FDA Expands List of Hand Sanitizers to Avoid—Here's What You Need to Know

Hand sanitizer has become a household essential over the last few months, but it’s not all made equally—and some types may be doing more harm than good, or no good at all.

The US Food and Drug Administration (FDA) continues to warn consumers against using products that may contain methanol, or wood alcohol, which can be toxic when absorbed through the skin and cause blindness or even death if swallowed. And now the agency is alerting consumers to another problem: test results show certain hand sanitizers contain "concerningly low levels" of the active ingredients ethyl alcohol or isopropyl alcohol.

As of August 6, the agency has expanded its list of potentially toxic and ineffective hand sanitizers to 135 different varieties. FDA's "do-not-use" list includes hand sanitizers containing "subpotent" levels of the active ingredient and products made in same facility as the ones that may be ineffective. The list also includes hand sanitizers either found to contain methanol, labeled as containing methanol, recalled by the manufacturer or distributor, or made in the same facility as products found by the FDA to contain methanol. If you're reading labels, you probably won't see methanol listed—it's never an acceptable ingredient in hand sanitizer. The agency's ongoing testing has detected methanol contamination of 1% to a whopping 80%.

FDA first warned consumers in June not to use hand sanitizer made by the Mexican company Eskbiochem SA due to the potential presence of methanol. Subsequently, Saniderm Products announced that it was voluntarily recalling 1-liter bottles of Saniderm Advanced Hand Sanitizer and all products made by Eskbiochem labeled "Made in Mexico." On July 2, the FDA reiterated its warning to consumers, noting that it continues to alert manufacturers and distributors about recalling dangerous hand sanitizers. The agency continues to test products entering the US border and update its do-not-use list.

The FDA and CDC still recommend hand sanitizers with at least 60% ethanol if you're unable to wash your hands with soap and water.

How Do You Know If Your Hand Sanitizer Is Ineffective or Dangerous?

First, go to the FDA's do-not-use list and then look for one or more of the following:

• Manufacturer name
• Product name
• National drug code (NDC number)

If any of these "identifiers" is a match, FDA recommends that consumers immediately stop using the product. (That applies even if a particular manufacturer's product or lot number isn't on the list.) Dispose of them immediately in appropriate hazardous waste containers (not by flushing or pouring them down the drain). Plus, if you’ve been exposed to any of these hand sanitizers, you should seek immediate medical treatment.

Methanol, a colorless, watery liquid with a strong odor, occurs naturally in humans, animals, and plants, but it is also manufactured as a solvent, pesticide and alternative fuel source, per the Centers for Disease Control and Prevention (CDC). It can be toxic when it’s ingested, inhaled in high concentrations, or absorbed through the skin—which is the risk of using the hand sanitizer products highlighted by the FDA. In fact, the CDC warns that absorption of methanol through the skin is “just as effective” as ingestion in producing toxic effects. However, most methanol poisoning occurs as a result of drinking beverages contaminated with methanol or from drinking methanol-containing products.

According to the CDC, methanol’s metabolic products cause its toxicity, which leads to an accumulation of acid in the blood (known as metabolic acidosis). Initial symptoms of methanol poisoning include confusion, drowsiness, headache, a reduced level of consciousness (CNS depression), and the inability to coordinate muscle movement (ataxia). Some people may also experience nausea, vomiting, and heart and respiratory failure. The toxicity of methanol increases the longer it is in the body, which means early treatment is crucial. However, signs of methanol poisoning may not be apparent for up to 72 hours after exposure. In the most severe cases, methanol poisoning can result in permanent blindness, seizures, permanent damage to the nervous system, coma, or death.

In 2018, an article in the International Journal of Environmental Research and Public Health warned that “severe system toxicity and even deaths” could occur from using hand sanitizers containing methanol. When methanol is used in these products, it’s as a substitute for ethanol (ethyl alcohol)—the alcohol that’s used in both hand sanitizers and to make alcoholic beverages. But methanol is more lethal, say the article authors, and methanol poisoning often requires antidotal therapy as well as supporting therapy and critical care.

Again, the FDA and CDC still state that ethanol-based hand sanitizers are safe when used as directed, as long as they contain at least 60% ethanol. (Products containing 70% isopropyl alcohol are also acceptable, the CDC notes.) Use it to wash your hands whenever soap and water aren’t readily available—especially after using the toilet, before eating, and after coughing, sneezing, or blowing your nose.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.