The most common reaction associated with the frequent and repeated use of hand-hygiene products is irritant contact dermatitis (ICD). ICD is a non-immunologically mediated dermatitis characterized by dryness, itchiness, or burning; the skin may feel “rough;” and appear erythematous, scaly, or fissured. These signs and symptoms of ICD are similar to those associated with allergic contact dermatitis (ACD), which can be ruled out by allergy testing.
Detergents damage skin by (1) denuding the stratum corneum, (2) depleting or reorganizing intracellular lipid moieties, (3) decreasing corneocyte cohesion, and (4) decreasing the water-binding capacity of the stratum corneum.21 Other factors that contribute to ICD include using hot water, physically stripping the stratum corneum while scrubbing, quality of paper towels used, shear forces associated with wearing and removing gloves, and low relative humidity (winter months).
ICD may also be caused by the antimicrobial agent or by other ingredients in a product. ICD is most commonly reported with iodophors. Following an exhaustive review of available data, the CDC concluded that alcohol-based hand rubs are the safest antiseptics available and ethanol is usually less irritating than isopropanol.16 However, washing hands after each use of an alcohol-based hand rub may contribute to ICD and is recommended only after 5 to 10 applications.