The most common reaction associated with the frequent and repeated use of hand-hygiene products is irritant contact dermatitis (ICD). ICD is a non-immunologically mediated dermatitis characterized by dryness, itchiness, or burning; the skin may feel “rough”; and appear erythematous, scaly, or fissured. These signs and symptoms are similar to those associated with allergic contact dermatitis, which can be ruled out by allergy testing. The irritation may be caused by the antimicrobial agent or by other ingredients of the formulation. Detergents damage skin by causing denudation of the stratum corneum proteins, changes in intercellular lipids (either depletion or reorganization of lipid moieties), decreased corneocyte cohesion, and decreased stratum corneum water-binding capacity.36
Other factors that contribute to ICD include using hot water, low relative humidity (winter months), the quality of paper towels used, and shear forces associated with wearing and removing gloves. Damage to the skin frequently leads to colonization by staphylococci and gram-negative bacilli, which contributes to further irritation. ICD is most commonly reported with iodophors. Other antiseptic agents that can cause ICD, in order of decreasing frequency, include chlorhexidine, phenolic derivatives, and triclosan. Following an exhaustive review of available data, the CDC concluded that alcohol-based preparations are the safest antiseptics available and ethanol is usually less irritating than isopropanol.37
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