Tape adhesive dermatitis reaction
Question:
6/28/2017
I have a patient who develops a dermatitis in reaction to many types of adhesives. During her first cardiac ablation, she premedicated with loratadine and had tolerable reactions on areas of the body where adhesives were used. However, her eyes were closed shut with Tegaderm and she developed a significant periorbital dermatitis requiring topical steroid treatment. Paper tape was used to secure the NG tube, and she also developed a significant reaction on her face where the paper tape was applied. She is scheduled for another cardiac ablation. Could you recommend a premedication regimen that may alleviate some of these reactions if use of these adhesives cannot be avoided?
Answer:
From the description it appears that this patient is having either an irritant or allergic contact dermatitis to the tapes that have been used. My suggestion would be to clarify the type of tape used, clarify if any other medications or topical lotions/gels/ medications where used and if possible perform patch testing to these agents. Interestingly I found a recent Journal Watch article that suggests most of these tapes reactions are irritants type reactions. (http://www.jwatch.org/na36936/2015/02/19/tape-reactions).
As a practical answer, assuming this is all "tape related" given the significance of the reaction it would appear that avoidance of tape would be prudent. IV sites and the NG tube could be secured with gauze. It is not clear to me why the patient’s eyes were taped shut but given the reaction I would defer from doing this and the anesthesiologist will have to take extra care to keep the patients eyes protected and lubricated during the procedure. It may be worth a phone call to ophthalmology for guidance on this topic.
I hope this has been helpful
Andrew Murphy, MD