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

Abstract

Sir: With great interest, we read the article entitled “Should We Stick with Surgical Glues? The Incidence of Dermatitis after 2-Octyl Cyanoacrylate Exposure in 102 Consecutive Breast Cases” by Nigro et al.1 In this article, the incidence of cyanoacrylate reaction is 14 percent, which is notably higher than that previously reported. Thus, the authors believe that cyanoacrylate glue use warrants a general reconsideration by surgeons and other physicians. However, there are some issues that may result in such a high incidence. Herein, we would like to talk about these issues. At the same time, we would like to share a bit of our experience in the application of cyanoacrylate glue as well. First, in the study by Nigro et al., the patients are all women, the mean age ± SD is 50.99 ± 13.40 years, and the study was carried out from January of 2018 to September of 2018, over a span of spring and summer. However, according to the study by the European Surveillance System on Contact Allergies,2 female sex and age older than 40 years were both risk factors for polysensitization. Meanwhile, Fleischer3 found that the greatest incidence of allergic dermatitis occurs in May and June; increased temperatures are associated with an increased likelihood of allergic dermatitis. Therefore, sex, age, and season are all risk factors that would greatly increase the incidence of polysensitization and allergic dermatitis in their study. Second, the location of surgical incision may have an impact on the results. We wonder whether dermatitis that occurred in the submammary fold incision as shown in the authors’ Figure 1 is more serious than others. Moreover, in terms of our experience, we press the breast down with elastic bandages after breast implant surgery, and the submammary fold may be “hidden deeper,” which may result in worse symptoms. Third, we suggest that the authors provide more information about the severity of postoperative allergic dermatitis with regard to symptoms such as erythema, urticaria, and pruritus. Another suggestion is that the results of scratch testing had better be evaluated by scoring. In this way, it would be better to take a few minutes to analyze the correlation between the two. The application of cyanoacrylate glue in surgery has become frequent. It has been popular for years because of its advantages, including intrinsic bactericidal properties, watertight nature, added wound/incisional strength, and aesthetics.4 In our department, cyanoacrylate glue is frequently used, while allergic dermatitis is rarely seen. Therefore, we think there are multiple factors that result in such a high incidence. If the above issues are taken into consideration, the results will be different. In our minds, to make the results appear more rigorous enough, a larger data analysis of multiple regions and multiple institutions is needed. In this way, we will also have a more comprehensive understanding of allergic reactions to cyanoacrylate. In the end, we are very grateful for authors’ sharing. It alerts us to apply cyanoacrylate with caution, and we also look forward to further research. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication.