Cutaneous hypersensitivity to chlorhexidine following facial fat grafting: a delayed intradermal response

Abstract Chlorhexidine (CHD) is commonly included in surgical antiseptics and can be associated with adverse reactions ranging from contact dermatitis to anaphylaxis. A 32-year-old female presented to the OR for facial fat grafting. Surgical sites were prepped with CHD gluconate or topical iodine. D...

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Bibliographic Details
Published inJournal of surgical case reports Vol. 2024; no. 7; p. rjae103
Main Authors Anderson, Brady J, Tanenbaum, Zachary G, Michael, Alexander, Owen, Scott R
Format Journal Article
LanguageEnglish
Published England Oxford University Press 01.07.2024
Subjects
Case Report
allergy
otolaryngology
dermatology
chlorhexidine
delayed hypersensitivity
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Summary:Abstract Chlorhexidine (CHD) is commonly included in surgical antiseptics and can be associated with adverse reactions ranging from contact dermatitis to anaphylaxis. A 32-year-old female presented to the OR for facial fat grafting. Surgical sites were prepped with CHD gluconate or topical iodine. Donor and recipient sites were infiltrated with local anesthetic injection prior to fat harvest and facial injection. Eleven days later, she presented with new painful, pruritic rash over donor sites where CHD had been applied prior to local anesthetic infiltration. Treatment with topical clobetasol and prednisone taper resulted in complete symptom resolution. This patient’s response most likely represented a delayed type IV, T-cell mediated hypersensitivity. CHD is a known trigger of allergic reactions. Infiltration of local anesthetic may introduce skin prep into the subcutaneous tissue akin to intradermal testing. For those with delayed cutaneous reactions, steroids may provide symptomatic relief.
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This article was presented as a poster at COSM AAFPRS 2024.
ISSN:2042-8812
2042-8812
DOI:10.1093/jscr/rjae103