ABSTRACT
Kazuyo Sujino, MD
Chief of Dermatology
Murayama Medical Clinic, Kannai Medical Clinic, and Medical Corporation Keihakukai
Yokohama, Kanagawa, Japan
【Background】It is known that hypersensitivity reaction(HSR) often appears after cyanoacrylate closure(CAC). However, the pathogenesis is not well known. We investigated the characteristics of HSR, frequency, timing, duration, treatment and blood test.
Methods: A retrospective review of patients who developed HSR after treated incompetent saphenous veins with CAC at our clinic(Yokohama, Japan) from September 2020 to December 2021. HSR was classified into three types: Mild is local erythema with no or slight symptoms, Moderate is local red subcutaneous induration with pain or itching, and Full-body type.
Results: A total of 254 patients were treated by CAC, for great and small saphenous veins. HSR
occurred
in 123 of 254 patients (48.4%). Mild is 93 patients (36.6%), Moderate is 27 (10.6%), and Full-body type is 3 (1.2%). Blood samples were taken in 64 of 123 patients who occured HSR (Mild:47patients, Moderate:16patients, Full-body:1patient). Except for one interrupted visit, 63 patients were observed until recovered. The average time of onset was 17.7 days (7-42 days) in Mild, 17.9 days (7-42 days) in Moderate, and 21 days in Full-body type. Subjective symptoms were localized itchiness (40 patients), pain (28 patients), and Full-body itchiness (single case), there were overlap (a total 64 patients). Eosinophils elevated in 24 patients (38.1%), CRP >1 elevation in 23 patients (36.5%), and both eosinophils and CRP elevated in 11 cases (17.5%). Onset time averaged 26.0 days (14-42 days) for cases with elevated eosinophils and 18.0 days (7-28 days) for those with elevated CRP. Treatment consisted of oral or topical steroids. Duration of symptoms was within 4 weeks in 55 patients (87.5%), 5-8 weeks in 5 patients (7.8%), and 9-16 weeks in 3 patients (4.7%). No significant differences were found in the timing of onset or duration according to the three of types.
Conclusions: Most of HSR recovered within 4 weeks with early treatment. Mainly, the symptoms were localized the glue puncture site and near there. However, in rare cases, skin symptoms appeared full-body. Patients with eosinophils elevated tended to develop symptoms. We all know that the skin is an important site of immune response, but skin is the only place where immune response occurs? Since CAC involves the direct insertion of a foreign body into a blood vessel, it is possible that a combination of immune allergic reactions and thrombophlebitis may occur in the blood vessels in all patients. Immune reactions in blood vessels are an unknown field that is expected to be elucidated in the future.