- Research Article
2
- 10.1111/cod.14576
Cyanoacrylate contact allergy: Tape stripping modification of conventional patch testing.
- May 10, 2024
- Contact dermatitis
- Ruchika Kumari + 6 more +6
Eight patients with suspected cyanoacrylate contact allergy post-surgery underwent patch testing with an extended European baseline of contact allergens and a ‘mini’ acrylates series (Chemotechnique Diagnostics, Vellinge, Sweden, in IQ Ultra™ chambers). Additionally, patch testing with the surgical glues Dermabond® (2-octyl cyanoacrylate, Ethicon, New Jersey) or Histoacryl® (n-butyl cyanoacrylate, B. Braun Medical Ltd, Sheffield, UK), was performed, in the conventional manner for all eight cases, and with tape stripping before application for cases 4–8. Allergens were occluded for 2 days, with readings on days 2, 4 and 7 in line with European Society of Contact Dermatitis guidelines. Tape stripping was performed by applying adhesive tape (Sellotape®) uniformly, 20 times, on the upper arm, prior to the application of the cyanoacrylates. Five of the patients (case 1–5) had a negative or doubtful reaction on conventional patch testing to the skin adhesive despite strong clinical suspicion, two of whom were strongly positive at the tape strip testing sites (Table 1, Figure 1). Conversely, all cases where tape strip testing was performed were positive. Ethyl cyanoacrylate (ECA) was positive in five cases; only one patient had a history of prior reactions to glue used for artificial nails. Dermabond® (N) ECA (N) Lipofilling to left breast reconstruction closed with Dermabond® N.B. left mastectomy 2 years previously, complicated with infection requiring multiple surgical procedures Dermabond® (N) ECA (+++) Itchy, blistering eruption around incisions – 48 h post-surgery N.B. History of similar skin reactions with glues used with artificial nails Dermabond® (N) ECA (++) Dermabond® (N) ECA (N) Dermabond® (++) ECA not tested Histoacryl® (?+) ECA (?+) Histoacryl® (++) ECA (++) Dermabond® (+) ECA (+) Dermabond® (++) ECA (++) Battery change for sacral neuromodulator– closed with Dermabond® N.B. initial sacral neuromodulator fit 5 years previously- also closed with Dermabond® Dermabond® (+) ECA (+) Dermabond® (++) ECA (++) Dermabond® (++) ECA (N) Dermabond® (+++) ECA not tested Cyanoacrylates are commonly found in adhesives used in domestic and healthcare environments. ECA is found in eyelash glues and ‘superglues’. Topical skin adhesives (e.g., Dermabond®, Histoacryl®) are increasingly used for closure of small wounds. These are quick and easy to use, with a favourable cosmetic outcome compared with more traditional suturing.1, 2 They rapidly polymerize and bond to surface keratin, which is thought to prevent penetration beyond the stratum corneum, therefore avoiding antigen-presenting cells deeper in the epidermis.3 Both 2-octyl cyanoacrylate and n-butyl cyanoacrylate are not commercially available patch testing allergens. Tape stripping before patch testing is a modification which removes the stratum corneum barrier that limits hapten penetration. This increases bioavailability in the deeper epidermal layers and upper dermis, mimicking the use of cyanoacrylates during surgical procedures.2, 4 It is a less invasive method of removing the stratum corneum compared with scratch testing or skin abrasion. Dickel et al. have published a suggested method for strip patch testing, aiming to reach the stratum lucidum.4 In our case series, we used a standardized number of 20 applications of adhesive tape. In our cohort, it was user-friendly and efficient for the healthcare professionals, reproducible and well tolerated by all our patients. In four patients who tested positive to Dermabond® or, Histoacryl®, three reacted to ECA as well when tested. Potential cross-reactivity or co-sensitisation has previously been reported.2 In a larger study, just 29% of Dermabond-allergic patients had positive patch test reactions to ECA.5 Therefore, we consider it helpful to also test to ECA in patients with suspected 2-octyl or butyl cyanoacrylate allergy, but it may not be a sensitive enough marker when tested alone. This case series highlights the increased sensitivity of patch testing to cyanoacrylates by using the simple and pragmatic method of tape stripping prior to the application of the allergen. It is particularly useful for testing with the medical adhesives themselves where the suspected allergens are not commercially available. Ruchika Kumari: Writing – original draft; writing – review and editing; investigation; data curation; project administration. Analyn Gelvezon: Writing – review and editing; investigation; data curation; project administration. Ying X. Teo: Writing – review and editing; investigation; data curation; project administration. Louise Cunningham: Writing – review and editing; investigation; data curation; project administration. Sheila M. McSweeney: Investigation; data curation. John P. McFadden: Conceptualization; supervision. Ian R. White: Conceptualization; writing – review and editing; investigation; data curation; validation; supervision. The authors declare no conflicts of interest. Consent has been provided by all patients included for images to be used for publication.
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