Multiple cases of sensitization to an antiseptic containing chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol with different profiles of sensitization in adults and children

Background An aqueous antiseptic containing “chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol” (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL‐GERDA) has collected many cases in the last few years. Objectives To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB. Methods We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB. Results A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components. Conclusion CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children. In this French multicentre study we report 102 cases of contact allergy to an antiseptic solution containing chlorhexidine digluconate, benzalkonium chloride, and benzyl alcohol (CBB); time to correct diagnosis was often delayed. CBB had been mostly applied on wounds, but occasionally also on various dermatoses. Patch tests with all three components identified the culprit allergen(s) in 97% of cases, mainly benzyl alcohol in adults and chlorhexidine digluconate in children, with a remarkably high rate of sensitization to several components in both populations. Testing all components is necessary to guide avoidance.