Repeat Exposure to Mesh-Glue Dressing Is Associated With Allergic Contact Dermatitis: A Prospective Cohort Study.

Abstract

<h4>Background</h4>Certain postoperative dressing types have been associated with allergic contact dermatitis (ACD), presenting as a peri-incisional eczematous skin reaction. The purpose of this study was to compare rates of ACD following arthroplasty between patients who have prior exposure and those naïve to a specific dressing type (self-adhesive polyester mesh and 2-octyl cyanoacrylate liquid adhesive).<h4>Methods</h4>There were 222 patients undergoing 245 procedures (163 total knee arthroplasties, 69 total hip arthroplasties, and 13 unicompartmental knee arthroplasties) who were prospectively evaluated between August 2023 and May 2024 at a single institution. Patients were categorized as "exposed" or "naïve" based on prior exposure to the studied dressing. Patients were excluded if they had a previous skin reaction to the mesh-glue dressing or unknown exposure. Skin checks were performed on postoperative days 7 and 14. The primary outcome of the study was ACD requiring treatment. Baseline demographics, comorbidities, and 90-day complications were compared. Multivariable logistic regression analysis was utilized to determine the independent risk of dressing exposure on ACD. There were 86 procedures in patients previously exposed and 159 in those naïve to a specific dressing type. There were no differences in age, sex, smoking status, body mass index, or Charlson Comorbidity Index between the two cohorts (P > 0.05).<h4>Results</h4>An ACD was more common in exposed patients (seven of 86; 8.1%) than in naïve patients (three of 159; 1.9%; P = 0.030). After controlling for sex, age, body mass index, procedure type, and Charlson Comorbidity Index, exposed patients were more likely to experience ACD (odds ratio: 6.48, 95% confidence interval: 1.64 to 25.43, P = 0.003).<h4>Conclusions</h4>Previous exposure to the mesh-glue dressing increases the risk of ACD by 6-fold as compared to dressing naïve patients. This is likely through a type-IV delayed hypersensitivity reaction. Although symptoms uniformly resolved with treatment, clinicians should weigh the benefits of repeat use of this dressing given the risk of ACD.<h4>Level of evidence</h4>Therapeutic Level II.