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Niro A, Pignatelli F, Fallico M, Sborgia A, Passidomo F, Gigliola S, Nacucchi A, Sborgia G, Boscia G, Alessio G, Boscia F, Addabbo G, Reibaldi M, Avitabile T. Polyhexamethylene biguanide hydrochloride (PHMB)-properties and application of an antiseptic agent. A narrative review. Eur J Ophthalmol 2022; 33:11206721221124684. [PMID: 36083163 DOI: 10.1177/11206721221124684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The prevention and management of ocular surface infections is still one of the great challenges for ophthalmologists. The spread of antimicrobial resistance makes it necessary to use antiseptic substances with a broad antimicrobial spectrum. Polyhexamethylene biguanide hydrochloride (Polyhexanide, PHMB) is a broad-spectrum antiseptic with excellent tolerance and a low-risk profile. Its physicochemical action on the phospholipid membrane and DNA replication or repair mechanism, prevents or impedes the development of resistant bacterial strains. PHMB revealed its effective against numerous organisms like viruses, Gram-negative and Gram-positive bacteria, and fungi. Polyhexanide is commonly used as preservative in commercially available disinfecting solutions for contact lens care and in ophthalmic formulations at different concentrations ranging from 1 µg/ml to 50 µg/ml. The administration of 0.02% (200 µg/ml) PHMB is often the first-line therapy of Acanthamoeba keratitis. However, to date, only one close-out randomized controlled study tested the efficacy of 0.02% PHMB in Acanthamoeba keratitis and a phase III study is still ongoing. This paper reviews the antiseptic agent PHMB, focusing on biochemical mechanisms, safety profile and applications in ophthalmology.
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Affiliation(s)
- Alfredo Niro
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | | | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Fedele Passidomo
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | - Samuele Gigliola
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | | | - Giancarlo Sborgia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Giacomo Boscia
- Eye Clinic Section, Department of Surgical Sciences, 9314University of Turin, Turin, Italy
| | - Giovanni Alessio
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Giuseppe Addabbo
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | - Michele Reibaldi
- Eye Clinic Section, Department of Surgical Sciences, 9314University of Turin, Turin, Italy
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Kolodziej M, Kiewert A, Skudlik C, Brans R. Allergic contact dermatitis caused by polyhexamethylene biguanide may contribute to work-related hand eczema. Contact Dermatitis 2021; 85:97-98. [PMID: 33486772 DOI: 10.1111/cod.13792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Michaela Kolodziej
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Alexander Kiewert
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Christoph Skudlik
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
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Sukakul T, Dahlin J, Pontén A, Antelmi A, Bruze M, Hamnerius N, Hauksson I, Isaksson M, Lejding T, Svedman C. Contact allergy to polyhexamethylene biguanide (polyaminopropyl biguanide). Contact Dermatitis 2020; 84:326-331. [PMID: 33098110 PMCID: PMC8048451 DOI: 10.1111/cod.13728] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/20/2022]
Abstract
Background Polyaminopropyl biguanide (INCI name) and polyhexamethylene biguanide (PHMB) are polymeric biguanides. PHMB is a broad‐spectrum antimicrobial substance used as a preservative in many products. Due to our limited knowledge on PHMB contact allergy frequency and the fact that cases of allergic contact dermatitis to PHMB might be missed, we have included PHMB as a screening allergen since 2016. Objective To report the prevalence of positive patch test reactions to PHMB as a screening allergen in patients with suspected allergic contact dermatitis. Methods A retrospective analysis of 1760 patch tested patients from July 2016 to December 2018 was performed. Polyaminopropyl biguanide 2.0% aqua was included in the extended Malmö baseline series during the study period. Results Of all patients, 1204 (68.4%) were female. Positive patch test reactions were reported in 19 patients (1.1%). The most common sites of lesions were face, head, and neck (52.6%). There was a significant correlation between concomitant reactions to PHMB and other cosmetic‐related allergens. Conclusion The prevalence of positive reactions to PHMB was higher than that previously reported. Patch testing with PHMB should be performed in patients with dermatitis who have lesions on the face, head, and neck.
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Affiliation(s)
- Thanisorn Sukakul
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jakob Dahlin
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Ann Pontén
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Annarita Antelmi
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Nils Hamnerius
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Inese Hauksson
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Marléne Isaksson
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Tina Lejding
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden
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Johnson W, Boyer I, Zhu J, Bergfeld WF, Belsito DV, Hill RA, Klaassen CD, Liebler DC, Marks JG, Shank RC, Slaga TJ, Snyder PW, Heldreth B. Safety Assessment of Polyaminopropyl Biguanide (Polyhexamethylene Biguanide Hydrochloride) as Used in Cosmetics. Int J Toxicol 2020; 39:26S-73S. [PMID: 33203268 DOI: 10.1177/1091581820958683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Expert Panel for Cosmetic Ingredient Safety (Panel) reviewed the safety of Polyaminopropyl Biguanide (polyhexamethylene biguanide hydrochloride), which functions as a preservative in cosmetic products. The Panel reviewed relevant data relating to the safety of this ingredient and concluded that Polyaminopropyl Biguanide is safe in cosmetics in the present practices of use and concentration described in the safety assessment, when formulated to be nonirritating and nonsensitizing, which may be based on a quantitative risk assessment or other accepted methodologies. The Panel also concluded that the data are insufficient to determine the safety of Polyaminopropyl Biguanide in products that may be incidentally inhaled.
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Affiliation(s)
- Wilbur Johnson
- * 44002Cosmetic Ingredient Review Senior Scientific Analyst/Writer
| | - Ivan Boyer
- ** Former 44002Cosmetic Ingredient Review Toxicologist
| | - Jinqiu Zhu
- *** 44002Cosmetic Ingredient Review Toxicologist
| | | | | | - Ronald A Hill
- **** Expert Panel for Cosmetic Ingredient Safety Member
| | | | | | - James G Marks
- **** Expert Panel for Cosmetic Ingredient Safety Member
| | | | | | - Paul W Snyder
- **** Expert Panel for Cosmetic Ingredient Safety Member
| | - Bart Heldreth
- † 44002Cosmetic Ingredient Review Executive Director
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Yun T, Cheng P, Qian F, Cheng Y, Lu J, Lv Y, Wang H. Balancing the decomposable behavior and wet tensile mechanical property of cellulose-based wet wipe substrates by the aqueous adhesive. Int J Biol Macromol 2020; 164:1898-1907. [PMID: 32800954 PMCID: PMC7422816 DOI: 10.1016/j.ijbiomac.2020.08.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/30/2020] [Accepted: 08/08/2020] [Indexed: 12/13/2022]
Abstract
With the current global outbreak of novel coronaviruses, the fabrication of decomposable wet wipe with sufficient wet strength to meet daily use is promising but still challenging, especially when renewable cellulose was employed. In this work, a decomposable cellulose-based wet wipe substrate is demonstrated by introducing a synthetic N-vinyl pyrrolidone-glycidyl methacrylate (NVP-GMA) adhesive on the cellulose surface. Experimental results reveal that the NVP-GMA adhesive not only significantly facilitates the chemical bonding between cellulose fibers in the wet state, but also increase the surface wettability and water retention. The as-fabricated cellulose-based wet wipe substrate displays a superb water retention capacity of 1.9 times, an excellent water absorption capacity (completely wetted with 0° water contact angle), and a perfect wet tensile index of 3.32 N.m.g−1. It is far better than state-of-the-art wet toilet wipe on the market (non-woven). The prepared renewable and degradable cellulose-based substrate with excellent mechanical strength has potential application prospects in diverse commercially available products such as sanitary and medical wet wipes. A decomposable wet wipe substrate was prepared from the bio-based materials. Synthetic adhesive enhanced the wet strength of the cellulose sheet. Enhancement of cellulose-based material was achieved under aqueous conditions. As-prepared cellulose substrate balanced the dispersibility and wet strength.
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Affiliation(s)
- Tongtong Yun
- School of Light Industry and Chemical Engineering, Dalian Polytechnic University, Dalian 116034, Liaoning, PR China
| | - Peng Cheng
- School of Light Industry and Chemical Engineering, Dalian Polytechnic University, Dalian 116034, Liaoning, PR China
| | - Fang Qian
- School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, Liaoning, PR China
| | - Yi Cheng
- School of Light Industry and Chemical Engineering, Dalian Polytechnic University, Dalian 116034, Liaoning, PR China
| | - Jie Lu
- School of Light Industry and Chemical Engineering, Dalian Polytechnic University, Dalian 116034, Liaoning, PR China
| | - Yanna Lv
- School of Light Industry and Chemical Engineering, Dalian Polytechnic University, Dalian 116034, Liaoning, PR China.
| | - Haisong Wang
- School of Light Industry and Chemical Engineering, Dalian Polytechnic University, Dalian 116034, Liaoning, PR China.
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9
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Kramer A, Eberlein T, Müller G, Dissemond J, Assadian O. Re-evaluation of polihexanide use in wound antisepsis in order to clarify ambiguities of two animal studies. J Wound Care 2019; 28:246-255. [PMID: 30975054 DOI: 10.12968/jowc.2019.28.4.246] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Due to classification of the agent polihexanide (PHMB) in category 2 'may cause cancer' by the Committee for Risk Assessment of the European Chemicals Agency in 2011, the users of wound antiseptics may be highly confused. In 2017, this statement was updated, defining PHMB up to 0.1% as a preservative safe in all cosmetic products. In the interest of patient safety, a scientific clarification of the potential carcinogenicity of PHMB is necessary. METHODS A multidisciplinary team (MDT) of microbiologists, surgeons, dermatologists and biochemists conducted a benefit-risk assessment to clarify the hazard of antiseptic use of PHMB. RESULTS In two animal studies, from which the assessment of a carcinogenic risk was derived, PHMB was administered orally over two years in extremely high concentrations far above the NO(A)EL (no-observed-(adverse-) effect level) in rats and mice. Feeding in the NO(A)EL range resulted in no abnormal effects. In one male in the highest dose group of 4000ppm PHMB, an adenocarcinoma was found, which the author attributed to chronic inflammation of the colon with systemic atypical exposure. The increasing incidence of hemangiosarcomas highly probably resulted from increased endothelial proliferation, triggered by the exceedingly high dosage fed, because PHMB is not genotoxic and there is no evidence for epigenetic effects. DISCUSSION It is well known that PHMB is not absorbed when applied topically. Considering the absence of genotoxicity and epigenetic effects together with the interpretation of the animal studies, it is the consensus of the multidisciplinary experts that a carcinogenic risk from PHMB-use for wound antisepsis can be ruled out. CONCLUSION On this basis and considering their effectiveness, tolerability and clinical evidence, the indications for PHMB based wound antiseptics are justified.
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Affiliation(s)
- Axel Kramer
- Consultant Clinical Microbiology and Infection Control, Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Thomas Eberlein
- Consultant Wound Management, College of Medicine and Medical Science, Arabian Gulf University Manama, Kingdom of Bahrain
| | - Gerald Müller
- Biochemist, Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Joachim Dissemond
- Medical Dermatologist, Department of Dermatology, Venerology and Allergology, University Hospital Essen, Germany
| | - Ojan Assadian
- Consultant Clinical Microbiology and Infection Control, Consultant Infectious Diseases and Tropical Medicine, Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Austria.,Consultant Clinical Microbiology and Infection Control, Consultant Infectious Diseases and Tropical Medicine, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
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Aerts O, Goossens A. Preservatives. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_85-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Pastor-Nieto MA, González-Muñoz P, Pérez-Mesonero R, Melgar-Molero V, Pastor-Nieto MB, Zarallo-Gallardo J, Martín-Alcalde E, De Eusebio-Murillo E. Allergic contact dermatitis caused by poly(hexamethylene) biguanide hydrochloride in contact lens care solutions. Contact Dermatitis 2018; 76:373-376. [PMID: 28497633 DOI: 10.1111/cod.12730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Raquel Pérez-Mesonero
- Department of Dermatology, University Hospital of Guadalajara, Guadalajara 19002, Spain
| | | | - María-Begoña Pastor-Nieto
- Opthalmology Department, Infanta Sofía University Hospital, 28702 San Sebastián de los Reyes (Madrid), Spain
| | | | - Eva Martín-Alcalde
- Department of Pharmacy, University Hospital of Guadalajara, Guadalajara, Spain
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Kramer A, Dissemond J, Kim S, Willy C, Mayer D, Papke R, Tuchmann F, Assadian O. Consensus on Wound Antisepsis: Update 2018. Skin Pharmacol Physiol 2017; 31:28-58. [PMID: 29262416 DOI: 10.1159/000481545] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/15/2017] [Indexed: 02/03/2023]
Abstract
Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.
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Affiliation(s)
- Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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Allergic Contact Dermatitis to Ophthalmic Medications: Relevant Allergens and Alternative Testing Methods. Dermatitis 2016; 27:333-347. [DOI: 10.1097/der.0000000000000224] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Verhulst L, Goossens A. Cosmetic components causing contact urticaria: a review and update. Contact Dermatitis 2016; 75:333-344. [DOI: 10.1111/cod.12679] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/24/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Lien Verhulst
- Department of Dermatology; University Hospitals KU Leuven; Leuven 3000 Belgium
| | - An Goossens
- Department of Dermatology; University Hospitals KU Leuven; Leuven 3000 Belgium
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Bervoets A, Aerts O. Polyhexamethylene biguanide in wound care products: a non-negligible cause of peri-ulcer dermatitis. Contact Dermatitis 2015; 74:53-5. [DOI: 10.1111/cod.12469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- An Bervoets
- Department of Dermatology; Wound Care Clinic, University Hospital Antwerp; 2650 Edegem Belgium
| | - Olivier Aerts
- Contact Allergy Unit, Department of Dermatology; University Hospital Antwerp; 2650 Edegem Belgium
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Aerts O, Smeets J, Adriaenssens K, Lambert J, Goossens A. Contact allergy to biguanides might explain cases of unresolved eyelid dermatitis. J Eur Acad Dermatol Venereol 2014; 29:2064-5. [DOI: 10.1111/jdv.12598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- O. Aerts
- Department of Dermatology; University Hospital Antwerp; Antwerp Belgium
| | - J. Smeets
- Department of Skin therapy; The Hague University of Applied Sciences; The Hague The Netherlands
| | - K. Adriaenssens
- Department of Dermatology; University Hospital Antwerp; Antwerp Belgium
| | - J. Lambert
- Department of Dermatology; University Hospital Antwerp; Antwerp Belgium
| | - A. Goossens
- Department of Dermatology; University Hospitals K. U. Leuven; Leuven Belgium
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