A 71-year-old woman, discharged after total hip replacement arthroplasty, returned to the hospital on postoperative day 9 with a 3-day history of itchy eczematous lesion around the surgical wound (Fig. ). The patient was afebrile, and there was no warmth, redness, or tenderness on wound examination. A blood test at that time showed the following: white blood cell (WBC) count, 5100/μL (normal 4000–10,000/μL); erythrocyte sedimentation rate (ESR), 84 mm/h (normal 0–20 mm/h); and C-reactive protein (CRP), 4.43 mg/dL (normal 0–0.6 mg/dL). The patient's inflammatory markers were mildly elevated compared with the blood test results 5 days earlier: WBC, 3600/μL; ESR, 30 mm/h; and CRP, 2.46 mg/dL. Because SSI could not be ruled out, the patient received cefazolin, 2 g, intravenously. The next day, the patient was diagnosed with contact dermatitis at the dermatology clinic and treated with local steroid ointment without additional antibiotics. Also, the mesh applied at the surgical wound was removed immediately. The skin lesion resolved after 1 week of treatment.
A 33-year-old Caucasian woman with a BMI of 30.5 and a documented penicillin allergy () was prepped with chlorhexidine gluconate and the following sutures were utilized: silk for drains, deep polyglactin 910, subcuticular poliglecaprone 25, and poliglecaprone 25 for the nipple. Six days later, bilateral breast swelling, blisters, and eczematous, erythematous patches near the DERMABOND PRINEO Skin Closure System were noted. Diphenhydramine did not relieve the pruritus. An oral steroid taper pack and hydroxyzine were prescribed. Although the dermatitis was not consistent with a drug rash, the cephalexin was stopped due to the risk for cross reactivity. Steroid taper was discontinued after five days due to gastrointestinal intolerance. At this time, the rash had intensified and spread from chest to arms, neck, and face. All drains and residual DERMABOND PRINEO Skin Closure System were removed; the skin was washed with saline and covered with sterile mesh gauze impregnated with petrolatum 3% bismuth tribromophenate (Xeroform) and petrolatum ointment. A steroid taper was restarted and dermatology consult was made. Two days later, the rash had greatly improved. After six additional days, there was no trace of the rash ().