Two Additional Cases of Allergic Contact Dermatitis Caused by Wound Closure Tape Steri‐<scp>Strip^3M</scp>

To date, only a few cases of allergic contact dermatitis (ACD) caused by wound closure tape streristrip3M have been reported [1, 2]. Tert butylphenols (TBPs) are often described as the culprit allergens. We describe two additional cases of severe ACD from this dressing and the potential allergen involved. Five days after surgery for melanoma on the right thigh, a 55-year-old nonatopic man presented with eczematous dermatitis under the wound dressing (Figure 1A). The wound was covered with Steri-Strips R1541 (3 M, USA) and Tegaderm (3 M, USA). He had not applied any topical medication and had never previously experienced any allergic reactions. Patch tests were performed with the European baseline series, a glue series (containing in particular butylhydroxyanisole (BHA), butylated hydroxytoluene (BHT), tert-butylcatechol and tert-butylphenol); acrylate series (Chemotechique Diagnostics, Vellinge, Sweden, and Allergeaze, Smart Practice, Phoenix, AZ); 4,4′ thiobis (2-tert-butyl-5-methylphenol) [obtained from Sigmaaldrich Merck (Darmstadt, Germany) and prepared in-house patch test preparations at 1% in pet.]; Steri-Strips “as is”; Tegaderm; and other alternative dressings such as leukostrips (Smith & nephew, UK) and micropore (3 M, USA). The tests and readings after day (D) 2 and D4 were performed according to the European Society of Contact Dermatitis (ESCD) criteria [3]. The following results were observed: Myroxylon pereirae (25% pet), nickel (5% pet), fragrance-mix1 (8% pet), p-tert-butylcatechol (TBC) (0.25% pet), 4,4′ thiobis (2-tert-butyl-5-methylphenol) (TBBC) (1% pet) and Steri-Strip (+/++) (Figure 1C), while tests with leukostrips, Tegaderm and micropore remained negative. One week after surgery for peritoneal dialysis catheter implantation, a 31-year-old non-atopic woman developed an acute vesicular eruption around the edges of the Steri-strip R1541 cover by Cutiplast (Smith & nephew, UK) wound tape (Figure 1B). Patch tests were performed to the European baseline series, a glue series (also containing BHA, BHT, tert-butylcatechol and tert-butylphenol); acrylates series (Chemotechnique Diagnostics, Vellinge, Sweden, and AllergEAZE, SmartPractice, Phoenix, AZ); as well as 4,4′ thiobis (2-tert-butyl-5-methylphenol) [raw material, kindly obtained by the team of the first patient and prepared in-house patch test preparations at 1% in pet.]; and Steri-Strips and Cutiplast “as is.” Following an occlusion of 2 days, the tests were read on D2 and D4 according to ICDRG criteria. Positive reactions were only observed to TBC (−/++), BHA (2% pet) and Steri-Strips 3M (−/+). A chromatography-mass spectrometry (GC–MS) analysis on Steri-Strips R1541 confirmed the presence of thiobis 2-tert-butyl-5-methylphenol (6 μg/cm2). No other TBPs were found in the sample. The analyses were performed on an Agilent 8860 gas chromatograph coupled to an Agilent 5977B mass selective detector. The Column VF-5 ms 40 m × 250 μm × 0.25 μm was purchased from Agilent technologies (Santa Clara, CA, USA). Injections were made in split mode (3.3:1) at an injection port temperature of 280°C. The column oven temperature was initially set to 80°C for 2 min and then raised at 15°C/min to 280°C and held for 17 min. The total run time was 32 min. The temperatures of the interface, the source and the quad interface were 250°C, 230°C and 150°C, respectively. High-purity helium was used as the carrier gas with a flow rate of 1.5 mL/min. Ionisation was obtained with electron impact using an electron energy of 70 eV. Data were acquired in full scan mode in a mass range of m/z 50 to 500. The generated spectra were compared to the NIST 20 mass spectral database (Libnist version 1.0.6.3). Approximately 1cm2 of sample was extracted in 1 mL of acetone (Biosolve, valkenswaard, the Netherlands). This was placed in an ultrasonic bath for 30 min after which it was filtered through a 0.45 μm PTFE syringe filter before being injected. To date, four cases of ACD caused by Steri-Strip3M have been previously reported in the literature [1, 2]. In these cases, chromatographic analyses identified the presence of tert-butyl phenolic compounds', including 4,4′-thiobis(6-tert-butyl-3-cresol) (TBBC), 6-tert-butyl-m-cresol (BC) and 2,4-di-tert-butylphenol (BP) [4]. TBBC has been identified as the responsible allergen in ACD caused by Steri-Strip3M R1547 and also several types of dressings [2]. Thiobis-tert-butyl-methylphenol, also known as thiobis-tert-butyl-m-cresol (TBBC; CAS 96–69-5) is an antioxidant used in the composition of certain dressings. Although TBBC was detected in Steri-Strips R1541 used by our patients, it did not elicit a reaction in one of our patients. Although 1% seems to be the appropriate concentration of TBBC used for testing patients reported in literature, this could be insufficient in some patients, such as one of our patients. It should also be noted that no reading at D7 was performed in these two patients. This could be proposed in order not to miss sensitisation. It is important to stress that both patients reacted to p-tert-butylcathechol (TBC), which is commercially available, unlike TBBC. As noted by Dendoven et al. [5], all the tert-butyl phenol derivatives present in medical devices may not react in patch tests. However, as explained by Dendooven et al., TBC exhibits greater reactivity than TBBC and other tert-butylphenols. This is due to the spontaneous oxidation of TBC into its corresponding tert-butylbenzoquinones. This oxidation process significantly enhances TBC's reactivity, as the resulting benzoquinones are capable of forming covalent bonds with skin proteins via nucleophilic Michael addition. Consequently, these benzoquinones are likely the true haptens, while the tert-butylphenols act as pre-haptens/pro-haptens. Therefore, TBC appears to be a good screener agent for detecting potential sensitisation to tert-butylphenol derivatives. Anne Herman: writing – original draft, investigation, conceptualization, methodology, validation, writing – review and editing, data curation. Stefan Kerre: writing – review and editing, investigation, data curation, methodology. Ania Stras: methodology, data curation, investigation, formal analysis. Bart Desmedt: investigation, writing – review and editing, data curation, methodology, formal analysis. We thank Mariana Andrade, MD, who provided editorial assistance. Patients in this manuscript have given written informed consent to the publication of these case details. The authors declare no conflicts of interest.