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Rouhani DS, Rosenbloom  A, Zeng S, Sun A, et al. . J Am Coll Surg. March 2026.

This systematic review and meta-analysis synthesized data from 74 studies encompassing 26,330 patients exposed to 2-octyl cyanoacrylate (2-OCA) adhesives to define the incidence and risk profile of allergic contact dermatitis (ACD) in surgical wound closure. 

Among 20 analytic cohorts (n = 25,442), the pooled incidence of ACD was 4%, although there was substantial heterogeneity (I²=94.5%) reflecting differences in study design. Subgroup analysis demonstrated variability by specialty, with higher rates in plastic surgery (8%) compared to orthopedic (4%) and obstetrics/gynecology (2%) cohorts (p = 0.015), suggesting that procedural factors such as adhesive volume and surface area exposure influence risk. The increasing proportion of studies published after 2020 (48.6%) further indicates growing recognition of this complication. 

A consistent and clinically important finding across studies was the marked impact of re-exposure and sensitization. Initial exposure carried relatively low risk (~1–3%), whereas repeat exposure increased reaction rates to >20% in several cohorts, including a 22-fold increase in staged bilateral total knee arthroplasty and 6.5-fold increased odds (OR 6.48) in arthroplasty patients with prior exposure. Additional sensitization pathways including prior cosmetic acrylate exposure (nail or eyelash adhesives) were frequently implicated, supported by patch testing demonstrating cross-reactivity across cyanoacrylate compounds.

Given the significant increase in contact dermatitis with increased surface area or re-exposure to cyanoacrylate, surgeons should consider these risk factors when choosing whether to add these adhesives as a part of the closure technique and individualize patient care based on risk factors.