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Okeke CAV, Khanna R, Ehrlich A. Quaternary Ammonium Compounds and Contact Dermatitis: A Review and Considerations During the COVID-19 Pandemic. Clin Cosmet Investig Dermatol 2023; 16:1721-1728. [PMID: 37409071 PMCID: PMC10319159 DOI: 10.2147/ccid.s410910] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
The recent global pandemic has resulted in increased use of quaternary ammonium compounds (QACs). Currently, QACs are active ingredients in 292 disinfectants recommended by the US EPA for use against SARS-CoV-2. Among QACs, benzalkonium chloride (BAK), cetrimonium bromide (CTAB), cetrimonium chloride (CTAC), didecyldimethylammonium chloride (DDAC), cetrimide, quaternium-15, cetylpyridinium chloride (CPC), and benzethonium chloride (BEC) were all identified as potential culprits of skin sensitivity. Given their widespread utilization, additional research is needed to better classify their dermal effects and identify other cross-reactors. In this review, we aimed to expand our knowledge about these QACs to further dissect its potential allergic and irritant dermal effects on healthcare workers during COVID-19.
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Affiliation(s)
- Chidubem A V Okeke
- Department of Dermatology, Howard University College of Medicine, Washington, DC, USA
| | - Ramona Khanna
- Georgetown University School of Medicine, Washington, DC, USA
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Peyneau M, de Chaisemartin L, Gigant N, Chollet-Martin S, Kerdine-Römer S. Quaternary ammonium compounds in hypersensitivity reactions. FRONTIERS IN TOXICOLOGY 2022; 4:973680. [PMID: 36211198 PMCID: PMC9534575 DOI: 10.3389/ftox.2022.973680] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Quaternary ammonium compounds (QAC) are commonly used disinfectants, antiseptics, preservatives, and detergents due to their antibacterial property and represent the first used biocides before phenolic or nitrogen products. Their common structure consists of one or more quaternary ammonium bound with four lateral substituents. Their amphiphilic structure allows them to intercalate into microorganism surfaces which induces an unstable and porous membrane that explains their antimicrobial activity towards bacteria, fungi, and viruses. QAC are thus found in many areas, such as household products, medicines, hygiene products, cosmetics, agriculture, or industrial products but are also used in medical practice as disinfectants and antiseptics and in health care facilities where they are used for cleaning floors and walls. QAC exposure has already been involved in occupational asthma in healthcare workers or professional cleaners by many authors. They also have been suggested to play a role in contact dermatitis (CD) and urticaria in workers using cosmetics such as hairdressers or healthcare workers, inciting reglementary agencies to make recommendations regarding those products. However, distinguishing the irritant or sensitizing properties of chemicals is complex and as a result, the sensitizing property of QAC is still controverted. Moreover, the precise mechanisms underlying the possible sensitization effect are still under investigation, and to date, only a few studies have documented an immunological mechanism. Besides, QAC have been suggested to be responsible for neuromuscular blocking agents (NMBA) sensitization by cross-reactivity. This hypothesis is supported by a higher prevalence of quaternary ammonium (QA)-specific IgE in the professionally exposed populations, such as hairdressers, cleaners, or healthcare workers, suggesting that the sensitization happens with structurally similar compounds present in the environment. This review summarizes the newest knowledge about QAC and their role in hypersensitivities. After describing the different QAC, their structure and use, the most relevant studies about the effects of QAC on the immune system will be reviewed and discussed.
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Affiliation(s)
- Marine Peyneau
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
- Department « Autoimmunité, Hypersensibilités et Biothérapies », DMU BioGeM, APHP, Hôpital Bichat, Paris, France
- *Correspondence: Marine Peyneau,
| | - Luc de Chaisemartin
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
- Department « Autoimmunité, Hypersensibilités et Biothérapies », DMU BioGeM, APHP, Hôpital Bichat, Paris, France
| | - Nicolas Gigant
- CNRS, BioCIS, Université Paris-Saclay, Châtenay-Malabry, France
| | - Sylvie Chollet-Martin
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
- Department « Autoimmunité, Hypersensibilités et Biothérapies », DMU BioGeM, APHP, Hôpital Bichat, Paris, France
| | - Saadia Kerdine-Römer
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
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Dear K, Palmer A, Nixon R. Contact allergy and allergic contact dermatitis from benzalkonium chloride in a tertiary dermatology center in Melbourne, Australia. Contact Dermatitis 2021; 85:146-153. [PMID: 33656745 DOI: 10.1111/cod.13826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Benzalkonium chloride (BAK) is a quaternary ammonium compound that is used widely as an antiseptic and preservative. It is a strong irritant and considered a weak sensitizer. OBJECTIVE To analyze the temporal trend of BAK sensitization and the demographics of sensitized patients. METHODS We conducted a single-center retrospective study of 7390 patients who were patch tested with BAK between January 1, 2003 and December 31, 2019. RESULTS Of the 7390 patients who were patch tested to BAK, 108 (1.5%) had a positive reaction, with 21 reactions deemed clinically relevant (0.3% of total patch tested) and a further 5 doubtful reactions deemed clinically relevant, resulting in a total of 26 relevant reactions (0.4% of total patch tested). Common sources of exposure were ophthalmic drops (30.8%), topical antiseptic preparations (26.9%), cosmetics (15.4%), disinfectant solutions (11.5%), hand sanitizers (11.5%), and hand washes (7.7%). One fifth of patients with relevant reactions were health care workers. There has been a dramatic increase in the number of positive reactions since 2017, for reasons not totally clear. CONCLUSION Contact allergy (CA) and allergic contact dermatitis (ACD) in response to BAK are now increasing at our center. Awareness of this trend is important, given that the coronavirus disease 2019 (COVID-19) pandemic is likely to further expose people to BAK.
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Affiliation(s)
- Kate Dear
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
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Latheef F, Wilkinson M. Adverse Skin Reactions to Cosmetics and Skin Care Products. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ferguson FJ, Street G, Cunningham L, White IR, McFadden JP, Williams J. Occupational dermatology in the time of the COVID-19 pandemic: a report of experience from London and Manchester, UK. Br J Dermatol 2020; 184:180-182. [PMID: 32790187 PMCID: PMC7436592 DOI: 10.1111/bjd.19482] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/10/2023]
Affiliation(s)
- F J Ferguson
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - G Street
- Contact Dermatitis Investigation Unit, Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK
| | - L Cunningham
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - I R White
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - J P McFadden
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - J Williams
- Contact Dermatitis Investigation Unit, Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK
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Latheef F, Wilkinson M. Adverse Skin Reactions to Cosmetics and Skin Care Products. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_83-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Latheef F, Wilkinson M. Cosmetics and Skin Care Products. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_83-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chu CY, Lee CH, Shih IH, Chen HC, Huang PH, Yang CY, Wang WJ, Chen YJ, Sheu HM, Wang WM, Lee WR, Lo YH, Dai YS, Wang LF, Tsai TF, Yang CH. Taiwanese Dermatological Association consensus for the management of atopic dermatitis. DERMATOL SIN 2015. [DOI: 10.1016/j.dsi.2015.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Rubel D, Thirumoorthy T, Soebaryo RW, Weng SCK, Gabriel TM, Villafuerte LL, Chu CY, Dhar S, Parikh D, Wong LC, Lo KK. Consensus guidelines for the management of atopic dermatitis: an Asia-Pacific perspective. J Dermatol 2013; 40:160-71. [PMID: 23289827 DOI: 10.1111/1346-8138.12065] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/14/2012] [Indexed: 12/15/2022]
Abstract
Atopic dermatitis (AD) is a relatively common disease in patients in the Asia-Pacific region. It presents a particular clinical challenge and requires careful clinical management. The chronic nature of AD characterized by flares, exacerbations and periods of quiescence requires a multipronged approach aimed at reducing itch, inflammation and the appearance of secondary lesions. In addition, varying levels of maintenance therapy may be required to avoid exacerbations. Survey data from the region indicate that there is significant variation across the Asia-Pacific with regard to current treatment practices. The management of AD may also be influenced by differing health-care systems, variable climate, access to medical care and cultural diversity. The current consensus guidelines have been developed to provide up-to-date and concise evidence- and experience-based recommendations directed towards general practitioners and general dermatologists in the Asia-Pacific region on the management of pediatric and adult AD.
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Affiliation(s)
- Diana Rubel
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
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Hann S, Hughes TM, Stone NM. Flexural allergic contact dermatitis to benzalkonium chloride in antiseptic bath oil. Br J Dermatol 2007; 157:795-8. [PMID: 17714561 DOI: 10.1111/j.1365-2133.2007.08134.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Benzalkonium chloride (BAK) is an acknowledged irritant but has also been identified as a cause of allergic contact dermatitis. The antiseptic bath emollient Oilatum Plus (Stiefel, High Wycombe, U.K.) contains a relatively high concentration of 6% BAK. We describe six patients who presented with flexural eczema, particularly involving the anogenital area, who had a history of using Oilatum Plus. Patch testing showed all six to have a type 4 allergy to BAK as well as other allergens. Avoidance of Oilatum Plus led to a resolution of the flexural eczema in each case.
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Affiliation(s)
- S Hann
- Department of Occupational Dermatology, Royal Gwent Hospital, Newport, U.K.
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Moyle M, Moore EJ, Varigos GA. Characteristic adverse skin reactions to antiseptic bath oils. Med J Aust 2007; 186:652-3. [PMID: 17576185 DOI: 10.5694/j.1326-5377.2007.tb01087.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 04/18/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Mignon Moyle
- Dermatology Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Halvarsson K, Lodén M. Increasing quality of life by improving the quality of skin in patients with atopic dermatitis. Int J Cosmet Sci 2007; 29:69-83. [DOI: 10.1111/j.1467-2494.2007.00364.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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ORTAK TURGUT, UYSAL AHMETCAGRI, ALAGOZ MURATSAHIN, ORBAY HAKAN, SENSOZ OMER. Epidermodysplasia Verruciformis. Dermatol Surg 2006. [DOI: 10.1097/00042728-200602000-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lodén M, Buraczewska I, Edlund F. Irritation potential of bath and shower oils before and after use: a double-blind randomized study. Br J Dermatol 2004; 150:1142-7. [PMID: 15214901 DOI: 10.1111/j.0007-0963.2004.05923.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Difficulties in avoiding weak irritants may contribute to chronic contact dermatitis. A large variety of shower and bath oils are claimed to be suitable for use on dry skin because of their mildness and because they deposit a protective oil film on the skin. OBJECTIVES The aim of the present study was to investigate possible differences in the irritation potential of eight shower or bath oils and to investigate whether surfactant residues may form a reservoir of irritant substance on the skin. PATIENTS AND METHODS The study was double-blind and randomized using healthy human volunteers. The inherent capacity of the products to induce irritation was determined using conventional patch test techniques. Detection of potentially irritant residues was done by occlusion of the treated and rinsed skin area, followed by evaluation of the biological response. Instrumental measurements of transepidermal water loss and superficial skin blood flow served as indicators of the injurious effects of the products. RESULTS AND CONCLUSIONS The results showed large differences between the products in irritant potential. Some did not irritate skin more than water, whereas others demonstrated considerably damaging effects. Moreover, the study proved the presence of barrier-impairing residues on the skin after rinsing with water. Thus, instead of protecting the skin, some formulations may induce subclinical injuries and delay skin barrier function recovery with prolonged risk for patients with eczema.
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Affiliation(s)
- M Lodén
- ACO Hud AB, SE-194 26 Upplands Väsby, Sweden.
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Abstract
Siblings aged 7 and 5 years developed extensive truncal and flexural inflammation and desquamation unresponsive to standard eczema therapy. After delays in diagnosis, subsequent history revealed prior use of an antiseptic bath oil in a much stronger concentration than recommended. The case illustrates the severe irritant contact dermatitis that can arise following inadequate dilution of antiseptic bath oils, presumably as a result of skin contact with benzalkonium chloride and triclosan. Features that may direct attention to such irritant dermatitis are flexural predominance with superficial desquamation and rapid improvement after avoidance of exposure to the antiseptic solution.
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Affiliation(s)
- Emma Storer
- Department of Dermatology, The Women's and Children's Hospital, Adelaide, South Australia, Australia
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