Systematic Review and Meta-Analysis of Allergic Contact Dermatitis from 2-Octyl Cyanoacrylate Adhesives

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.

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.

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.

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.