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Publications

Published: 5 March 2015

A Topical Issue - Serious Hypersensitivity and Burning Reactions

Prescriber Update 36(1): 2
March 2015

Key Messages

  • Serious hypersensitivity reactions including anaphylaxis have been reported following the use of topical acne products that contain benzoyl peroxide or salicylic acid.
  • There is a risk of chemical skin burns with the use of chlorhexidine solution for skin disinfection in premature neonates.
Topical acne products containing benzoyl peroxide or salicylic acid


Benzoyl peroxide and salicylic acid are used in topical acne products available from pharmacies, supermarkets and other retail stores. These products include gels, creams and face washes.

Local skin irritation reactions such as redness, burning, dryness, itching, peeling, or slight swelling are known to occur particularly with benzoyl peroxide.1 Serious hypersensitivity reactions including anaphylaxis have also been reported following the use of these topical acne products.2

The Centre for Adverse Reactions Monitoring (CARM) has received reports of angioedema, periorbital oedema, bronchospasm and syncope with the use of topical acne products that contain benzoyl peroxide or salicylic acid.

Consumers should be advised to stop using these products and to seek emergency medical attention immediately if they experience throat tightness, difficulty breathing, feeling faint, or swelling of the eyes, face, lips or tongue. These are symptoms of a serious hypersensitivity reaction.

Use of chlorhexidine in premature neonates


Chlorhexidine solution is used as a skin disinfectant prior to invasive procedures in neonates. It is available in both alcohol-based and water-based solutions.

There have been reports internationally of chemical skin burns in premature neonates who were treated with chlorhexidine solution before central venous catheterisation.3 This risk has been associated with both alcohol-based and water-based solutions.

According to these reports and the published literature, the risk appears to be higher in premature neonates, especially those born before 32 weeks of gestation and within the first two weeks of life.

To reduce the risk of chemical skin burns, use the minimum amount of chlorhexidine solution required and do not allow the solution to pool in skin folds or under the patient. Remove any excess solution and any soaked materials from the skin. Monitor patients frequently to ensure that cutaneous side effects are detected and managed at an early stage. 3

There have also been reports of severe allergic reactions including anaphylaxis following chlorhexidine use. Medsafe has previously notified healthcare professionals of this risk (www.medsafe.govt.nz/profs/PUArticles/June2013Chlorhexidine.htm).

References
  1. Galderma Australia Pty Ltd. 2011. Benzac AC Gel Consumer Medicine Information. 4 August 2011. URL: www.medsafe.govt.nz/consumers/cmi/b/benzacACgel.pdf (accessed 7 January 2015).
  2. The Food and Drug Administration. 2014. FDA warns of rare but serious hypersensitivity reactions with certain over-the-counter topical acne products.Drug Safety Communications 25 June 2014. URL: www.fda.gov/Drugs/DrugSafety/ucm400923.htm (accessed 7 January 2015).
  3. Medicines and Healthcare products Regulatory Agency. 2014. Chlorhexidine solutions: risk of chemical burn injury to skin in premature infants. Drug Safety Update June 2014. URL: www.mhra.gov.uk/home/groups/dsu/documents/publication/con428334.pdf (accessed 7 January 2015).
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