Blake Stephanie C, O'Dea Stephanie, Murrell Dedee F
University of New South Wales, Faculty of Medicine, Sydney, Australia.
Department of Dermatology, St. George Hospital, Sydney, Australia.
Int J Womens Dermatol. 2019 May 2;5(4):269-270. doi: 10.1016/j.ijwd.2019.04.023. eCollection 2019 Sep.
Chlorhexidine is a commonly used disinfectant throughout Australian hospitals. It is responsible for a number of iatrogenic complications. We describe a case of 27-yearold female who sustained a severe, blistering reaction at the site of chlorhexidine application, associated with significant pain. This reaction was initially managed with wet dressings and topical corticosteroids, but there was no improvement in pain or rash. Management was then changed to silver-coated polyethylene mesh dressings, with resolution of pain and rash after four days. No debridement was required, and area healed without scarring. Chlorhexidine is associated with a number of hypersensitivity reactions, ranging from anaphylaxis to irritant and allergic contact dermatitis. However, physical or chemical burns remain an underrecognised complication of chlorhexidine use. Intra-operatively, there is a risk of physical burn secondary to pooled chlorhexidine catching alight after cautery is applied, and this has been described in ten cases in the literature. Chemical burns from exposure to chlorhexidine can occur in neonatal patients, and in adult patients where a tourniquet has been used. It can be difficult to differentiate between chlorhexidine hypersentivity and burns clinically. When evaluating these patients, a differential diagnosis of burns should be considered, particularly if patients are not responsive to first line therapies. Surgeons and anaesthetists should consider the risk of burns when in theatres, and prevent any pooling of chlorhexidine - particularly when cautery is being used. Using chlorhexidine without alcohol, and allowing at least three minutes for the solution to dry can further reduce the risk of surgical fires.
洗必泰是澳大利亚各医院常用的消毒剂。它会引发一些医源性并发症。我们描述了一例27岁女性病例，该患者在洗必泰涂抹部位出现严重的水疱反应，并伴有剧痛。这种反应最初采用湿敷和外用皮质类固醇进行处理，但疼痛和皮疹均无改善。随后治疗改为使用镀银聚乙烯网状敷料，四天后疼痛和皮疹消退。无需清创，该部位愈合后无疤痕。洗必泰会引发多种过敏反应，从过敏反应到刺激性和过敏性接触性皮炎不等。然而，物理或化学烧伤仍然是洗必泰使用中未得到充分认识的并发症。在手术过程中，存在因洗必泰积聚在烧灼后着火而导致物理烧伤的风险，文献中已描述了十例此类病例。新生儿患者以及使用止血带的成年患者可能会因接触洗必泰而发生化学烧伤。临床上很难区分洗必泰过敏和烧伤。在评估这些患者时，应考虑烧伤的鉴别诊断，尤其是当患者对一线治疗无反应时。外科医生和麻醉师在手术室时应考虑烧伤风险，并防止洗必泰积聚——尤其是在使用烧灼术时。使用不含酒精的洗必泰，并让溶液至少干燥三分钟可进一步降低手术火灾的风险。
