CD21 A sticky situation: diagnosing skin glue allergy

Abstract

A 45-year-old woman developed wound dermatitis following breast surgery. Allergic contact dermatitis (ACD) to a skin glue was suspected. She was patch tested with a baseline series and Dermabond® (octyl cyanoacrylate). This showed allergy to terpenes, budesonide and chloroxylenol, with no reaction to Dermabond. She was referred for further assessment and tested to the British baseline series; cosmetic, fragrance, corticosteroids and acrylate allergens; Liquiband® (90% butyl cyanoacrylate and 10% octyl cyanoacrylate) and Histoacryl® (octyl cyanoacrylate). She had a strong allergic (++) reaction to Liquiband on days 2 and 4, with no reaction to Histoacryl or ethyl cyanoacrylate 10% in petrolatum. Allergy to terpenes was confirmed, with a weak allergy to para-phenylenediamine. The results confirmed a diagnosis of ACD to surgical glue. Cyanoacrylates are fast-acting glues (‘superglue’) used for press-on nails, continuous glucose monitors and surgical adhesives. Although initially considered nonsensitizing due to rapid polymerization triggered by water on the bonded surface, they are now well recognized as a cause of ACD, particularly octyl cyanoacrylate. Cyanoacrylates do not cross­react with other (meth)acrylates, and octyl cyanoacrylate has a low rate of crossreactivity with ethyl cyanoacrylate, the only cyanoacrylate currently available as a patch test reagent. Our patient’s isolated reaction to Liquiband suggests allergy to butyl cyanoacrylate, its main component. A review of 1551 patients who had skin adhesive wound closure reported the incidences of ACD from octyl cyanoacrylate and butyl cyanoacrylate to be 2.7% and 2.2%, respectively, with no statistically significant difference between the two. Our case illustrates the importance of testing different brands of glue to detect cyanoacrylate ACD. Glues should be tested straight after patch test preparation. Tape stripping or abrading the skin may increase sensitivity, but was unnecessary in our case, where testing on intact skin elicited a strong reaction.