The presenting differential diagnosis of these patients would include cellulitis, but the presentation of the patients was not consistent with an infectious cause with, specifically, the lack of fever, induration, local discomfort, or increased warmth. Neither patient had a sense of malaise. Of significance in both patients was the painless intense pruritic nature of the erythema, which is also not consistent with cellulitis.
2-Octylcyanoacrylate is a monomer in liquid form. On contact with tissue anions (e.g., tissue, blood, fluid), there is rapid polymerization and binding to epidermal keratin in an exothermic reaction.2,3 It is touted that the speed of polymerization and high reactivity of the cyanoacrylate compound should prevent the molecule from being a strong immunosensitizer.1,3
The long-term treatment of contact dermatitis ideally is avoidance of the contact allergen. Short-term treatment includes removal of the offending material and possibly brief use of a topical steroid.1 Application of 2-octylcyanoacrylate should be avoided on open wounds or incompletely closed surgical incisions to avoid immunosensitization and subsequent development of allergy to cyanoacrylates.
Although contact dermatitis secondary to Dermabond is seemingly rare, plastic surgeons should be prepared to recognize the presence of 2-octylcyanoacrylate allergy and treat accordingly. The exanthem is hallmarked by intense painless pruritus. Treatment consists of removal of the Dermabond and consideration of short-term use of topical steroids.
Dr. Howard has not received any financial support from and has no financial interest in Ethicon, Inc. Dr. Downey has been a paid consultant for Ethicon, Inc., in the past.
Brian K. Howard, M.D.
Susan E. Downey, M.D.
Los Angeles, Calif.
1. Hivnor CM, Hudkins ML. Allergic contact dermatitis after postsurgical repair with 2-octylcyanoacrylate. Arch Dermatol
2. Ethicon, Inc. Dermabond package insert. Somerville, NJ: Ethicon, Inc.
3. Tomb RR, Lepoittevin JP, Durepaire F, Grosshans E. Ectopic contact dermatitis from ethyl cyanoacrylate instant adhesives. Contact Dermatitis
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