Antiseptics: Uses, Types, and Safety — DermNet

What is an antiseptic?

An antiseptic is a chemical agent that slows or stops the growth of microorganisms on external surfaces of the body and helps to prevent infection.

Antiseptics should be distinguished from antibiotics, which destroy microorganisms inside the body; and from disinfectants, which destroy microorganisms found on inanimate (non-living) objects. Antiseptics can be referred to as skin disinfectants.

Antiseptics

A 1 in 10,000 dilution of potassium permanganate ready to use

Chlorhexidine wash

What are antiseptics used for?

When the skin or mucous membranes are damaged or breached, an antiseptic can be used to cleanse the area and reduce the chance of infection by normally occurring microorganisms. Antiseptics kill, inhibit, or reduce the number of microorganisms by mechanical removal or chemical activity.

Antiseptics are commonly used for:

• Hand washing — chlorhexidine gluconate and povidone-iodine 

  solutions

  are often used in hand rubs in hospitals and other health care settings. Alcohol in concentrations > 60% will destroy

  pathogens

  such as the SARS-CoV-19 virus. 
• Preoperative skin disinfection — antiseptics can be used to clean intact skin prior to an operation (to reduce the risk of surgical site

  infections

  ) or a procedure such as intravenous (IV) cannulation.

• Mucous membrane

   disinfection — antiseptic irrigations may be instilled into the bladder, 

  urethra

  , or

  vagina

  to cleanse the cavity prior to a medical procedure such as catheterisation.
• Preventing and treating infected skin — antiseptics can be used to clean contaminated cuts, wounds, abrasions, burns, and bites, including in some skin conditions such as acne and

  atopic

  dermatitis

  (

  eczema

  ). See also: Wound cleansers.
• Treating oral infections — mouth and throat infections can be treated with antiseptic throat lozenges, gargles, and mouthwashes.

Many agents can be used as both an antiseptic and a disinfectant, depending on the concentration. For example, hydrogen peroxide 6% solution is used for cleansing wounds, while stronger solutions (>30%) are used in industry as bleach and oxidising agents.

Types of antiseptics

Antiseptics can be classified according to their chemical structure. The following table lists commonly used antiseptic groups and some examples.

Table 1. Antiseptic groups and examples

Antiseptic groups

Uses

Examples

Alcohols

• Skin disinfectant

• Ethyl alcohol
• Isopropyl alcohol

Quaternary ammonium compounds

• Skin disinfectant
• Irrigation
• Eye drop preservative

• Benzalkonium chloride
• Cetrimide
• Methylbenzethonium chloride
• Cetalkonium chloride
• Cetylpyridinium chloride
• Dofanium chloride
• Demiphen bromide

Chlorhexidine and other diguanides

• Pre-operative skin disinfectant
• Wound treatment
• Bladder irritation
• Dental antiseptic at lower concentrations

• Chlorhexidine gluconate
• Chlorhexidine acetate

Antibacterial dyes

• Skin disinfectant
• Wound treatment
• Burn treatment

• Proflavine hemisulphate
• Triphenylmethane
• Brilliant green
• Crystal violet
• Gentian violet

Chlorine and hypochlorites

• Skin disinfectant

• Sodium hypochlorite (bleach) eg, bleach baths

Iodine compounds

• Skin disinfectant (including pre-operative)
• Wound treatment

• Povidone - iodine

Peroxide and permanganates

• Wound cleanser
• Gargle and mouthwash
• Irrigation
• Skin disinfectant

• Hydrogen peroxide solution
• Potassium permanganate solution
• Benzoyl peroxide

Halogenated phenol derivatives

• Skin disinfectant
• Medicated soap and solution

• Chlorocresol
• Chloroxylenol
• Chlorophene
• Hexachlorophane / hexachloropene (no longer available)
• Triclosan (no longer available in

  over-the-counter

  antiseptics in the US as of 2016)

Quinolone derivatives

• Wound treatment
• In throat lozenges
• Skin disinfectant

• Hydroxyquinoline sulphate
• Potassium hydroxyquinoline sulphate
• Chlorquinaldol
• Dequalinium chloride
• Diiodohydroxyquinoline

Other

• Various uses eg, skin disinfectant, wound or bite treatment

• Burow's solution (aqueous solution of aluminium acetate)
• Silver

What are the precautions when using antiseptics?

Table 2. Antiseptic

contraindications

and precautions

Antiseptic

Contraindications

Precautions

Ethyl alcohol

• Hypersensitivity

• Cover cuts or broken skin with waterproof plasters before using alcohol-based hand rub to prevent stinging
• Do not

  ingest

• Keep away from potential sources of ignition such as electrical outlets or electrocautery due to flammability 

Chlorhexidine gluconate

• Hypersensitivity (both immediate type 1 reactions and allergic contact dermatitis)

• Infants <2 months (risk of

  dermal

  irritation or chemical burns)
• Avoid contact with eyes and ears
• Do not swallow
• Wait 30 minutes after brushing teeth before using mouthwash

Povidone - iodine

• Pregnancy (esp.

  vaginal

  products)
• Lactation
• Infants <6 months
• Deep puncture wounds
• Serious burns
• Iodine/povidone sensitivity
• Thyroid disease

• Avoid regular use in patients taking lithium
• Do not ingest

  topical

  formulations

  or apply to eyes (ophthalmic preparations are also available)

Hydrogen peroxide

• Hypersensitivity
• Children <2 years
• Use in the eyes or over large areas of the body
• Use during surgery or in closed body cavities
• Prolonged use (longer than a week)

• Deep puncture wounds
• Animal bites
• Burns
• Avoid use in the eyes
• Avoid use on healthy skin
• Can bleach fabric
• Avoid

  concomitant

  use with iodine or potassium permanganate

Benzoyl peroxide

• Hypersensitivity

• Use in

  neonates

• Breastfeeding: avoid application to breasts
• Avoid contact of acne treatments with eyes, mouth, and

  mucous membranes

• Avoid excessive exposure to sunlight
• Can bleach fabrics or

  hair

• Pregnancy

What are the benefits and disadvantages of antiseptics?

Antiseptics reduce the number of microorganisms living on the skin, in wounds, and in mucous membranes. They can be particularly useful when an individual needs to cleanse the skin quickly. Many antiseptics are available to buy over-the-counter at pharmacies, making them convenient and easily accessible.

Antiseptics can cause severe skin irritation or chemical burns. Skin reactions may include erosions, ulcers, vesicles, and scarring. Allergic reaction such as immediate type 1 reactions, anaphylaxis, and allergic contact dermatitis may occur. 

There is also the risk of product contamination from repeated use of topical antiseptics. This can lead to further problems such as localised or systemic infections when the contaminated product is reapplied to open skin, a wound, or a burn.  

Alcohol-containing products are flammable and need to be kept away from fire at all times. 

Antiseptic safety and

efficacy

The effectiveness and complete safety of antiseptics have proven difficult to establish. 

In September 2016, the US Food and Drug Administration (FDA) issued a final rule establishing that over-the-counter consumer antiseptic wash products containing any of the nineteen ingredients listed could not be marketed. This included triclosan and triclocarban. The rationale cited being:

• Lack of evidence that antibacterial wash is more effective than plain soap and water at preventing illness.
• Prolonged household use of antibacterial products such as antibacterial soaps may contribute to antibiotic resistance.

In December 2017, the FDA further ruled that 24 ingredients found in antiseptic products (including triclosan) were generally not recognised as safe and effective (often due to inadequate data). These required regulatory approval for marketing from December 2018 as new drugs. A decision was deferred on a further six ingredients (benzalkonium chloride, benzethonium chloride, chloroxylenol, ethyl alcohol, isopropyl alcohol, and povidone-iodine).

It is important to note that antiseptics may impair wound healing if they kill skin cells that are involved in the healing process, such as fibroblasts. Routine use of antiseptics for cleansing clean wounds is no longer recommended. Pus and necrotic tissue can also inactivate some antiseptics, reducing their efficacy.  

Antiseptics should also be differentiated from antibiotics. Antiseptics only reduce microorganisms on the surface of the tissue whereas antibiotics may be needed if infection exists within the tissues.

What are the side effects and risks of antiseptics?

Individuals using antiseptics need to do so correctly. Strong antiseptics should be appropriately diluted before being applied to the skin, as concentrated products may cause chemical burns or severe irritant contact dermatitis. Prolonged contact with dilute antiseptics can also cause erosive contact dermatitis, as described with chlorhexidine-impregnated dressings.

Antiseptic products should not be used for more than one week on acute wounds. Chronic wounds with no improvement after 10 to 14 days should be also referred for medical review.

Additional reasons to stop using an antiseptic and to seek medical attention include: 

• The affected area has not healed or improved
• There is a large wound, deep cut, burn, or abrasion embedded with particles that won’t wash away
• Injury due to a human or animal bite.

People with allergies of any kind should check with a doctor or pharmacist before using an over-the-counter antiseptic product. Some antiseptics can irritate the skin and cause allergic contact dermatitis.

Side effects of common antiseptics are listed in the table below. Emollients and moisturisers are recommended after use if the hands are dry or develop contact dermatitis due to antiseptic use.

Table 3. Antiseptic side effects

Antiseptic

Side effects

Ethyl alcohol

• Skin irritation
• Allergic contact dermatitis
• Contact

  urticaria

  syndrome

• Hypersensitivity (rare)

Povidone-iodine

• Skin irritation
• Redness
• Swelling
• Irritant or allergic contact dermatitis
• Can stain skin, hair, and clothing
• Can potentially interfere with thyroid function test results
• Chronic use in pregnancy may be associated with

  neonatal

  hypothyroidism

• Rare case reports of iododerma associated with prolonged use of iodine-containing antiseptics to large areas of broken skin (see: Halogenoderma)
• Hypersensitivity (rare)

Chlorhexidine gluconate

• Mucosal

  irritation or reversible discolouration of teeth and tongue can occur with mouthwash
• Skin sensitivity
• Irritant and allergic contact dermatitis can be associated with chronic use

• Keratitis

• Conjunctivitis

• Exposure to the middle ear can cause

  sensorineural

  deafness
• Anaphylaxis (rare), particularly from mucosal exposure

Hydrogen peroxide

• Redness
• Stinging/mild burning sensation

• Oedema

• Scaling

• Crusting

• Pruritus

• Can bleach skin, hair,

  nails

  , and clothes

• Cytotoxic

  to

  keratinocytes

  ; may impair wound healing
• Hypersensitivity (rare)

Burow’s solution (aluminium acetate)

• Local irritation
• Skin dryness
• Hypersensitivity (rare)

We suggest you refer to your national drug approval agency such as the Australian

Approved datasheets are the official source of information for medicines, including approved uses, doses, and safety information. Check the individual datasheet in your country for information about medicines.We suggest you refer to your national drug approval agency such as the Australian Therapeutic Goods Administration (TGA), US Food and Drug Administration (FDA) UK Medicines and Healthcare products regulatory agency (MHRA) emc , and NZ Medsafe, or a national or state-approved formulary eg, the New Zealand Formulary (NZF) and New Zealand Formulary for Children (NZFC) and the British National Formulary (BNF) and British National Formulary for Children  (BNFC).