Topical skin adhesives

Author: Alicia May Li Loh, Medical Student, University of Auckland, New Zealand, 2010.


What are topical skin adhesives?

The topical skin adhesives (or glues) are liquid cyanoacrylate monomers that polymerize into long solid chains upon contact with blood or a wound surface, thus holding wound edges together.1

The table below lists the types of topical skin adhesives along with their trade name.

TypeTrade name
2-Octyl-cyanoacrylate Dermabond®
SurgiSeal™
n-2-Butyl-cyanoacrylate Histoacryl®
Indermil®
GluStitch™, GluSeal®, PeriAcryl®
LiquiBand™
2-Ethyl-cyanoacrylate Epiglu®
Topical skin adhesives

When can topical skin adhesives be used?

Topical skin adhesives are ideal for simple cuts such as punctures from minimally invasive surgery (e.g. hair transplantation), skin graft sites, and simple trauma-induced lacerations.

Topical skin adhesives are ideal for:

  • non-bleeding wounds in areas where skin is not being stretched or pulled
  • hair-free areas of the skin
  • areas not inside the mouth
  • children, to avoid pain of local anaesthetic injection.

However, topical skin adhesives cannot be used on all cuts. They are generally not used on:

  • infected or gangrenous wounds
  • patients with a known hypersensitivity / allergy to cyanoacrylate or formaldehyde.

What are the benefits of topical skin adhesives?

Benefits of topical skin adhesives include:

  • fast and painless
  • do not leave any hatch marks (unlike sutures and staples) which results in excellent cosmetic outcome
  • do not require a follow-up procedure to remove them after their purpose has been achieved — topical skin adhesives simply sloughs off spontaneously after 5 to 10 days
  • eliminate the fear and risk of needle sticks
  • create a moist environment which provides the optimal condition for wound healing
  • have antimicrobial features against gram-positive organisms so less risk of wound infection 3

Are there any disadvantages?

Disadvantages compared to suturing include:

  • The wound strength using cyanoacrylates is reduced and may be only 10% of a sutured wound. The wound should be tape stripped for reinforcement.
  • Ointments should not be applied to the wound as they weaken the skin adhesive
  • Blood or serous fluid may accumulate beneath the plastic membrane preventing healing and increasing risk of infection
  • The final cosmetic result for facial wounds may not be not as good as with conventional sutures

Are there any side effects from topical skin adhesives?

At the time of treatment some patients may report a sensation of heat or minor discomfort.

After treatment the area may be red, swollen, painful or tender. See your doctor if these signs persist for a few weeks.

Besides that, topical skin adhesives can also cause wound dehiscence (reopening of a previously closed wound). Topical adhesive may be reapplied or sutures can be used.

In rare cases, contact allergic dermatitis may occur during or after the treatment. Reactions usually clear up in a few days but occasionally persist for months. See your doctor immediately if you have an allergic reaction.

Allergic reactions may include:

  • Shortness of breath, low blood pressure, and chest pain.
  • Urticaria (hives)
  • Red, itchy or sore lumps at injection sites

The safety of topical skin adhesives on animals has not been established.

How can I take care of the wound?

  • Check how the wound looks.
  • Do not put any medicine or ointment on the wound.
  • Keep the wound dry.
  • Protect the wound with a non-stick dressing.

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Related information

 

References:

  • Quinn JV. Clinical Approaches to the Use of Cyanoacrylate Tissue Adhesives. In: Quinn JV, ed. Tissue Adhesives in Clinical Medicine. 2nd ed. Hamilton, Ontario: BD Decker Inc; 2005:27-76.
  • Singer AJ, Hollander JE, Quinn JV. Evaluation and management of traumatic lacerations. N Engl J Med. 1997;337(16):1142-1148.
  • Quinn JV, Osmond MH, Yurack JA, Moir PJ. N-2-butylcyanoacrylate: risk of bacterial contamination with an appraisal of its antimicrobial effects. J Emerg Med. 1995;13(4):581-585.

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