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Chlorhexidine gluconate and acetate in patch testing.

B B Knudsen1, C Avnstorp

  • 1Department of Dermatology, Gentofte Hospital, Denmark.

Contact Dermatitis
|January 1, 1991
PubMed
Summary
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Patch testing for chlorhexidine sensitivity in leg ulcer patients revealed that chlorhexidine acetate identified more allergies than chlorhexidine gluconate. However, acetate is a significant irritant, necessitating further concentration studies for accurate allergy diagnosis.

Area of Science:

  • Dermatology
  • Allergology
  • Wound Care

Background:

  • Patch testing is crucial for diagnosing allergic contact dermatitis.
  • Chlorhexidine gluconate is the standard for patch testing, but its efficacy may be limited.
  • Leg ulcers are common conditions where topical antiseptics like chlorhexidine are frequently used.

Purpose of the Study:

  • To compare the diagnostic yield of chlorhexidine acetate versus chlorhexidine gluconate in patch testing.
  • To evaluate the irritant potential of chlorhexidine acetate in patients with and without leg ulcers.
  • To determine the prevalence of chlorhexidine sensitization in leg ulcer patients.

Main Methods:

  • Conducted patch testing on 297 patients, primarily those with leg ulcers, using both chlorhexidine acetate 1% and chlorhexidine gluconate 1%.

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  • Assessed reaction relevance by correlating positive tests with clinical improvement after discontinuing chlorhexidine.
  • Evaluated irritant reactions in 109 patients without leg ulcers.

    • Main Results:

    • Chlorhexidine acetate yielded more positive reactions (36) than chlorhexidine gluconate (18).
    • Relevant chlorhexidine allergy was confirmed in 22 patients; 10 diagnoses would have been missed using only gluconate.
    • Chlorhexidine acetate 1% showed a higher irritant potential (17%) compared to gluconate (5%).

    Conclusions:

    • Chlorhexidine gluconate alone may miss a significant number of chlorhexidine allergies.
    • Chlorhexidine acetate 1% is a potent irritant, suggesting a need for optimized concentrations.
    • Up to 13% of leg ulcer patients may be sensitized to chlorhexidine, warranting reconsideration of its use in this population.