Effects of Chlorhexidine Gluconate and Alternative Cleansers in Pediatric Skin Cells In Vitro: Are There Less Toxic Alternatives?

BACKGROUND: Chlorhexidine Gluconate (CHG) is a commonly used antimicrobial cleanser, but its safety in children and neonates is not fully understood. This study analyzed the cytotoxicity of CHG and two alternatives in pediatric epidermal keratinocytes and dermal fibroblasts in vitro. METHODS: Keratinocytes and fibroblasts were cultured from skin of three pediatric donors. CHG, a baby wash, and a colloidal silver foam were diluted and analyzed in cells versus untreated controls. Proliferation, migration, and expression of genes involved in proliferation, apoptosis, and inflammation were analyzed in vitro. RESULTS: CHG inhibited keratinocyte and fibroblast proliferation the most; colloidal silver foam had the least effect. CHG and baby shampoo significantly inhibited keratinocyte migration, whereas no cleanser significantly affected fibroblast migration. Gene expression suggested CHG decreased keratinocyte proliferation, increased fibroblast inflammatory signaling, and increased apoptosis in both cell types. CONCLUSIONS: The results suggest CHG damages pediatric skin cells but less cytotoxic alternatives exist. Although keratinized epidermal layers in skin provide a barrier to protect deeper proliferative cells, this barrier is thinner in pediatric vs. adult skin, potentially exposing these cells to cytotoxic CHG levels. Further studies including antimicrobial assays are required to fully define the optimal cleanser to combat infection without damaging pediatric skin.