Recomiendan no utilizar clorhexidina en la cara, en particular cerca de los ojos!

Chlorhexidine Is Contraindicated as a Facial Antiseptic

TAKE-HOME MESSAGE

• A review of chlorhexidine antiseptic solution as a surgical scrub on the face and scalp found 11 sentinel cases of chlorhexidine-related keratitis, many requiring corneal transplant, reported in the late 1980s. Chlorhexidine that enters the middle ear through a perforated tympanic membrane can damage the middle ear, leading to permanent sensorineural deafness. Chlorhexidine is contraindicated on the face and scalp. Eye protection is recommended in healthcare workers due to the splash risk of chlorhexidine.

• Chlorhexidine antiseptic solution is highly effective as a surgical scrub and is useful in areas where the risks do not outweigh the benefits. Povidone–iodine 10% is a safe alternative to chlorhexidine on the face and scalp.

  – Sarah Churton, MD

 Dermatology

Written by

 

 

Bo Huang MD, PhD

This article documents a well-known and rather severe complication of using facial antiseptic preparations such as chlorhexidine. Extensive clinical and laboratory evidence has shown that corneal exposure to chlorhexidine, even at a concentration as low as 0.02%, has led to ulceration and loss of corneal epithelium and Bowman's membrane, massive loss of keratocytes with apparent apoptosis, and irreversible loss of the corneal endothelial cells. Many of these chlorhexidine injuries to the cornea have led to severe visual loss and required corneal transplant with poor visual outcomes. Dermatologists are therefore advised to use alternative skin preparations on facial skin and around the orbit area. As indicated in this article, 10% povidone–iodine solution (alcohol- and detergent-free) is routinely used to prep for eye surgeries and is safe to use on the face and scalp.

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Abstract

BACKGROUND

Effective antiseptic to reduce surgical site infections is a cornerstone of modern surgery. Chlorhexidine gluconate-based antiseptics are among the most effective of these products. Unfortunately, chlorhexidine solutions are toxic to the cornea and middle ear, and they pose a splash risk to both the patient and health care personnel.

OBJECTIVE

To examine the clinical evidence that led to the disavowal of chlorhexidine antiseptic solution for use on the face and head.

METHODS AND MATERIALS

Reference searches were performed using PubMed, Embase, and LexisNexis databases without restriction to the date of publication, language, or study setting.

RESULTS

The literature revealed 11 sentinel cases of severe chlorhexidine-related keratitis in the late 1980s. These cases are reviewed together with data on ototoxicity and alternative products to understand why chlorhexidine solution should not be used on the face and scalp.

CONCLUSION

Chlorhexidine antiseptic solutions are highly effective. However, they pose a risk to the middle ear and have the potential to irreversibly damage the cornea with a minimal splash exposure. Povidone-iodine is a safe and effective alternative.

Additional Info

• Article Citation

Dermatologic Surgery

Chlorhexidine Keratitis: Safety of Chlorhexidine as a Facial Antiseptic

Dermatol Surg 2016 Jul 04;[EPub Ahead of Print], KD Steinsapir, JA Woodward