Discussion
Cyanoacrylate (monomer) technology has the biochemical property of immediate polymerization on contact with moist, denuded skin, forming a flexible, breathable, continuous barrier to outside moisture and friction.[7,8] In laboratory testing, CSP has been shown to decrease transepidermal water loss (TEWL), similar to solvent-based nonalcohol-based polyacrylate skin protectant (Cavilon; 3M Health Care).[9] Chakravarthy et al[9] demonstrated equivalent TEWL between the 2 barriers 1 to 2 hours after application, which indicated that both serve as an excellent protective barrier; however, skin treated with CSP returned to baseline TEWL values after 2 hours despite the visible barrier, which indicates superior breathability of this technology. The researchers also demonstrated superior thickness of CSP compared with the polyacrylate skin protectant. Under microscopic evaluation, CSP had a tight binding to the outer epidermis and no visible gaps between the skin and solution. Woo and Chakravarthy[10] compared the same 2 products in human participants and demonstrated laboratory evidence of stronger protection afforded by CSP against moisture loss with washing and abrasion using a sponge. Clinical data from studies of adult patients support the efficacy of CSP in peristomal irritation, resulting in epidermal resurfacing and increased longevity of ostomy wafer use.[11] Intact tracheostomy site, without breakdown, was reported with cyanoacrylate use and reduced maceration in adults[12] with wet venous leg ulcers;[13] CSP was used to prevent peritracheostomy breakdown. Vlahovic et al[8] reported successful resolution of pedal skin fissures, with excellent patient satisfaction, no stinging, and fast pain resolution after treatment with CSP.
The current study supports the efficacy of CSP against moisture-associated skin damage seen in an ostomy and gastrostomy-associated dermatitis, peritracheostomy maceration, incontinence-associated dermatitis, and allergic contact dermatitis. Cyanoacrylate liquid skin protectant suppresses granulation tissue growth, likely by to diminished friction and allowing healing. In addition, progression of skin tears (Figure 8) and epidermal stripping were halted with 1 application of CSP. Challenging denuded and moist wounds resulting from various illnesses can benefit from the drying effects of CSP as demonstrated by improvement in difficult-to-manage GVHD lesions. The patients in the current study represented various ages, from preterm neonates with fragile, underdeveloped skin to extremely immunocompromised teenagers with multiple lesions affecting their body image and quality of life. Neonatal and pediatric pain scale scores reflected comfortable application of CSP, and older patients confirmed a lack of stinging, burning, or pain.
Figure 8.
(A) Initial skin tear presentation. (B) Cyanoacrylate liquid skin protectant and medical-grade honey were applied to the middle of the wound. (C) Healed skin at 14 days.
Limitations
The main limitation of this study is that it is a retrospective, single-center case series with a limited number of patients. Outcomes reported reflect the author's experience.
Wounds. 2022;34(3):83-89. © 2022 HMP Communications, LLC
