Last update: Sept. 22, 2017

Hexachlorophene

Very High Risk for breastfeeding


Very unsafe. Contraindicated.
Use of an alternative or cessation of breastfeeding.

Halogenated phenol derivative.
It has been used as a skin disinfectant, including for nipple-areola (West 1975), vaginal disinfectant (Strickland 1983) and in dental preparations for cavity treatment.

As it is highly liposoluble it has high skin absorption, even through intact skin, both in infants and adults (Bye 1975), and its repeated use can cause elevated plasma levels (Tyrala 1977, Nal-BMJ 1972) that cause neurotoxicity (Evangelista 1996) and serious risk to life. It is very toxic when taken orally and can result in death (Mullick 1973, Nal-BMJ 1972).

Between 1950 and 1980, it was used as a cutaneous disinfectant in neonates admitted to neonatal units to prevent infections from staphylococcus aureus (Tyrala 1977, Baber 1967) and in umbilical cord treatment, which led to deaths due to spongiform encephalomyelopathy (Martin 1982, Anderson 1981, West 1981).
There have also been fatalities in older children where it was used as a disinfectant in burns and other skin conditions (Chilcote 1977, Mullick 1973).

Since the late 1970s, it has been gradually replaced by other disinfectants (Hnatko 1977), although surprisingly its use persisted for years in many hospitals (Malhotra 1986, Martin 1982) with more than one tragic result (Martin 1982).
There are restrictions on its sale, ranging, according to the country, from their total ban to limiting its concentration to less than 1% in disinfectants, soaps and cosmetics.

Since the last update there has been limited published data on its excretion in breast milk.

Its liposolubility makes it very likely that it will pass into breast milk in amounts that could be significant.

The use of hexachlorophene to clean the nipple between feeds resulted in milk levels, although low, between 2 and 9 nanograms/ml (West 1975). Its use as powder for umbilical cord treatment doubled plasma levels at 8th day of life relative to birth (Gillespie 1974).

The small dose of hexachlorophene in dental products may be low risk, but in many countries hexachlorophene has been replaced by other phenolic disinfectants (thymol, parachlorophenol).

The American Academy of Pediatrics (AAP 2001) and experts (Hale 2017, p.449) find it inappropriate to use hexachlorophene during breastfeeding.

Due to its rapid absorption, it should not be used on mucous membranes or damaged skin, much less on the chest.

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Hexachlorophene is also known as


Hexachlorophene in other languages or writings:

Group

Hexachlorophene belongs to this group or family:

Tradenames

Main tradenames from several countries containing Hexachlorophene in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 (oral) %
Molecular weight 407 daltons
Protein Binding 92 %
pKa 8,79 -
Tmax 6 - 10 hours
T1/2 6 - 44 (neonatal) hours

References

  1. Evangelista de Duffard AM, Duffard R. Behavioral toxicology, risk assessment, and chlorinated hydrocarbons. Environ Health Perspect. 1996 Abstract Full text (link to original source) Full text (in our servers)
  2. Malhotra KK. Care of the newborn in perinatal units in New Brunswick. CMAJ. 1986 Abstract
  3. Strickland DM, Leonard RG, Stavchansky S, Benoit T, Wilson RT. Vaginal absorption of hexachlorophene during labor. Am J Obstet Gynecol. 1983 Abstract
  4. Martin-Bouyer G, Lebreton R, Toga M, Stolley PD, Lockhart J. Outbreak of accidental hexachlorophene poisoning in France. Lancet. 1982 Abstract
  5. Martin-Bouyer G, Lebreton R, Toga M, Stolley PD, Lockhart J. Outbreak of accidental hexachlorophene poisoning in France. Lancet. 1982 Abstract
  6. West DP, Worobec S, Solomon LM. Pharmacology and toxicology of infant skin. J Invest Dermatol. 1981 Abstract Full text (link to original source) Full text (in our servers)
  7. Anderson JM, Cockburn F, Forfar JO, Harkness RA, Kelly RW, Kilshaw B. Neonatal spongioform myelinopathy after restricted application of hexachlorophane skin disinfectant. J Clin Pathol. 1981 Abstract Full text (link to original source) Full text (in our servers)
  8. Chilcote R, Curley A, Loughlin HH, Jupin JA. Hexachlorophene storage in a burn patient associated with encephalopathy. Pediatrics. 1977 Abstract
  9. Hnatko SI. Alternatives to hexachlorophene bathing of newborn infants. Can Med Assoc J. 1977 Abstract Full text (link to original source) Full text (in our servers)
  10. Tyrala EE, Hillman LS, Hillman RE, Dodson WE. Clinical pharmacology of hexachlorophene in newborn infants. J Pediatr. 1977 Abstract
  11. West RW, Wilson DJ, Schaffner W. Hexachlorophene concentrations in human milk. Bull Environ Contam Toxicol. 1975 Abstract
  12. Bye PG, Morison W, Rhodes EL. The absorption of hexachlorophane from Ultralanum ointment. Br J Dermatol. 1975 Abstract
  13. Gillespie WA, Corner BD, Burman D, Alder VG. Absorption of hexachlorophane from dusting powder on newborn infant's skin. J Hyg (Lond). 1974 Abstract Full text (link to original source) Full text (in our servers)
  14. Mullick FG. Hexachlorophene toxicity. Human experience at the Armed Forces Institute of Pathology. Pediatrics. 1973 Abstract
  15. [No authors listed] Hexachlorophane challenged. Br Med J. 1972 Abstract Full text (link to original source) Full text (in our servers)
  16. Baber KG, Corner B, Duncan EH, Eades SM, Gillespie WA, Walker SC. A prospective study of staphylococcal infection and its prevention among infants and mothers after childbirth in hospital and at home. J Hyg (Lond). 1967 Abstract

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