Should We Stick with Surgical Glues? The Incidence of Dermatitis after 2-Octyl Cyanoacrylate Exposure in 102 Consecutive Breast Cases

Abstract

Summary: Skin adhesives have become standard in wound closure as alternatives to traditional sutures or as sterile occlusive dressings after surgery of all types. The literature is replete with case reports of contact dermatitis following exposure to cyanoacrylate-based adhesives, such as 2-octyl cyanoacrylate. Nonetheless, it has been the impression of the senior author and others that the incidence of allergic and/or contact dermatitis is much higher than commonly considered. The authors prospectively studied 102 consecutive patients who underwent breast surgery performed by the senior author with 2-octyl cyanoacrylate placed over incisions as an occlusive dressing. Two patients with a known glue allergy did not receive cyanoacrylate at surgery but were scratch tested to confirm the diagnosis. All patients were followed postoperatively. Twelve patients went on to develop significant dermatitis postoperatively after glue placement. Cyanoacrylate was confirmed as the cause of all rashes by allergy scratch testing for a total incidence of 14 percent (14 patients). Given the popularity of cyanoacrylate products across emergency rooms, clinics, and operating rooms, awareness of the true incidence of these reactions may caution against their use in the future. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Skin hypersensitivity following application of tissue adhesive (2-octyl cyanoacrylate)

“…Nigro et al recently evaluated a cohort of patients who underwent breast surgery with cyanoacrylate products. 17 Twelve patients developed significant dermatitis reactions. Two patients had previous known allergies to cyanoacrylate.…”

A Prospective Randomized Trial of N-butyl-cyanoacrylate + Metacryloxysulfolane Adhesive versus Suture Alone for Grafting in Rhinoplasty: 9 year Follow-up

“…5 CA glues, despite generally safe, can sometimes cause infection in the site where they are applied 6 or dermatitis. 7 An adverse event could be due to subject’s sensitivity to the active principle or to one of the excipients contained in the glue. Literature reports different prevalence of infection (up to a complete absence) based on the brand and formulation used.…”

Diagnosis and Treatment of Perioperative Allergic Complications: A Practical Review

“…Cyanoacrylate glues are used as dressings or adjuncts to closure and can expedite closing times, lead to improved scars, and provide an antibacterial barrier to skin pathogens. [51][52][53] There are multiple reports of contact dermatitis as a result of cyanoacrylate glue products, [53][54][55][56][57] with rates ranging from 0.5% to 14%, and have been hypothesized to vary based on anatomic location due to skin thickness. 53,58 A prospective study of cosmetic and reconstructive breast surgery found 14% developed contact dermatitis, with allergy to cyanoacrylate confirmed by allergy scratch testing.…”

“…[51][52][53] There are multiple reports of contact dermatitis as a result of cyanoacrylate glue products, [53][54][55][56][57] with rates ranging from 0.5% to 14%, and have been hypothesized to vary based on anatomic location due to skin thickness. 53,58 A prospective study of cosmetic and reconstructive breast surgery found 14% developed contact dermatitis, with allergy to cyanoacrylate confirmed by allergy scratch testing. 53 Presentation is characterized by eczematous to urticarial dermatitis 5-14 days after surgery and can progress to a systemic response known as id reaction or auto-eczematization characterized by widespread macular/papular eruption and generalized pruritis.…”