Hand eczema due to hygiene and antisepsis products: not only an irritative etiology.

We read with interest the recent article by Batalla et al. on the use of hand hygiene and antisepsis products among health care professionals and the relationship between these products and hand eczema. While we are in full agreement with the central message of the article and the authors’ algorithm for the management of patients with intolerance to alcohol-based products, we would like to add the following points. Since 2009, when the World Health Organization published its guidelines on hand hygiene for health care professionals, there has been a marked upswing in the distribution and use of alcohol-based products because of the numerous advantages they offer over traditional handwashing. The hand rubs that have achieved the greatest commercial success (e.g., Sterillium and Manorapid r.f.u.) are those that contain isopropyl alcohol (Chemical Abstract Service number 67-63-0). Before these products were developed, isopropyl alcohol was rarely used in medical or cosmetic preparations. Type IV hypersensitivity reactions were, therefore, rare leading some authors to even doubt whether isopropyl alcohol was in fact an allergen in humans. However, the marked increase in the use of products containing isopropyl alcohol has led to a substantial increase in exposure. At the same time, it has been found that isopropyl alcohol is potentially an important allergen, especially when used directly on the skin although also in the case of occupational exposure. In Europe, there are already numerous reports of health professionals who have been diagnosed with contact allergy to this substance, especially nurses and nursing assistants working in highly specialized units where frequent hand