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Pannu CD, Farooque Md K. Allergic Contact Dermatitis to Octyl Cyanoacrylate Skin Glue After Surgical Wound Closure: A Systematic Review. Dermatitis 2024. [PMID: 38386590 DOI: 10.1089/derm.2023.0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
The rising incidence of allergic contact dermatitis (ACD) after cyanoacrylate adhesive use necessitates a comprehensive understanding of its clinical presentations, risk factors, and management. In this systematic review, we conducted an exhaustive search following PRISMA guidelines within Medline and PubMed databases to identify studies reporting cases of ACD resulting from cyanoacrylate adhesive application in wound closure. A total of 47 studies, covering 193 ACD cases, were included in our analysis. These cases involved 35 male, 120 female patients, and 38 cases without gender information (M:F ratio = 1:3.43), with ages ranging from 7 to 92 years (mean age 43.9 years). The majority of cases (n = 140) were part of 6 orthopedic studies, focusing on joint replacements (n = 68), orthopedic surgeries (n = 38), and breast surgeries (n = 29). The remaining 58 cases encompassed various surgical procedures. Common clinical manifestations included swelling, pruritic rash, erythema, vesicles, and itching around the surgical sites, typically appearing around 10 days post-adhesive application (within a range of 6 hours to 6 weeks). Patients with prior exposure to 2-octyl cyanoacrylate tended to exhibit earlier symptoms. Similar rates of dermatitis were observed across different adhesive brands, suggesting brand independence. Treatment strategies involved adhesive removal, administration of steroids and antihistamines, meticulous wound care, and, in some cases, surgical intervention. Notably, 3.1% of the 193 cases required surgical intervention. Risk factors, including a history of atopic dermatitis, high body mass index, diabetes, prior adhesive exposure, and surgical history, were identified in the studies. Patch tests confirmed 2-octyl cyanoacrylate as the allergen in 21 studies. Our review aims to enhance health care professionals' understanding of ACD resulting from the use of cyanoacrylate adhesive, facilitating improved postsurgical management and prevention strategies. Recognizing diverse risk factors, understanding varying clinical presentations, distinguishing ACD from infection, and employing appropriate treatment approaches are essential for achieving optimal outcomes in such cases.
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Affiliation(s)
- Chaitanya Dev Pannu
- From the Department of Specialist Surgery, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Kamran Farooque Md
- Department of Orthopaedics and Trauma, All India Institute of Medical Sciences, New Delhi, India
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Salazar PE, Habib N, Pasha MA. 2-Octyl cyanoacrylate, a hidden allergen, a common cause of postsurgical allergic contact dermatitis. Allergy Asthma Proc 2022; 43:529-532. [PMID: 36335423 DOI: 10.2500/aap.2022.43.220070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: 2-Octyl cyanoacrylate, a topical adhesive used for wound closure, is becoming a common cause for rashes in postsurgical patients. There is an increased number of cases of postsurgical contact dermatitis attributable to 2-octyl cyanoacrylate. Localized skin reactions to 2-octyl cyanoacrylate have been described in different case reports, but there are limited case reports of diffuse cutaneous allergic reactions. Objective: The aim of the study was to review our experience in patch testing with cyanoacrylates. Methods: We reported five cases of allergic contact dermatitis to 2-octyl cyanoacrylate, confirmed by a patch test. All the patients experienced a skin reaction a few days after surgery. The patients described an erythematous pruritic rash initially localized over the incision and that subsequently spread to surrounding areas. Two of the five patients developed a more widespread rash, which required a longer duration of systemic steroids. 2-Octyl cyanoacrylate remains an agent of low diagnostic suspicion as the possible cause of contact dermatitis after a surgical procedure. Results: All the patients, but one had a positive reaction to 2-octyl cyanoacrylate on PT. Four had a positive PT result, with one patient having a positive scratch test after a negative PT result. Testing on abraded skin further increased yield. Conclusion: Postsurgical patients should be evaluated by using a patch test if there is a clinical picture suggestive of contact dermatitis.
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Affiliation(s)
- Peggy E Salazar
- From the Division of Allergy and Immunology, Department of Medicine, Albany Medical College, Albany, New York; and
| | - Nazia Habib
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
| | - Muhammad A Pasha
- From the Division of Allergy and Immunology, Department of Medicine, Albany Medical College, Albany, New York; and
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Atwater AR, Bembry R, Liu B, Warshaw EM, DeKoven JG, Silverberg JI, Taylor JS, Zug KA, Houle MC, Belsito DV, Maibach HI, Reeder MJ, Sasseville D, Dunnick C, Fowler JF, Pratt MD, DeLeo VA. Medical Adhesive Allergens: Retrospective Analysis of Cross-Sectional Data from the North American Contact Dermatitis Group, 2001-2018. J Am Acad Dermatol 2021; 87:1024-1032. [PMID: 34875303 DOI: 10.1016/j.jaad.2021.11.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/16/2021] [Accepted: 11/29/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Identification of allergens causing medical adhesive contact allergy is difficult. OBJECTIVE Characterize the demographics, clinical characteristics, patch test results and occupational data for North American Contact Dermatitis Group (NACDG) patients with medical adhesive contact allergy. METHODS Retrospective study of 43,722 NACDG patients patch-tested 2001-2018, with: 1) medical adhesive (tapes/band aids/adhesive aids/suture glue) source, 2) positive patch test, and 3) final primary diagnosis of allergic contact dermatitis. RESULTS 313 (0.7%) patients met inclusion criteria. Compared to other patients with final primary diagnosis of allergic contact dermatitis, medical adhesive allergy patients were less likely male (odds ratio 0.58, 95% confidence interval [0.45-0.77]) and/or age >40 (0.76 [0.6-0.96]). The most common NACDG screening series allergens were colophony (80.7%), balsam of Peru (3.9%), 2-hydroxyethyl methacrylate (2.7%) and carba mix (2.7%). One-fourth (79/313, 25.2%) had positive patch test reactions to supplemental allergens/materials, and 17.3% (54/313) only had reactions to supplemental allergens/materials. LIMITATIONS Results of comprehensive patch testing may be prone to referral population selection bias and may not be representative of the general dermatology population. CONCLUSION Colophony was the most common allergen. Supplemental allergens and materials should be tested in the evaluation of suspected medical adhesive contact allergy.
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Affiliation(s)
- Amber Reck Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
| | - Raina Bembry
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Erin M Warshaw
- Departments of Dermatology, Minneapolis Veterans Affairs Medical Center, Park Nicollet Health Services, and University of Minnesota, Minneapolis, MN
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Howard I Maibach
- Department of Dermatology, University of California Medical School, San Francisco, CA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - Cory Dunnick
- Department of Dermatology, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, KY
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Patch Testing Ingredients of Dermabond and Other Cyanoacrylate-Containing Adhesives. Dermatitis 2020; 30:314-322. [PMID: 31517667 DOI: 10.1097/der.0000000000000514] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cyanoacrylates are strong adhesives used for a variety of medical, industrial, and cosmetic applications and have been implicated as a cause of allergic contact dermatitis. OBJECTIVE The aim of the study was to review our experience in patch testing with cyanoacrylates. METHODS We reviewed patch test results of 38 patients with a clinical history of contact dermatitis due to a cyanoacrylate-containing adhesive (mostly Dermabond). Testing used cyanoacrylates of >99% purity diluted to 10% to 30% in petrolatum (pet.), undiluted octyl cyanoacrylate, and/or Dermabond Mini or Advanced "as is." Patch tests were also performed with methacrylates, formaldehyde (a cyanoacrylate impurity), benzalkonium chloride, and cyanoacrylate polymerization inhibitors. Three patients were also tested with Dermabond Mini on abraded skin. RESULTS Commercial cyanoacrylate patch testing material (ethyl cyanoacrylate 10% pet.) detected 29% of Dermabond-allergic patients, whereas patch testing with octyl cyanoacrylate 10% pet. increased detection to 50%. Testing with higher concentrations and/or on abraded skin further increased yield. Thirteen (37%) of our 35 cyanoacrylate-allergic patients were also allergic to methacrylates or acrylates. CONCLUSIONS Octyl cyanoacrylate is the usual allergenic ingredient in Dermabond. Patch testing with high concentrations is often required. Testing Dermabond on abraded skin further improves diagnostic sensitivity by more closely simulating clinical use.
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