Chlorhexidine is one of the most widely used antiseptics in our environment. Allergic contact dermatitis to chlorhexidine is common in adults, but is quite rare in the pediatric population. Its diagnosis is important because it can mimic other dermatoses common during childhood, and it can also lead to acute immediate hypersensitivity | 541 Pediatric Dermatology BRIEF REPORT undiagnosed. 1 Only 4 cases have been reported of ACD to chlorhexidine in pediatric patients without underlying AD. 3-5 Darrigade et al reported the largest case series of pediatric patients with ACD to chlorhexidine. Epicutaneous patch testing for chlorhexidine digluconate was positive in 7 of 14 patients tested, whereas 8 of them exhibited positivity to benzyl alcohol and positivity to both allergens in 4 cases. 1Our work showcases the role of chlorhexidine as a cause for ACD in the pediatric population, especially, but not exclusively, among patients with AD. It is worth noting that a history of surgery at an early age was identified in one patient suggesting the possibility that sensitization had occurred then. We emphasize the clinical utility of ROAT as a simple initial diagnostic approach during the initial evaluation of a patient presenting with symptoms suggestive of ACD to chlorhexidine. The different commercial formulations of this antiseptic must be taken into account, as some regularly used excipients, such as benzyl alcohol, which can also cause ACD. 1 Furthermore, we must inform parents that chlorhexidine is not only present in antiseptic products but also as a component of cosmetics. 2 Last but not least, it is imperative to rule out immediate hypersensitivity reactions, as even mild cases of ACD can indicate a potential risk of acute hypersensitivity reactions following successive exposures to chlorhexidine. 6

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Chlorpromazine is known to produce both systemic phototoxic and photoallergic reactions. However, it may also cause photoallergic contact dermatitis and, albeit exceptionally, allergic contact dermatitis (ACD). We present a series of photoallergic contact dermatitis and ACD to chlorpromazine diagnosed at a tertiary centre cutaneous allergy unit between 1980 and 2019.

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