Allergic Contact Dermatitis (ACD) to Topical Products in Orthopedic Surgery: Clinical Characteristics and Treatment Strategies

Document Type : CURRENT CONCEPTS REVIEW

Authors

1 SINY Dermatology, Brooklyn, NY, USA

2 Montefiore Medical Center - Department of Orthopedic Surgery, New York, USA

3 1 SINY Dermatology, Brooklyn, NY, USA 3 Department of Dermatology, NYU Langone Medical Center, New York, NY, USA

4 Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

Abstract

The potential for many of the commonly used surgical site wound adhesives, skin antiseptic solutions, 
topical antibiotics, and suture materials to sensitize and subsequently result in allergic contact 
dermatitis (ACD) has become increasingly recognized within orthopedic surgery. Particularly with 
subsequent exposure to the offending allergen, the cutaneous allergic reaction may present in a similar 
fashion to cellulitis, thus making early differentiation between the two etiologies to initiate the 
appropriate and timely treatment crucial. Recognition of the characteristic appearance and severity of 
ACD surrounding a surgical wound often drives the initial management. This typically consists of anti -
histamines, topical corticosteroids, and possible removal of the offending allergen for low grade findings 
and oral steroids and prophylactic oral antibiotics for the more severe reactions. Multidisciplinary care, 
including the expertise of a dermatologist or wound care specialist when faced with this challenging 
clinical scenario is critical and elective patch testing may be indicated to ascertain the exact allergen 
involved, particularly in patients with a prior history of wound issues. Finally, any clinical cases of ACD 
following an orthopedic procedure should be documented in the patient’s chart so that exposure can 
be avoided with any future surgery. 
 Level of evidence: III

Keywords

Main Subjects

References

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4.                Drucker AM, Pratt MD. Acrylate contact allergy: patient characteristics and evaluation of screening allergens. 

Dermatitis. 2011; 22(2):98-101.

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  23. Lauriola MM, Corazza M. Allergic contact dermatitis due to a preoperative antiseptic solution. Contact Dermatitis. 2021; 85(4):460-462. doi: 10.1111/cod.13879.
  24. Dick AG, Dhinsa B, Walker RP, Singh S. Delayed allergic reaction to ChloraPrepTM in foot and ankle surgery. J Foot Ankle Surg. 2019; 58(1):192-194. doi: 10.1053/j.jfas.2018.08.019.
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32. Al-Qattan MM, Kfoury H. A delayed allergic reaction to 

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  8. Choi KY, Koh IJ, Kim MS, Park DC, Sung YG, In Y. 2-Octyl Cyanoacrylate topical adhesive as an alternative to subcuticular suture for skin closure after total knee arthroplasty: a randomized controlled trial in the same patient. J Arthroplasty .2021; 36(9):3141-3147. doi: 10.1016/j.arth.2021.04.033.
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  12. Yagnatovsky M, Pham H, Rokito A, Jazrawi L, Strauss E. Type IV hypersensitivity reactions following Dermabond adhesive utilization in knee surgery: a report of three cases. Phys Sportsmed. 2017; 45(2):195-198. doi: 10.1080/00913847.2017.1283208.
  13. Chalmers BP, Melugin HP, Sculco PK, Schoch JJ, Sierra RJ, Pagnano MW, Stuart MJ, Taunton MJ. Characterizing the diagnosis and treatment of allergic contact dermatitis to 2-octyl cyanoacrylate used for skin closure in elective orthopedic surgery. J Arthroplasty. 2017; 32(12):3742-3747. doi: 10.1016/j.arth.2017.07.012.
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  15. Pate RC, Neumeister MW. Severe wound complication due to Prineo surgical dressing in shoulder hemiarthroplasty: a case report. JBJS Case Connect. 2020; 10(1):e0306. doi: 10.2106/JBJS.CC.18.00306.
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The Archives of Bone and Joint Surgery
Volume 11, Issue 10
October 2023
Pages 604-616

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History

  • Receive Date: 30 January 2023
  • Revise Date: 17 July 2023
  • Accept Date: 08 July 2023

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