key: cord-1039435-lpssafaz authors: Sinha, Surabhi; Sardana, Kabir title: Contact leukoderma following irritant contact dermatitis to an isopropanol‐based hand rub: A consequence of rigorous hand hygiene date: 2020-12-01 journal: Contact Dermatitis DOI: 10.1111/cod.13743 sha: aa009d359db5c8dddd0a9c051bdc9e9f6e63928a doc_id: 1039435 cord_uid: lpssafaz nan isopropanol Contact leukoderma is usually due to direct melanocyte damage by aliphatic or aromatic phenols and catechols. Rarely, it can follow irritant or allergic contact dermatitis. The use of alcohol-based hand rubs (ABHRs) has become prevalent in the general population since the start of the COVID-19 pandemic. While ABHRs are usually well-tolerated, they may incite irritant contact dermatitis (ICD) in conjunction with other irritants such as detergents and frequent hand washing. Continued use may result in permanent sequelae, such as contact leukoderma, as in our case, which has important consequences on skin of colour. A 40-year-old male office worker presented with confluent depigmentation and a few confetti macules on the interdigital web spaces of both hands which had appeared one week ago (Figure 1) . No other anatomical sites were involved. He had been regularly using a 70% (v/v) isopropanol CAS no. 67-63-0) hand rub for 2 months during the COVID-19 pandemic. He had noticed itching and mild erythema over the web spaces after a few days of using the hand rub, but continued its F I G U R E 1 Clinical photograph showing confluent depigmentation with few confetti macules (black arrows) on all interdigital web spaces of (A) the right and (B) left hands. Fine scaling can be seen in the web spaces as well application. He also reported frequent handwashing, sometimes with hot water, and doing wet household work without the application of moisturizers. No other potential irritants or allergens could be discerned from the history. A semi-open test was performed (isopropanol being a potential irritant) with the undiluted sanitizer "as is" and in 50% dilution and a closed test was done with isopropanol 10% aq. along with the Indian baseline series. 1 The tests were read as per International Contact Dermatitis Research Group grading at day (D)2 and D4 (Table S1) Contact leukoderma following repeated use of certain chemicals, most frequently phenolic/catecholic derivatives, is a consequence of selective destruction of melanocytes, pigment transfer block, or decreased melanogenesis. 3 Rarely, some chemicals may incite irritant or allergic contact dermatitis in certain at-risk individuals resulting in pigment loss. 4 Ghosh and Mukhopadhyay reported the largest study of 864 patients with chemical leukoderma in which only 5% had evidence of contact dermatitis at the site of depigmentation. 5 Most cases followed topical exposures, presumably to higher concentration of the offending chemical delivered to cutaneous melanocytes. 3 Hand dermatitis is often an occupational dermatosis for healthcare workers and is more frequently irritant rather than allergic contact dermatitis. 6 ABHRs are recommended for hand hygiene among healthcare workers but, since the the COVID-19 pandemic, are now widely used also by the general population. Although subjective irritation is common, alcohol is not a strong irritant, and cases of irritant or allergic dermatitis are rare. 7 However, multiple irritants used concurrently have a synergistic effect due to the alteration of skin permeability that would not occurr with one agent alone (the "crossover phenomenon"). [8] [9] [10] Anionic detergents and repeated contact with water, especially hot water, are known irritants and probably augmented the propensity of isopropanol to cause ICD in the interdigital spaces in our case and contact leukoderma mirrored the distribution. 11 The presence of confetti macules, earlier thought to be characteristic of chemical-leukoderma, is now considered to be a sign of highly active vitiligo, but may signify rapid progression in contact leukoderma. 3 Contact leukoderma following ICD is very rarely reported; however, this could also be due to the difficulty in diagnosing ICD. 12 Patch testing with a patient's own materials handled at work Chemical leukoderma: what's new on etiopathological and clinical aspects? Chemical-induced vitiligo Pigmented contact dermatitis and chemical depigmentation Chemical leucoderma: a clinicoaetiological study of 864 cases in the perspective of a developing country Importance of irritant contact dermatitis in occupational skin disease How irritant is alcohol? Allergic or irritant contact dermatitis after patch testing with alcohol -that is the point Irritant contact dermatitis How irritant are n-propanol and isopropanol? A systematic review Occupational hand dermatitis in hospital environments Contact depigmentation following irritant contact dermatitis to chloroxylenol (Dettol) The authors declare no conflicts of interest. Surabha Sinha: Conceptualization; data curation; formal analysis; writing-original draft; writing-review and editing. kabir sardana: Conceptualization; writing-original draft; writing-review and editing. https://orcid.org/0000-0002-0423-7588 Additional supporting information may be found online in the Supporting Information section at the end of this article.