The COVID‐19 pandemic has led to increased hygiene and disinfecting practices throughout industries, homes, and healthcare settings. Hazardous exposure to disinfectants and cleaning agents, seen by US poison centres, has increased by almost 25% since the pandemic began. 1
CASE REPORT
A 67‐year‐old nurse presented to our tertiary referral occupational dermatology clinic 7 weeks following the onset of a painful, pruritic, vesicular eruption with marked oedema of her hands and forearms (Figure 1). The eruption began within 2 hours of direct dermal exposure to Clinell Sporicidal Wipes (GAMA Healthcare Ltd, London, UK), which she used to clean a metal pole, without the use of protective gloves. The eruption worsened in severity over 24 hours. There was no atopy or previous skin disease. She was initially commenced on oral prednisolone, 25 mg once daily, for 2 weeks, alongside topical methylprednisolone aceponate 0.1%, with improvement. However, on weaning of prednisolone, her symptoms relapsed. When examined, she had a vesicular eruption of her palms as well as the dorsal aspect of her hands, with more marked fissuring on the left hand.
FIGURE 1.
Bilateral erythema with vesicles papules and oedema following direct dermal exposure to peracetic acid in Clinell Sporicidal wipes
She was extensively patch tested to the Australian Baseline Series, rubber chemicals, cosmetics, antiseptics, and to her own samples. Positive reactions to paraphenylenediamine, cobalt, limonene, linalool, textile mix, and benzoic acid were seen, however none was thought relevant to her condition. No other causative exposures or triggers could be elicited. A microbiological swab showed normal skin flora. Histology showed moderate spongiosis with vesiculation, compatible with irritant contact dermatitis (ICD).
She was commenced on mycophenolate (500 mg mane, 1000 mg nocte) with a weaning dosage of prednisolone. She underwent narrowband ultraviolet light therapy for 2 months, but this aggravated the condition and was ceased. After 4 months of treatment, the eruption had resolved and there was just residual erythema. A diagnosis of severe ICD was made, with post‐traumatic eczema secondary to direct skin contact with Clinell Sporicidal Wipes.
DISCUSSION
Clinell Sporicidal Wipes are dry, single surface, disinfectant wipes that generate peracetic acid (C2H4O3) and hydrogen peroxide from sodium percarbonate and tetraacetylethylenediamine once wet. 2 Designed for disinfecting surfaces of non‐invasive medical equipment, they have powerful sporicidal activity against a range of fungal, bacterial, and viral pathogens including C.difficile spores and coronaviruses. 3 , 4 Peracetic acid can be corrosive and is already well known to be a strong skin, eye, and mucous membrane irritant in humans, but not a sensitizer. 5 It is also toxic when ingested or inhaled. 6 When peracetic acid comes into contact with the skin, it can cause erythema, pain, blisters, and burns. 6
Disinfectant wipes have an important role in healthcare settings, and their use should not be restricted. However, this case report highlights the importance of following the manufacturer's guidance and using appropriate personal protective equipment when handling these potentially harmful disinfectant wipes. In our patient's case, her severe ICD evolved into post‐traumatic eczema, likely to be a result of significant cutaneous trauma caused by the corrosive and irritating nature of peracetic acid. 6 Systemic immunosuppression in addition to a topical corticosteroid was required to adequately manage our patient's condition. The long, protracted healing course had a significant impact on the patient's financial situation and her quality of life.
As hygiene practices evolve during the COVID‐19 pandemic, dermatologists are likely to see a rise in ICD as well as other skin conditions. Healthcare workers must remain mindful of the implications of handling corrosive and irritating substances without the use of appropriate skin protection.
CONFLICT OF INTERESTS
The authors declare no conflict of interests.
AUTHOR CONTRIBUTIONS
Kate Dear: Conceptualization; writing‐original draft; writing‐review & editing. Jennifer Nguyen: Writing‐review & editing. rosemary nixon: Supervision.
Dear K, Nguyen J, Nixon R. Disinfectant cleaning wipes can burn! The hazards of cleaning without adequate skin protection. Contact Dermatitis. 2021;85:109–110. 10.1111/cod.13800
REFERENCES
- 1. Chang A, Schnall A, Law R. Cleaning and disinfectant chemical exposures and temporal associations with COVID‐19 ‐ National Poison Data System, United States, January 1, 2020‐March 31, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(16):496‐498. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Gama Healthcare . Safety Data Sheet Clinell Sporicidal Wipes 2019. https://gama.getbynder.com/m/16be8532bf8221b8/original/Sporicidal-Wipes-SDS-Australia.pdf. Accessed December 24, 2020
- 3. Lukula S. Virucidal Quantitative Suspension Test for Chemical Disinfectants and Antiseptics Used in the Medical Area: MERS‐Coronavirus (MERS‐CoV) 2020. https://gama.getbynder.com/m/626f1fe9d80dc1f8/original/Coronavirus-efficacy-report-Clinell-Universal-and-Clinell-Sporicidal.pdf. Accessed December 24, 2020
- 4. Rutala W, Weber D. Guideline for Disinfection and Sterilization in Healthcare Facilities 2019. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/. Accessed December 24, 2020
- 5. You Y, Bai Z, Yan L. Peracetic acid exposure assessment during outbreak of SARS in Tianjin, China. Epidemiology. 2006;17(6):S217‐S218. [Google Scholar]
- 6. Lewis RJ, Larrañaga MD, Lewis RA. Peracetic Acid. In: Hawley's Condensed Chemical Dictionary. 16th ed. John Wiley & Sons; 2016;1045. [Google Scholar]