Hexachlorophene Soaps: Names and Clinical Considerations
Hexachlorophene soaps are primarily known by the prescription-only brand name pHisoHex, containing 3% hexachlorophene, and Septisol Foam (0.23% hexachlorophene in a 46% ethyl alcohol base). 1, 2, 3
Background on Hexachlorophene
Hexachlorophene is a bisphenol antiseptic composed of two phenolic groups and three chlorine moieties. Its antimicrobial activity stems from its ability to inactivate essential enzyme systems in microorganisms. Key characteristics include:
- Bacteriostatic agent with good activity against Staphylococcus aureus
- Relatively weak activity against gram-negative bacteria, fungi, and mycobacteria
- Provides residual antimicrobial activity for several hours after application
- Demonstrates cumulative effect with repeated use 1
Historical Usage and Formulations
Hexachlorophene was widely used in the 1950s and early 1960s in several formulations:
- 3% emulsions for hygienic handwashing
- Surgical scrubs
- Bathing solutions for infants in hospital nurseries
- 2.5% soap gel formulations
- 0.23% concentration in alcohol-based foam (Septisol) 1, 4, 3
Efficacy Considerations
- Single handwash efficacy: Only modest bacterial reduction after one use
- Cumulative effect: Gradually reduces bacterial counts with multiple applications
- Comparative efficacy: Less effective than chlorhexidine gluconate for surgical scrubs
- Formulation differences: 2.5% soap gel formulations demonstrated broader antimicrobial spectrum and faster killing action compared to 3% detergent formulations 1, 5, 4
Safety Concerns and Regulatory Status
- Hexachlorophene is absorbed through the skin with repeated use
- Blood levels of 0.1-0.6 ppm have been documented in healthcare workers regularly using 3% preparations
- In the early 1970s, infants bathed with hexachlorophene developed neurotoxicity (vacuolar degeneration)
- FDA issued warnings in 1972 against routine use for infant bathing
- Currently classified by FDA as "not generally recognized as safe and effective" for antiseptic handwash use
- 3% hexachlorophene soaps are available by prescription only 1, 6
Clinical Applications and Limitations
- Should not be used for patients with burns or extensive areas of susceptible skin
- Lower concentration formulations like Septisol (0.23% hexachlorophene) may offer reduced absorption risk while maintaining efficacy
- Septisol has demonstrated an infection rate of only 0.3% in surgical cases
- Hexachlorophene is no longer recommended for routine use due to safety concerns and availability of safer alternatives like chlorhexidine 1, 5, 2
Risk Factors for Hexachlorophene Toxicity
Patients at highest risk for elevated blood hexachlorophene levels include:
- Infants weighing less than 1,200 grams
- Those with postconceptional age less than 35 weeks
- Patients with large areas of abraded skin
- Individuals with liver disease 6
Despite historical effectiveness in controlling Staphylococcus aureus infections in nurseries, current guidelines recommend against routine use of hexachlorophene-containing products due to potential neurotoxicity and the availability of safer alternatives.