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

Skin adhesives containing 2-octyl cyanoacrylate are a common source of allergic contact dermatitis (ACD), a complication of postoperative wound healing. Few studies have described postoperative cutaneous reactions to skin adhesives and their clinical management. The aim of this study was to review the incidence, descriptions, and clinical management of surgical site ACD caused by 2-ocyl cyanoacrylate. A comprehensive systematic literature search was conducted in September 2023 of the PubMed/MEDLINE (National Library of Medicine, Bethesda, MD), Web of Science (Clarivate Analytics, Philadelphia, PA), and Cochrane databases (Cochrane Library, John Wiley & Sons, Ltd., Hoboken, NJ) for studies reporting ACD after skin closure with liquid adhesives containing 2-octyl cyanoacrylate. Additionally, we queried the FDA Manufacturer and User Facility Device Experience (FDA MAUDE, U.S. Food and Drug Administration, Silver Spring, MD) in September 2023 and retrieved clinician-inputted records of ACD caused by liquid adhesives containing 2-octyl cyanoacrylate from 2014 to2023. Nine articles were included for review, with a median of 102 patients exposed to 2-octyl cyanoacrylate for surgical site skin closure. The reported incidence of cutaneous reactions to 2-octyl cyanoacrylate ranged from 0.5% to 14%. The review also included 609 unique FDA MAUDE records reporting surgical site skin reactions to 2-octyl cyanoacrylate. 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. Reported incidences of cutaneous reactions to 2-octyl cyanoacrylate vary widely and guidelines for clinical management remain unclear. The FDA MAUDE provides important insights to cutaneous reactions to 2-octyl cyanoacrylate including surgery-type, cutaneous descriptors, and clinical management. Future research is needed to identify patients at risk of 2-octyl cyanoacrylate skin reactions in the preoperative setting.

Level of evidence: 3 (therapeutic):