Reply: Should We Stick with Surgical Glues? The Incidence of Dermatitis after 2-Octyl Cyanoacrylate Exposure in 102 Consecutive Breast Cases.

Abstract

Sir: We greatly appreciate the comments on our article “Should We Stick with Surgical Glues? The Incidence of Dermatitis after 2-Octyl Cyanoacrylate Exposure in 102 Consecutive Breast Cases” and would like to thank the authors for sharing their experience with Dermabond Prineo (Ethicon, Inc., Somerville, N.J.).1 The inclusion of a self-adhering mesh in the product makes it unique as compared to the cyanoacrylate agents we studied. Despite this, it is most likely the liquid component (the 2-octyl cyanoacrylate) that is causing the “extreme reactions” noted. Allergy testing would be warranted to verify the true allergen in this case. The authors noted that only one of the three patients with reactions had a known allergy to tapes, but that the other two had no known history of allergy to cyanoacrylate, formaldehyde, tapes, or adhesives. In preparing our own study, we were surprised to learn how commonplace cyanoacrylate is in everyday consumer products (e.g., lash extension glue, artificial nail glue, wire wrapping, over-the-counter cyanoacrylate wound dressings, household glues). Many patients may not be aware of or recall prior reactions to such products. In addition, although we were unable to demonstrate a statistical significance in our study, we believe repeated exposures increase the likelihood of a reaction to surgical glue. Perhaps repeated prior exposures to cosmetic products (e.g., lashes and nails) sensitized the patients to Prineo. With regard to patch testing before the use of Prineo on patients, this raises some practical considerations. Given that there would be a risk of sensitizing with a patch test because of the theoretical additional exposure, albeit small, it may be worth selectively patch testing patients with prior exposure to such cosmetic products and other cyanoacrylate-containing products before applying Prineo, Dermabond, Liquiband (Advanced Medical Solutions Limited, Winsford, Cheshire, United Kingdom), and others. The cost of each individual-use vial used for each patient’s patch test is quite high. Using an alternative to surgical grade cyanoacrylate, such as can be found over the counter in pharmacies for minor wounds, would be a less expensive option but may be unreliable. Alternatively, the risks could be relayed to the patient for a joint decision on whether to test the surgical glue or not. This is certainly an area warranting further research. We appreciate the authors sharing their experience with reactions to Prineo for plastic surgeons worldwide. DISCLOSURE The authors have no financial disclosures to report.