What are the alternatives to Prineo (2-octyl cyanoacrylate) Dermabond for dressing in a patient with a severe adhesive allergy?

Alternatives to Prineo Dermabond for Patients with Severe Adhesive Allergy

For patients with severe adhesive allergies, silicone-based dressings are the recommended alternative to Prineo (2-octyl cyanoacrylate) Dermabond, as they provide effective wound coverage while minimizing skin damage and allergic reactions. 1

Understanding the Problem

Adhesive allergies in the medical setting typically present as:

• Contact dermatitis (either allergic or irritant) at the site of adhesive application 2
• Reactions to 2-octyl cyanoacrylate (the active component in Dermabond/Prineo) which have been increasingly reported in post-surgical patients 3
• Higher risk in patients with documented history of contact allergies (38.5 times higher odds of developing adhesive-related allergic contact dermatitis) 4

Recommended Alternatives

First-Line Options:

• Glycerin hydrogel or glycogel dressings

  • Strong recommendation for use as an alternative to standard adhesive dressings 5
  • Demonstrated significant reduction in infection scores compared to standard dressings 5
  • Can be applied the day after placement and changed weekly 5

• Silicone-based adhesive dressings

  • Provide reliable wound coverage with sufficient adhesion without negatively affecting periwound skin 1
  • Associated with minimal pain at removal and high patient satisfaction 1
  • Examples include Leukomed T skin sensitive and Leukomed T plus skin sensitive 1

Second-Line Options:

• Non-adherent dressings with secondary securing methods

  • Use gauze bandages or tubular bandages to secure dressings instead of adhesive tape 5
  • Consider soft silicone tapes if minimal adhesion is required 5
  • Use silicone medical adhesive remover when removing any adherent dressings 5

• Open wound management

  • For appropriate wounds, dressings can be omitted entirely and the site left open 5
  • After initial healing, cleansing with soap and water of drinking quality is sufficient 5

Application Techniques for Sensitive Skin

• For initial wound care:

  • Handle skin carefully to reduce shearing forces and minimize epidermal trauma 5
  • Apply a greasy emollient (50% white soft paraffin with 50% liquid paraffin) over the epidermis 5
  • Consider aerosolized formulations to minimize shearing forces 5

• For securing necessary medical devices:

  • Use soft bandages or tubular bandage to secure dressings and cannulas 5
  • Consider soft silicone tapes to attach essential clinical items 5
  • Avoid pressing adhesive materials firmly against the skin 5

Special Considerations

• For patients with extensive skin involvement:

  • Leave detached, lesional epidermis in situ to act as a biological dressing 5
  • Blisters should be decompressed by piercing and expression or aspiration of tissue fluid 5
  • Apply nonadherent dressings to denuded dermis (suitable options include Mepitel™ or Telfa™) 5

• For peristomal leakage or skin protection:

  • Use zinc oxide-based skin protectants 5
  • After stoma healing, reduce dressing changes to once or twice weekly 5

Monitoring and Follow-up

• Watch for signs of allergic reaction:

  • Erythematous pruritic rash initially localized over the incision that may spread to surrounding areas 3
  • In severe cases, widespread rash may develop requiring systemic steroids 3
  • Differentiate between allergic contact dermatitis and irritant contact dermatitis (more common) 2

• Wound assessment:

  • Monitor for signs of infection or delayed healing 5
  • Evaluate wound improvement regularly (94% of patients show improvement with appropriate non-allergenic dressings) 1

Pitfalls and Caveats

• Irritant contact dermatitis is more common than true allergic contact dermatitis to adhesives, but both can present similarly 2
• Patients with a history of adhesive or contact allergy have significantly higher risk of developing reactions to surgical adhesives 4
• Avoid preparations containing sensitizers or irritants in patients with known adhesive allergies 5
• Consider that patients may incorrectly self-report "adhesive allergy" when they've experienced irritant reactions rather than true allergic reactions 2