title: Contact dermatitis caused by cetrimide in antiseptics.
abstract: Cetrimide and chlorhexidine are widely used antiseptics. Irritant contact dermatitis from cetrimide has been reported, but only rarely and without pathologic study. We report the clinical and pathologic findings from a series of 18 cases of contact dermatitis caused by antiseptic solutions containing 3% cetrimide and 0.3% chlorhexidine. The patients consisted of 10 males and 8 females, aged from 2 to 62 years. Most patients developed pruritic, burning or painful rashes over the flexors and genitalia after 1 to 4 weeks of daily use of undiluted antiseptics for an underlying pruritic dermatosis. The lesions varied from slight scaling with minimal erythema to fiery or dusky red patches with a glazed surface. The rashes resolved in 2 to 4 weeks after discontinuing the antiseptics. Concentric annular lesions were noted in some patients. Patch testing revealed negative reaction to chlorhexidine 0.5% aq. but irritant reaction to cetrimide 0.5, 1 or 2% aq. and Savlon at 1:3 or 1:6 dilution. Light microscopy showed compact orthokeratosis and confluent parakeratosis without spongiosis. Our study suggests that the dermatitis was an irritant reaction to cetrimide after improper self-application of the antiseptic liquids for underlying pruritic rashes or personal hygiene. Recognition of the characteristic xerosis- or chemical-burn-like features primarily involving the flexors or genital area is essential to the diagnosis.
authors.affiliation: Department of Dermatology, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: J Y
authors.initials: JY
authors.lastname: Lee
authors.forename: B J
authors.initials: BJ
authors.lastname: Wang
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000009:adverse effects*; D000077286:Cetrimonium; D002593:Cetrimonium Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine; D003877:Dermatitis, Contact / Q000209:etiology / Q000473:pathology; D017453:Dermatitis, Irritant / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010328:Patch Tests
chemical_list: D000891:Anti-Infective Agents, Local; D002593:Cetrimonium Compounds; D002710:Chlorhexidine; D000077286:Cetrimonium