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Contact dermatitis from Mastisol® spray adhesive used to secure epidural catheters in laboring women
Abstract Number: F-81
Abstract Type: Case Report/Case Series
Introduction: Many women choose epidural analgesia for labor and adhesive spray is commonly used to prevent dislodgement of the catheter during labor and delivery. We discuss an increased incidence of contact dermatitis after switching from Vi-Drape (Medical Concepts) adhesive to Mastisol (Ferndale Laboratories).
Case: 33 yo G2P1 presenting for induction of labor for preeclampsia. Patient received a combined spinal-epidural procedure for labor analgesia and catheter was secured with Mastisol spray, Tegaderm™ (3M™) and silk tape. Labor and delivery progressed uneventfully. The epidural catheter, Tegaderm™ and tape were removed after delivery with no signs of irritation. On post-delivery day 2, she requested steroid cream for pruritic rash on her back, originally in the distribution of the Tegaderm™ and tape, but eventually covering entire back/flanks. Patient was sent home with topical/oral steroids, antihistamines and dermatology follow-up. The rash resolved after 3 weeks. Of note, patient delivered 2 years prior without issue. Our procedure for securing the epidural catheter had not changed in the 2 years with the exception of adhesive spray used. We were alerted to 3 other women with similar symptoms within 2 months of this case.
Discussion: Adhesive sprays are used for many applications. We routinely use adhesive to secure the epidural catheter in laboring women. We used Vi-Drape adhesive spray (active ingredients: Isopropyl Alcohol, Dimethyl Phthalate), until the product was discontinued. At that time, we switched to Mastisol (active ingredients: gum mastic, Styrax, Alcohol, methyl salicylate). Styrax is a genus name and might indicate Styrax benzoin. There are many reports of severe allergic reactions to Mastisol spray.1-3 Surprisingly; it is extremely difficult to find complete ingredient lists for adhesive sprays, making identification of the culprit substance difficult. We assumed Mastisol was the causative agent in our case, given her previous uncomplicated delivery and same securing process, with the exception of the adhesive. The increase in contact dermatitis cases and lack of alternate led us to change our procedure. We now secure the catheter with only Tegaderm™ and tape, with only 1 accidental dislodgement, calling into question the need for adhesive spray at all.
1. Kline A. Foot & Ankle Journal 2008;1:2
2. Worsnop F, et al. Contact Dermatitis 2007;56:357-58
3. Han JS, et al. Ann Dermatol 2014;26:524-25