Journal Scan / Case Study · April 28, 2020

Occupational Allergic Contact Dermatitis to Tetrahydroxypropyl Ethylenediamine in Hand Sanitizers

Contact Dermatitis

TAKE-HOME MESSAGE

• The authors report the case of a woman with chronic dermatitis mainly on her hands who underwent a patch test. She was found to be allergic to tetrahydroxypropyl ethylenediamine (THPE), among other pertinent positives. Her dermatitis persisted despite removing known allergens from all her personal care products. The authors subsequently discovered that the hand sanitizer she was required to use at work contained THPE as reported on the safety data sheet. Her dermatitis resolved when she began using a hand sanitizer free from THPE.

• As encouragement of hand hygiene has increased significantly during the COVID-19 pandemic, allergic contact dermatitis to ingredients of soaps and hand sanitizers may become more common, and dermatologists should be aware of all potential allergens.

– Caitlyn T. Reed, MD

Written by

 

 

Christen Maria Mowad MD

Tetrahydroxypropyl ethylenediamine (THPE) is an ingredient used as a chelating agent; it is found in cosmetics, sunscreens, anti-aging products, moisturizers, and several other personal care products. It has infrequently been the cause of allergic contact dermatitis (ACD). This article highlights several key points when performing patch testing. This patient with atopic dermatitis had been previously patch tested and found to have allergens to fragrance, which upon avoidance did not result in clearance of her hand dermatitis. The hand dermatitis was attributed to her atopic dermatitis. However, the rash continued to flare most notably while at work. Given the exacerbation with work, a site visit to her workplace was conducted. Upon review of her contacts there, THPE was found in several products, including hand sanitizers. She was patch tested again and was positive to THPE. This chemical was not found in her personal care products, but was in her workplace exposures. Avoidance of the hand sanitizer resulted in clearance of her dermatitis.

This article highlights several key aspects of the patch testing process. First, atopic dermatitis and ACD can coexist in the same person, and, when dermatitis does not resolve, patch testing should be considered in order to identify any contributing allergens exacerbating underlying atopic disease. It also emphasizes the importance of determining factors that trigger or mitigate the dermatitis in order to search for and test to potential causative allergens. In this case, the workplace visit was instrumental in identifying the exposure site of the causative allergen, and a workplace visit should be considered when evaluating potential occupational contact dermatitis. Lastly, the importance of revisiting patch testing when the history points to ACD and prior patch testing was not helpful is also instructive. Sometimes repeat patch testing can identify a new relevant allergen and result in resolution of the dermatitis.

Abstract

Tetrahydroxypropyl ethylenediamine (INCI), CAS no 102-60-3, is an ingredient in cosmetic products listed in the COSING database as a chelating agent. Contact allergy has previously been described in patients after use of cosmetics and sunscreens (1, 2).

Contact Dermatitis

Occupational Allergic Contact Dermatitis to Tetrahydroxypropyl Ethylenediamine in Hand Sanitizers

Contact Derm 2020 Apr 13;[EPub Ahead of Print], A Antelmi, K Hopkins, C Svedman, J Dahlin