key: cord-0733228-36fyp7it
authors: Burden‐Teh, E.; Shinhmar, S.; Bleiker, T.
title: Fragranced hand gels: beware the risk of contact allergy
date: 2021-04-27
journal: Clin Exp Dermatol
DOI: 10.1111/ced.14639
sha: 217c823761b5ef962e7b0a8c6090959384938f9d
doc_id: 733228
cord_uid: 36fyp7it

nan

pompholyx that was either irritant or allergic in origin. We started the patient on a superpotent topical steroid cream (Dermovate â ; GlaxoSmithKline, Brentford, Middlesex, UK) twice daily, white soft paraffin/liquid paraffin 50 : 50, and advised using an antiseptic emollient (Dermol 500 â ; Dermal Laboratories, Hitchin, Hertfordshire, UK) instead of soap for hand-washing. At review 1 week later there was good improvement. Viral and bacterial swabs were both negative.

A detailed contact allergy history was taken and the patient was referred for patch testing. Testing to the standard series showed inconclusive results to some fragrances in the standard series (myroxylon pereirai, fragrance mix 1, fragrance mix 2, linalool and limonene). We repeated the patch testing to fragrance in the standard series and added the fragrance series. The repeat test confirmed allergic contact dermatitis to fragrance with a positive result to myroxylon pereirai, linalool, limonene, sandalwood oil and majantol. The hand gels used by the patient were found to contain linalool and limonene. Following this result, the patient's parents were advised to ensure only fragrance-free hand sanitizer and soaps are used in future.

Developing hand dermatitis, both irritant and allergic, to wet work, soaps and disinfectant scrubs is not new, and is an important cause of occupational disease among healthcare workers. 1 To curb the spread of COVID-19, regular hand-washing and use of alcoholbased hand sanitizers/gels are part of everyday hygiene guidance for the general public, 2 and therefore, the incidence of hand dermatitis is likely to rise. 3, 4 The World Health Organization and the Food and Drugs Administration advises that a minimum alcohol content of 60% is required to inactivate viral particles; however, it is also important to be aware that hand sanitizers/gels may also contain other constituents, including thickeners, humectants (e.g. propylene glycol) and fragrances. 5 We have compiled a table of alcohol-based hand sanitizers/gels and their ingredients, which have recently been independently investigated to confirm their alcohol content or are available in a clinical setting. The ingredients for four sanitizers were not available online. Out of those that listed their ingredients, five out of the seven products include fragrance (Table 1) . We would like to highlight to other dermatologists that contact allergy to fragrance and/or other components in hand sanitizer/gels may present acutely with pompholyx, and to consider testing patients with the standard and fragrance series if this is suspected. 

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