Contact dermatitis caused by cetrimide in antiseptics

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.