Systemic contact dermatitis caused by a surgical glue

Surgical glues, such as octyl cyanoacrylate, are widely used by many surgeons as alternatives to traditional sutures. The polymerization of octyl cyanoacrylate monomers, which is catalysed by the presence of moisture on the surface of the polymer, occurs rapidly. Because of their convenience, rapid action and powerful clinical applications, surgical glues, represented by octyl cyanoacrylate, are strongly favoured by surgeons. Here, we report the first case of systemic contact dermatitis (SCD) caused by one type of surgical glue (SurgiSeal, Surgical Specialties Corporation, Virginia) and highlight the diagnosis of delayed-type hypersensitivity secondary to immediate-type hypersensitivity.
A healthy 38-year-old woman presented with poor wound healing and serous exudation on the dorsal side of her feet 2 weeks after Swanson implant (Wright Medical Technology, Arlington, Virginia) arthroplasty for Freiberg disease. SurgiSeal (Surgical Specialties Corporation, Virginia), a surgical glue containing octyl cyanoacrylate, was used to close the wound. Two weeks later, a diffuse, itchy rash began to appear covering her entire body. Locally, a wound infection was initially suspected, but cultures were negative. The patient had no history of the following: atopy; similar skin reactions; previous contact with artificial nail adhesives, false eyelash glues, medical devices with glucose sensors or other implants; or relevant dental treatments.
On examination, the wound was red with swelling and a small serous exudative scab; the long-standing erythematous maculopapular rash was restricted to this area (Figure 1). Scattered papules and papulovesicles were also observed on her trunk and limbs (Figure 2). Treatment with antihistamines and topical corticosteroids yielded poor results.
The patient underwent extensive patch testing with the European baseline series (Chemotechnique Diagnostics, Vellinge, Sweden), an acrylate series (not including octyl cyanoacrylate) and a plasticizer series. SurgiSeal and the silicone implant were also tested “as is”. We used IQ Ultra chambers (Chemotechnique Diagnostics). Readings were taken on day (D) 3 and D5, according to the criteria of the International Contact Dermatitis Research Group (ICDRG) and European Society of Contact Dermatitis (ESCD) [1]. SurgiSeal caused positive reactions on both days (D3, +++; D5, +++). Other allergens were negative, and so were tests for other surgery-related substances. SurgiSeal was...


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