key: cord-0862912-ue7v7i49 authors: Blomberg, Maria; Jørgensen, Caroline C. L.; Bregnhøj, Anne; Ahrensbøll‐Friis, Ulrik; Zachariae, Claus; Sommerlund, Mette; Johansen, Jeanne D. title: Occupational allergic contact dermatitis caused by tetrahydroxypropyl ethylenediamine in hand disinfectants date: 2022-04-05 journal: Contact Dermatitis DOI: 10.1111/cod.14115 sha: c61dde99ae9e183744421c4546b35e4747a3cad8 doc_id: 862912 cord_uid: ue7v7i49 nan A 54-year-old man with a history of atopic dermatitis and mild inter- A 40-year-old healthcare worker with a history of atopic dermatitis and hand eczema presented with worsening of hand eczema during the COVID-19 pandemic and improvement during periods of work leave. During a workday, she was exposed to wet work and used hand disinfectants up to 200 times. She experienced aggravation related to use of hand disinfectants. Patch testing was performed with the European Baseline Series. Personal products and three available hand disinfectants were tested "as is." Testing was performed like in Case 1. Positive reactions were F I G U R E 1 Positive Repeated Open Application Test with the Plum disinfection gel showing erythema in the cubital fossa after 3 days found to Ceduren ethanol gel (+ on days 3 and 7) and Quick disinfection gel (+ on day 7). Test with the presently used Plum hand disinfection liquid was negative. A recently used Plum hand disinfection gel declared THPE, but was not available for testing. THPE is an ingredient in the other two hand disinfectants used (Ceduren and Quick) according to the products labels. In one of the products, THPE is named by its synonym ethylenedinitrillotetrapropan-2-ol. Patch testing with THPE showed a dose-response reaction; follicular reaction to THPE 0.01%, and a positive reaction to 0.1% (+ on day 3) and 1% (+ on day 3; Figure 2 ). In conclusion, the patient had occupational allergic contact dermatitis to THPE contained in several hand disinfection products used in the workplace. The eczema improved after cessation of use of THPE-containing disinfectants. Both patients presented here were allergic to THPE in hand disinfection gels. THPE is used as a neutralizer to achieve the gel-like consistency. Only a few cases of THPE allergy have previously been reported, but most of them related to exposure to cosmetics and sunscreens. 2 Antelmi et al. 3 reported a case of occupational allergic contact dermatitis, also to Plum disinfection gel. In this case, the patient used a gel from an old batch, because batches produced after 2016 have been THPE free in Sweden. In Denmark, however, THPE is still included in the gel, but according to the producer, they are considering replacing it with another neutralizing agent. Both our patients had onset of symptoms during the COVID-19 pandemic. During this period the use of hand sanitizers exploded, potentially resulting in THPE allergy becoming more frequent. However, because many centres do not test with THPE by default, allergic contact dermatitis due to hand disinfectants could have been overlooked and the symptoms misinterpreted as irritant contact dermatitis. Allergic contact dermatitis due to hand disinfectants should be considered not only with hand eczema, but also in case of facial rashes, as touching of the face probably occurs unconsciously several times daily. European Society of Contact Dermatitis guideline for diagnostic patch testing -recommendations on best practice Allergic contact dermatitis caused by tetrahydroxypropyl ethylenediamine in cosmetic products Occupational allergic contact dermatitis to tetrahydroxypropyl ethylenediamine in hand sanitizers The authors thank photographer Jørn AJ Petersen for the photographic work. No funding or sponsorship was received for this case study. The authors have no conflicts of interest to declare. https://orcid.org/0000-0002-0993-9570Ulrik Ahrensbøll-Friis https://orcid.org/0000-0003-4181-0926Jeanne D. Johansen https://orcid.org/0000-0002-3537-8463