 Noviembre | 29 | 23 | 52 |
| 2020 Octubre | 50 | 11 | 61 |
| 2020 Septiembre | 43 | 20 | 63 |
| 2020 Agosto | 35 | 21 | 56 |
| 2020 Julio | 26 | 21 | 47 |
| 2020 Junio | 23 | 23 | 46 |
| 2020 Mayo | 20 | 9 | 29 |
| 2020 Abril | 20 | 10 | 30 |
| 2020 Marzo | 34 | 15 | 49 |
| 2020 Febrero | 8 | 0 | 8 |
| 2019 Diciembre | 1 | 0 | 1 |
| 2019 Mayo | 1 | 0 | 1 |
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