Hexachlorophene Used as a Surgical Scrub Discontinued

Hexachlorophene was previously a common ingredient of many over the counter products including soaps (Dial Soap), toothpaste (Ipana), cosmetics (Watkins Cologne for Men), and antibacterial skin cleansers (phisoderm and phisohex). The effect of the active ingredient, hexachlorophene, on brains of young children that resulted in 39 deaths in France and 15 deaths in the United States in 1972 lead to the discontinuation of the product.

Hexachlorophene Uses:

It was previously used as a surgical scrub and as a bacteriostatic skin cleanser.
It was used to control an outbreak of gram-positive infection when other procedures were unsuccessful.

Dose in adults:

All products containing the drug have been discontinued for more than a year because of the serious and sometimes fatal side effects.
It was used as a 5 ml solution applied to wet hands and arms followed by rubbing it over the skin for a few minutes.

Dose in Children:

All the products that contain the active ingredient have been discontinued.
It should be strictly avoided in children because it may cause serious brain injury and death.

Pregnancy Risk Factor X

Pregnancies should be avoided and vaginal tampons, packs, or application over mucus membranes should not contain the drug.
When applied topically, it is absorbed systemically and can cause serious side effects.
Systemic absorption has been observed in gynecological and obstetric procedures.

Use during breastfeeding:

It is unknown if the drug will be excreted into breastmilk.
This drug is no longer available and should not be used during breastfeeding.

Side effects of Hexachlorophene (Dermisan):

Local application-site related side effects:

Skin irritation
itching
hives
redness

CNS side effects:

Irritability
confusion
jitteriness
drowsiness
seizures

Contraindication to Hexachlorophene (Dermisan):

Allergy reactions to halogenated Phenol derivatives and the drug itself
Do not apply to skin that is already damaged or burned.
After applying the scrub, do not apply occlusive dressings, lotions, or wetpacks to your skin.
Avoid contact with mucous membranes
Use it as a vaginal wrap or tampon.
It should not be used for routine bathing.

Warnings and precautions

Cerebral irritability:
- Patients who experience central side effects, such as irritability or agitation, should not take it.
- confusion after applying the scrub.

Hexachlorophene: Drug Interaction

Risk Factor C (Monitor therapy)
BCG Vaccine (Immunization)	Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization).
Risk Factor D (Consider therapy modification)
Sodium Picosulfate	Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic.
Risk Factor X (Avoid combination)
BCG (Intravesical):	Antibiotics may diminish the therapeutic effect of BCG (Intravesical).

Monitoring Parameters:

None mentioned. Observe for allergic reactions such as itching, urticaria, and redness after application.

How to apply Hexachlorophene (Dermisan)?

It is applied to wet hands and forearms before a surgical procedure.
About 5 ml of the solution is poured into the palm and rubbed over the exposed forearm and hands thoroughly (including the interdigital areas).
The process may be repeated twice or thrice to ensure adequate antiseptic measures.