10.5826/dpc.1202a61
text/xml
2160-9381
1649
en
Pietro Rubegni
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
hand sanitizer gels
Sanitizing Hand Gels: A Potential Source of Burn in the COVID era
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-05-02
2021-01-28
2022-05-02
2022-05-24
e2022061
Dermatol Pract Concept
Pietro Rubegni
2022/05/02
10.5826/dpc.1202a61
e2022061
Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
2160-9381
hand sanitizer gels
en
e2022061
Cristaudo A, Pigliacelli F, Pacifico A, Damiani G, Iacovelli P, Morrone A. Teledermatology and hygiene practices during the COVID-19 pandemic. Contact Dermatitis. 2020;83(6):536. DOI: 10.1111/cod.13683. PMID: 32754901. PMCID: PMC7436540.
Sanitizing Hand Gels: A Potential Source of Burn in the COVID era
https://dpcj.org/index.php/dpc/article/download/1649/1593
     Sanitizing Hand Gels: a Potential Source of Burn
                     in the Covid-era
               Francesco Bruzziches1, Davide Cosetti1, Linda Tognetti1, Pietro Rubegni1


1 Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy



Key words: burn, hand sanitizing gel, SARS-CoV-2, skin allografts.
Citation: Bruzziches F, Cosetti D, Tognetti L, Rubegni P. Sanitizing hand gels: a potential source of burn in the covid-era.
Dermatol Pract Concept. 2022;12(2):e2022061. DOI: https://doi.org/10.5826/dpc.1202a61
Accepted: May 6, 2021; Published: April 2022
Copyright: ©2022 Bruzziches et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Francesco Bruzziches, MD, Department of Medical, Surgical and Neurological Science - Dermatology Section,
University of Siena. S. Maria alle Scotte Hospital, Viale Bracci 16, 53100 Siena, Italy. E-mail: francescobruzziches@hotmail.it




Introduction                                                              occurred when the patient lightened a cigarette just after
                                                                          having performed hand hygiene with a commercially avail-
The SARS-CoV-2 pandemic has brought new challenges to                     able hand sanitizing gel. The patient noticed a blue flame
the world. To limit virus spread, effective hand hygiene is               over the site of gel application and was able to extinguish it
crucial. WHO’s recently recommended healthcare workers                    by rapidly immerging both hands into cold water. The burn
to perform hand hygiene at 5 crucial moments (before touch-               was managed orally with amoxicillin-clavulanate for 1 week
ing a patient, before aseptic procedures, after body fluid                and oral analgesics. Patches of cryopreserved skin allografts
exposure, after touching a patient or surroundings), and                  were applied on the thenar eminence grade 2 burned areas
generally before putting on/after removal of positive protec-             for 7 days, followed by hyaluronic acid gauzes for 7 days,
tive equipment, before food preparation and eating and after              and hyaluronic acid cream for further 7 days.
using the toilet.                                                             Complete healing with moderate post-inflammatory
                                                                          dyspigmentation was observed after 21 days (Figure 2).
                                                                          The sanitizing hand gel was composed of: denatured alco-
Case Presentation
                                                                          hol, triethanolamine, benzyl salicylate glycerin, carbomer,
An otherwise healthy 43-year-old woman came to our der-                   o-phenylphenol, parfum, aqua.
matological emergency room with a burn injury in both
hands, first treated with topical antibiotics dressing for
                                                                          Discussion
48 hours.
    Clinical examination (Figure 1) revealed second and                   Some concerns have been previously raised about the flam-
first degree burns involving both palms, volar surface of                 mability characteristics of hand sanitizers gels [1]. Indeed,
the wrists and the back of her right hand (ie 2% of TBSA).                ­alcohol-based hand sanitizers should contain between 60%
Clinically, the injury was mid-dermal in depth. The incident              and 80% of alcohol (usually ethanol or methanol) to be



Research Letter | Dermatol Pract Concept. 2022;12(2):e2022061                                                                         1
Figure 1. Clinical appearance of the patient at presentation time, 48 hours after flame burn injury due to cigarette ignition after application
of hand sanitizing gel. (A) Second degree burns on both palms and volar surface of the fingers and wrists. (B) first degree burn of the dorsum
of the right hand and dorsal surface of the fingers of the left hand. (C) Hand sanitizing gel.




Figure 2. (A) Treatment cryopreserved skin graft for 7 days followed by hyaluron gauze for 7 days. (B) Clinical appearance after 21 days at
volar hand surfaces. (C) Clinical appearance after 21 days at dorsal hand surfaces.



effective: these alcohols can easily ignite and tend to burn rel-        healthcare workers, non-healthcare workers and the general
atively coldly. Moreover, the vapor produced on the hands                public are usually not aware, or not used to wait until the
after gel application is flammable [2]. From March 2020, ev-             product as completely dried on the skin surface in daily life.
eryone has started using hand sanitizing gel in daily life, either       People should now be informed on the flammability danger
for the recommendations and for their large availability at the          and should be aware of the necessity to wait few minutes to
entrances not only in hospitals, healthcare institutions and             respect adequate time before getting close to ignition sources
pharmacies, but also in every public shop and working place.             (eg cooking) or touching metal surfaces.
This widespread use has caused an increase in irritant/allergic
contact dermatitis cases, either relapsed or newly developed,
and generally a worsening of atopic eczema and dryness.
                                                                         References
                                                                          1. Tognetti L, De Piano E, Perotti R, et al.. Clinical Applica-
                                                                             tions of Skin Bank Bioproducts. In Technology in Prac-
Conclusions                                                                  tical Dermatology. 2020:443-449. Springer, Cham. DOI:
                                                                             10.1007/978-3-030-45351-0_42
In the Covid era, the danger related to the flammable na-
                                                                          2. Cristaudo A, Pigliacelli F, Pacifico A, Damiani G, Iacovelli P,
ture of hand sanitizing gels has yet not been stressed, and                  Morrone A. Teledermatology and hygiene practices during the
the occurrence of burns after cigarette lightening follow-                   COVID-19 pandemic. Contact Dermatitis. 2020;83(6):536. DOI:
ing sanitizing gel application never reported. Nevertheless,                 10.1111/cod.13683. PMID: 32754901. PMCID: PMC7436540.




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