Abstract and Introduction
Abstract
Introduction: Moisture-associated skin damage occurs in 4% to 37% of the pediatric population. Commonly described treatments can be challenging to apply to small neonatal wounds, and concerns exist about absorption, cutaneous side effects, and use in certain populations (eg, preterm neonates).
Objective: This single-center, retrospective case series evaluated the use of cyanoacrylate liquid skin protectant (CSP) to manage moisture-, friction-, and trauma-associated pediatric and neonatal wounds.
Materials and Methods: Fifteen pediatric and neonatal patients with wounds of various etiologies were treated with 1 to 3 applications of CSP. The product is a purple-colored liquid that comes in a small-sized and large-sized applicator and immediately adheres to the skin, taking approximately 1 minute to dry. One to 2 coats were applied to the affected area. Subsequent applications were prescribed as needed, depending on the skin condition. Before CSP application, some patients underwent different treatments deemed necessary by the treating practitioners.
Results: There were 7 neonate patients (age range, 4 days–3 weeks), with a gestational age of 25 weeks to full term. Wounds included incontinence-associated dermatitis; peristomal, gastrostomy-associated, and tracheostomy-associated dermatitis; and skin tears. In the 8 older patients (age, 1–5 months; 10 years; 12 years; 16 years), wounds included gastrostomy and tracheostomy-associated dermatitis and granulation tissue, epidermal stripping from adhesive dressing removal, intertriginous dermatitis, and lesions resulting from graft-versus-host disease. Application of CSP facilitated the healing of dermatitis and peristomal excoriations as well as facilitated skin dryness, leading to increased wear time of a peristomal appliance. Peristomal dryness contributed to less friction and likely was the reason for granulation tissue recession.
Conclusions: Cyanoacrylate liquid skin protectant can be considered in the management of pediatric moisture- and friction-associated cutaneous injuries, skin tears, and exudative wounds. It can be used as a stand-alone therapy or in combination with standard of care.
Introduction
Moisture-associated skin damage occurs in 4% to 37% of the pediatric population, with the highest incidence reported in neonates.[1] Incontinence-associated dermatitis, peristomal breakdown, and intertriginous and periwound maceration commonly arise from excessive moisture, friction, inflammation, and trauma. Diaper dermatitis is among the most common neonatal nuisances.[2] Bodily effluent, whether from ostomy, gastrostomy, or tracheostomy, commonly leads to irritation, dermatitis, erosion, and significant pain. Most of these cutaneous injuries are challenging to heal because the skin surfaces are uneven and small, and it may be difficult to achieve adherence of dressings and keep them in place. Numerous adhesive devices are attached to neonatal patients; these, together with friction, sheer, and moisture, contribute to skin breakdown. Certain injuries, such as skin tears from birth trauma or epidermal stripping caused by removal of adhesive products, require immediate attention, with the goal of an easy, one-time application of a product to minimize further wound development. Additionally, certain cutaneous side effects of systemic illnesses or treatments may manifest as moist, eroded wounds, such as injuries to the skin from graft-versus-host disease (GVHD) after a bone marrow transplant.[3]
Currently, management of moisture-, friction-, and trauma-associated skin damage in pediatric patients varies, with traditional emollients and zinc creams used for incontinence-associated dermatitis, absorptive barriers for peristomal irritations, topical antibiotics for birth injury, and various absorptive dressings for exudative wounds in patients with systemic conditions.[4–6] The location and size of certain injuries in neonate patients can make applications of products or dressings challenging. Skin immaturity and increased percutaneous absorption preclude the use of certain topical products. Because of the risks of bacterial and fungal overgrowth in neonate patients, especially for those housed in heated humidified isolettes, traditional emollients and topical antibiotics are a less desirable choice.
Cyanoacrylate polymers offer another option in the physician's armamentarium for protecting the skin and promoting healing. Cyanoacrylates are acrylate polymer derivatives that exist as monomers in a liquid form; when exposed to moisture on a surface, however, that moisture undergoes rapid polymerization, forming a flexible, strong film on the skin via a chemical bond with the outer epidermis.[7] The current study evaluated the use of cyanoacrylate-based liquid skin protectant (CSP; Marathon; Medline Industries, Inc) to treat patients with various pediatric and neonatal wounds. It was hypothesized that epidermal protection coupled with ease of application, lack of bulky dressings, and lack of thick, occlusive emollients would result in favorable outcomes by supporting the healing of moisture damage, stabilization of the epidermis in skin tears, and granulation tissue recession.
Wounds. 2022;34(3):83-89. © 2022 HMP Communications, LLC
