Ichthyosiform Irritant Contact Dermatitis Caused by Antiseptics for Personal Hygiene

Background: Antiseptics are commonly used for personal hygiene in Taiwan. We have previously reported a series of ichthyosiform irritant contact dermatitis induced by cetrimide-containing antiseptics. Objectives: To report a new series of antiseptics-induced ichthyosiform irritant contact dermatitis and bring attention to the potential irritation effects of antiseptics. Methods: We reviewed the clinicopathologic features of cases of cetrimide dermatitis, Savlon dermatitis or ichthyosiform irritant contact dermatitis diagnosed in our department (October 1993-August 2008). Cases with characteristic ichthyosiform, scarlet to dusky red or chemical burn-like skin lesions, primarily affecting the flexures and/or genital areas, and relevant exposure histories were included. Results: There were 35 patients (14 men and 21 women), aged from 3 to 79 years (mean 45 years). Most patients were seen in summer with a recognizable underlying pruritic dermatosis, and had used commercial products containing cetrimide. The exposure time was from 4 days to 2 months (mean 3.4 weeks). The great majority (80%) had moderate or severe skin lesions characterized by scarlet to dusky red or brownish lesions with a collodion membrane-like surface, and showed a preferential involvement of the flexural and genital areas, especially the groin and axilla where the lesions often manifested centrifugal rings. In no case was antiseptics-related dermatitis suspected by the clinicians or the patients. Skin biopsy was performed in 5 patients; all revealed changes consistent with cetrimide ichthyosiform irritant contact dermatitis. Conclusions: Our study showed that self-application of cetrimide-containing antiseptics is still an important cause of irritant contact dermatitis in southern Taiwan. This dermatitis should be differentiated from ichthyosis, tinea circinata, erythema annulare centrifugum, and nutritional deficiency diseases. Recognition of the clinical characteristics can prompt clinicians to inquire about exposure to antiseptics and facilitate correct diagnosis. (Dermatol Sinica 27: 218-226, 2009)