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February 2013

Chlorhexidine Gluconate–Impregnated Central Access Catheter Dressings as a Cause of Erosive Contact Dermatitis: A Report of 7 Cases

Author Affiliations

Author Affiliations: Departments of Dermatology (Drs Lauren, Weiser, LeBoeuf, Grossman, Garzon, and Morel) and Pediatrics (Drs Lauren, Biagas, Garzon, and Morel), College of Physicians and Surgeons, Columbia University, New York, New York. Ms Weitz is a medical student at Columbia University School of Medicine.

JAMA Dermatol. 2013;149(2):195-199. doi:10.1001/jamadermatol.2013.903

Background Chlorhexidine gluconate–impregnated dressings have become widely adopted as a means to reduce the risk for catheter-associated bloodstream infections. These dressings release antiseptic under occlusion onto the skin surrounding catheter insertion sites. Although chlorhexidine gluconate is a known cause of contact dermatitis, the phenotypic range of this adverse effect of chlorhexidine gluconate–impregnated dressings in critically ill patients has not been described.

Observations We report 7 cases of erosive irritant contact dermatitis due to chlorhexidine gluconate–impregnated transparent dressings. Six of these patients were children (age range, 4 months to 2 years); the adult was a critically ill 62-year-old man. Four patients were immunosuppressed after solid organ transplant and all were receiving blood pressure support at the time of this reaction. The insertion sites of femoral catheters were involved in all but 1 case; 3 catheter sites were involved in the adult patient. Results of extensive infectious workups were negative. All lesions resolved with discontinuation of the chlorhexidine gluconate–containing dressings, local wound care, and alternative antimicrobial dressings.

Conclusions Erosive contact dermatitis is an underrecognized complication of chlorhexidine gluconate–impregnated dressings. Health care providers should be aware of this risk, particularly in young children and immunosuppressed and/or critically ill patients, who may be more susceptible to the irritant effects of these dressings. When the dressings are used, patients should be monitored closely for skin breakdown.