Skin manifestations in perioperative hypersensitivity: state of the art

Among the various manifestations of perioperative hypersensitivity (POH), skin reactions are often the first and most visible signs of an allergic or hypersensitivity response to drugs, antiseptics, or other agents in the perioperative setting. This review aims to examine the range and significance of skin manifestations associated with POH reactions, particularly their diagnostic value and clinical presentation in the perioperative setting.

Cutaneous signs such as urticaria, angioedema, flushing, and erythema are common in POH and may present alone or alongside systemic symptoms. While these manifestations are frequently observed, they are not universally present, especially in life-threatening reactions like anaphylaxis. The timing, distribution, and morphology of these skin changes can provide diagnostic clues, although intraoperative factors like draping, lighting, and hypotension may hinder their identification. Cutaneous vasoconstriction signs such as pallor, piloerection, sweating, and cyanosis are strong indicators of life-threatening IgE-mediated allergic reactions compared to early vasodilation signs like erythema or urticaria.

Skin manifestations play a crucial role in the early recognition and management of POH, but their absence should not lead to false reassurance. A thorough understanding of these signs is essential for accurate diagnosis and safe management in the perioperative environment.