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2-octyl cyanoacrylate topical skin adhesives are associated with a 4% incidence of allergic contact dermatitisSkin glue used in surgery can cause allergic reactions

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Key Takeaway
Recognize that 2-octyl cyanoacrylate carries a 4% risk of allergic contact dermatitis, with higher rates in plastic surgery.

This meta-analysis synthesized data from 20 analytic cohorts to evaluate the incidence and characteristics of allergic contact dermatitis (ACD) in patients undergoing surgical wound closure with 2-octyl cyanoacrylate (2-OCA) topical skin adhesives. The total study population included 25,442 patients. The primary objective was to determine the incidence of ACD specifically related to 2-OCA adhesive use.

The analysis identified a pooled ACD incidence of 4% (95% CI 3% to 5%). However, the incidence varied significantly based on the surgical specialty of the cohort. Specifically, the incidence of ACD in orthopaedic cohorts was reported at 4%, while the incidence in plastic surgery cohorts was notably higher at 8%. Statistical analysis of subgroup differences across orthopaedic, plastic surgery, dermatology, and OB/GYN cohorts revealed significantly lower rates in dermatology and OB/GYN (p = 0.015).

Secondary outcomes focused on clinical features, risk factors, and the impact of reexposure. A critical finding was the impact of reexposure on reaction rates in cases involving staged or repeat procedures. In these instances, the reaction rates increased from 1% to 3%. This indicates a strong association between reexposure and increased postoperative reaction rates, which may be relevant for patients requiring multiple procedures.

Regarding safety and tolerability, the primary reported adverse event was allergic contact dermatitis. No specific data regarding serious adverse events, discontinuation rates, or general tolerability metrics were provided in the meta-analysis. The study notes that while the association between reexposure and increased reaction rates is strong, the data is derived from a mix of randomized, observational, and case-based reports.

Methodologically, the meta-analysis was characterized by substantial heterogeneity, with an I2 value of 94.5%. This high level of heterogeneity suggests significant variability in the included studies, which may impact the precision of the pooled estimates. The inclusion of diverse study designs, including case-based reports, contributes to this variability.

These results suggest that ACD to 2-OCA is a clinically meaningful and likely underrecognized complication in surgical practice. The variation in incidence between orthopaedic and plastic surgery cohorts, as well as the increased risk upon reexposure, suggests that clinicians should perform proactive risk assessments. These findings may influence how surgeons counsel patients and manage expectations regarding potential hypersensitivity reactions to skin adhesives.

Several questions remain regarding the specific clinical features and underlying risk factors that drive the higher incidence in certain specialties. Furthermore, the high heterogeneity of the data limits the ability to pinpoint the exact causes of the variance between surgical cohorts. Future research may need to focus on identifying specific patient phenotypes more prone to these reactions.

How this fits prior evidence

How this fits prior evidence: This meta-analysis addresses a gap in the management of allergic contact dermatitis by identifying a specific, underrecognized complication related to 2-octyl cyanoacrylate. While previous reviews highlighted critical gaps regarding tissue-resident memory T cells and sensitization thresholds in allergic contact dermatitis, this analysis provides specific incidence data (4% pooled) and identifies reexposure as a significant risk factor for increased reaction rates.

When a person undergoes surgery, doctors often use special medical glues to close wounds or incisions. One specific type of glue, known as 2-octyl cyanoacrylate, is commonly used because it provides a strong bond for the skin. However, some patients may experience a skin condition called allergic contact dermatitis. This is an itchy, red, and irritated rash that occurs when the skin reacts to a specific substance. Understanding the risks of this reaction is important for patients who need surgical procedures involving skin adhesives.

To better understand this issue, researchers conducted a meta-analysis, which is a large-scale review of existing data. They looked at information from 20 different groups of patients, totaling more than 25,000 people. These patients were undergoing various procedures, including orthopedic surgeries, plastic surgeries, and dermatology treatments. The goal was to determine how often people developed an allergic reaction to the specific glue used to close their wounds.

The findings showed that about 4 percent of all patients in the study developed an allergic reaction to the glue. However, the rate varied depending on the type of surgery. For example, patients in plastic surgery groups had a higher rate of reactions, at 8 percent, compared to those in other fields. The study also found that the risk of a reaction increased significantly if a patient had a second procedure involving the same glue. In these cases, the reaction rate jumped from 1 percent to 3 percent. This suggests that if a patient has a follow-up surgery, they may be at a higher risk for a skin reaction.

While the study identifies a clear link between the glue and skin irritation, there are some limitations to keep in mind. The data came from a mix of different types of reports, including observational and case-based studies. There was also a high level of variation in how the data was collected across the different groups. Because of these factors, the results should be viewed as a helpful guide rather than a definitive rule for every individual patient.

For patients today, this research means that allergic reactions to surgical glue are a real possibility, even if they are not always caught early. It highlights the importance of talking to a doctor before surgery. If you are scheduled for a procedure that uses skin glue, you can ask your medical team about the risk of allergic reactions and how they plan to monitor your skin during and after the procedure.

What this means for you:
About 4 percent of patients may develop a skin rash from surgical glue, with higher risks during repeat procedures.

Study Details

Study typeMeta analysis
Sample sizen = 25,442
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: For surgical wound closure, 2-octyl cyanoacrylate (2-OCA) topical skin adhesives are widely used but are increasingly associated with allergic contact dermatitis (ACD). We conducted a systematic review and meta-analysis to define the incidence, clinical features, and risk factors for 2-OCA-associated ACD. STUDY DESIGN: A systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines identified studies from PubMed, Embase, and Web of Science (2008 to 2025) reporting cutaneous hypersensitivity to 2-OCA in human wound closure. Randomized, observational, and case-based reports were included. Risk of bias was assessed using the Cochrane ROBINS-I and RoB-2 tools. Incidence from analytic cohorts was pooled using a random-effects model with prespecified subgroup analyses by surgical specialty. RESULTS: Seventy-four studies comprising 26,330 exposed patients were included; 20 analytic cohorts (25,442 patients) contributed to the meta-analysis. The pooled ACD incidence was 4% (95% CI 3% to 5%) with substantial heterogeneity ( I2  = 94.5%; prediction interval 0% to 12%). Incidence was 4% in orthopaedic cohorts and 8% in plastic surgery cohorts, with lower rates in dermatology and OB/GYN (p = 0.015 for subgroup differences). Reexposure markedly increased risk, with reaction rates rising from 1% to 3% after initial exposure to >20% in staged or repeat procedures in several cohorts. Earlier adhesive contact allergy and cosmetic acrylate exposure were also strong risk factors. Diagnosis was primarily clinical, with selective patch testing. Management typically involved adhesive removal and topical corticosteroids; systemic therapy was reserved for severe cases. CONCLUSIONS: ACD to 2-OCA is a clinically meaningful and likely underrecognized complication of surgical wound closure. Reexposure is strongly associated with increased postoperative reaction rates, supporting preoperative risk assessment and caution in repeat adhesive use.
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