How to manage a patient with an allergy to Dermabond (cyanoacrylate-based tissue adhesive)?

From the Guidelines

For patients with an allergy to Dermabond (cyanoacrylate-based tissue adhesive), alternative wound closure methods such as traditional sutures, staples, adhesive strips, or alternative tissue adhesives like fibrin glue should be used immediately. When managing a patient with a known allergy to Dermabond, it is crucial to document this clearly in their medical record and avoid using cyanoacrylate-based adhesives to prevent allergic reactions, which can range from mild localized erythema and pruritus to more severe contact dermatitis 1.

Key Considerations in Management

• Alternative wound closure methods should be selected based on the size, location, and depth of the wound, as well as the patient's overall health status and history of allergies.
• Symptoms of an allergic reaction to Dermabond can include localized erythema, swelling, warmth, pruritus, or contact dermatitis at the application site, and if a reaction occurs, the adhesive should be removed carefully using petroleum jelly or acetone.
• Topical corticosteroids, such as hydrocortisone 1% cream applied twice daily for 3-5 days, can provide symptomatic relief for mild to moderate reactions.
• Oral antihistamines like diphenhydramine (25-50mg every 6 hours) may be used to manage pruritus, and in cases of severe reactions, oral prednisone (40-60mg daily for 3-5 days with taper) may be necessary.

Preventive Measures

• A thorough allergy history should be taken before using any tissue adhesive, especially in patients with multiple medical adhesive allergies who may have cross-reactivity.
• The choice of alternative tissue adhesive or wound closure method should be guided by the patient's specific allergy profile and the characteristics of the wound.
• Given the potential for severe reactions, including anaphylaxis, although rare, vigilance and preparedness for emergency situations are paramount when managing patients with known allergies to medical adhesives like Dermabond.

From the Research

Management of Allergy to Dermabond

• The management of a patient with an allergy to Dermabond (cyanoacrylate-based tissue adhesive) involves removal of the adhesive and mesh earlier than planned, and treatment with corticosteroids 2.
• In some cases, systemic antibiotics may be necessary, especially if there is a suspected superficial skin infection 2.
• Patch testing can be used to confirm the diagnosis of allergic contact dermatitis (ACD) to Dermabond, and may involve testing with cyanoacrylates of high purity, undiluted octyl cyanoacrylate, and/or Dermabond "as is" 3.
• Testing with higher concentrations and/or on abraded skin may be necessary to increase the yield of patch testing 3.

Prevention of Allergic Reaction

• Orthopedic surgeons should be aware of the potential for ACD to Dermabond, especially among patients with previous exposure to Dermabond products 2.
• Clinicians who routinely use tissue adhesives should understand the incidence, risk factors, and management of allergic reaction to these products 4.
• Alternative methods of wound closure, such as subcuticular suture, may be considered in patients with a known allergy to Dermabond 5.

Treatment of Allergic Reaction

• Local wound care and steroid administration may be necessary to manage an allergic reaction to Dermabond 4.
• In some cases, revision surgery may be necessary to manage an allergic reaction to Dermabond 4.
• The dermatitis caused by an allergic reaction to Dermabond typically resolves within 2 weeks of dressing removal, with no adverse effect on the orthopedic outcome 2.