Surgical Site Allergic Contact Dermatitis to 2-Octyl-Cyanoacrylate: A Systematic Review and FDA MAUDE Review

Background: Skin adhesives containing 2-ocyl cyanoacrylate are a common source of allergic contact dermatitis (ACD) that complicate postoperative wound healing. There are limited studies that describe postoperative cutaneous reactions to skin adhesives and clinical management.

Objectives: To review the incidence, description, and clinical management of surgical site ACD to 2-ocyl cyanoacrylate.

Methods: A comprehensive systematic literature search was conducted in September 2023 using PubMed/MEDLINE, Web of Science, and Cochrane databases for studies reporting ACD after skin closure with liquid adhesives containing 2-octyl-cyanoacrylate. Additionally, we queried the FDA MAUDE in September 2023 and retrieved clinician-inputted records of ACD caused by liquid adhesives containing 2-octyl-cyanoacrylate from 2014-2023.

Results: Nine articles were included for review, with a median of 102 patients exposed to 2-ocyl cyanoacrylate for surgical site skin closure. The reported incidence of cutaneous reactions to 2-ocyl cyanoacrylate ranged from 0.5% to 14%. 609 unique FDA MAUDE records reporting surgical site skin reactions to 2-ocyl cyanoacrylate were included. Orthopedic procedures were the most common type of procedure, representing 47% of FDA MAUDE records. Nineteen clinical descriptors of cutaneous reactions were utilized. Topical corticosteroids and oral antihistamines were the most commonly prescribed treatments to manage postoperative cutaneous reactions.

Conclusions: Reported incidences of cutaneous reactions to 2-ocyl cyanoacrylate vary widely and guidelines for clinical management remain unclear. The FDA MAUDE provides important insights to cutaneous reactions to 2-ocyl cyanoacrylate including surgery-type, cutaneous descriptors, and clinical management. Future research is needed to identify patients at risk of 2-ocyl cyanoacrylate skin reactions in the preoperative setting.