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Benzalkonium Chloride: An Irritant and Sensitizer

Isaac, Jahdonna MSc*; Scheinman, Pamela L. MD

doi: 10.1097/DER.0000000000000316

Background Benzalkonium chloride (BAK) is a known irritant, and potentially cross-reacting quaternary ammonium compounds are commonly used as preservatives in personal care products.

Objective The aim of the study was to review positive reactions to BAK in 615 patients patch tested for suspected allergic contact dermatitis.

Methods A retrospective chart review was performed in 615 patients patch tested from June 2015 to October 2016. All patients were tested to a Modified American Contact Dermatitis Society core series of 70 allergens including BAK (0.1% aqueous). Initial readings were performed at 48 hours with final readings performed between 72 and 168 hours. Results were graded as + (weak: papules and erythema), ++ (strong: papules and edema or vesicles), or +++ (extreme: coalescing vesicles, spreading or bullous reactions).

Results A total of 141 men (23%) and 475 women (77%) were tested (mean age, 49 years). Four hundred thirty-two (70%) were atopic. Of 615 patients, 198 (32%) tested positive to BAK, and 64 (10%) had ++ or +++ reactions at their final reading. On average, BAK-positive patients were using at least 1 product containing BAK or possible cross-reactors.

Conclusions Widespread exposure to irritants in dermatitis patients can predispose to sensitization. Products containing BAK or potential cross-reactors should be used carefully in patients with compromised skin barriers.

From the *Tufts University School of Medicine and †Department of Dermatology, Brigham and Women's Hospital, Boston, MA.

Address reprint requests to Jahdonna Isaac, MSc, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111. E-mail:

This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.

The authors have no funding or conflicts of interest to declare.

© 2017 American Contact Dermatitis Society
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