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Anesth Analg 2003;97:1310-1311 © 2003 International Anesthesia Research Society
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Abstract |
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 Top Abstract IntroductionCase HistoryDiscussionReferences |
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IMPLICATIONS: We report a young woman with fragile facial skin after using cosmetics containing skin peeling agents. Removal of adhesive tapes applied to her face under general anesthesia caused patchy areas of skin loss. The complication may best be avoided by not applying adhesive tapes to the face.
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Introduction |
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TopAbstractIntroductionCase HistoryDiscussionReferences |
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Adhesive tapes are often used on the patient’s face during general anesthesia. Taping the eyelids closed prevents corneal abrasions and is more effective than eye ointment (1). Adhesive tapes are also used to fix the tracheal tube, nasopharyngeal temperature probe, nasogastric tube, and nerve stimulator electrodes. We report of a case of skin injuries produced by adhesive tapes in a patient who had fragile facial skin from cosmetics containing exfoliating agents.
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Case History |
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TopAbstractIntroductionCase HistoryDiscussionReferences |
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A 39-yr-old woman presented for laparoscopic ligation of the fallopian tubes. She had no previous history of surgery, significant medical illnesses, or allergies. Findings on physical examination were unremarkable.
In the operating room, an IV cannula was inserted on the dorsum of the left hand and fixed with a transparent plastic adhesive dressing (Tagaderm®; 3M Health Care, St. Paul, MN). General anesthesia consisted of tracheal intubation and inhaled anesthetics. For closure of the patient’s eyelids and fixation of the tracheal tube to the patient’s cheeks, we used adhesive tapes made respectively of nonwoven fabric and acrylic (Micropore®; 3M Health Care), and woven silk and cellulose acetate (Albusilk®; Smith & Nephew, London, UK). Surgery lasted 15 min. After the patient regained consciousness, we removed the adhesive tapes and the tracheal tube. Despite gentle removal of the adhesive tapes with skin support, patchy areas of superficial skin loss occurred around the eyelids and cheeks. The denuded areas were red and moist, showing punctate hemorrhage and exudate especially in the upper eyelids (Fig. 1). The adhesive dressing on the left hand was removed a few hours later without any complications.
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Later, we explained the skin injuries to the patient. She informed us that she had started facial cosmetic treatment with skin exfoliating agents 3 wk previously. The treatment was recommended by a cosmetician and bought over-the-counter. The major active ingredient was 0.05% retinoic acid.
The patient complained of mild pain over the skin wounds. A plastic surgeon recommended conservative treatment. After 1 wk the wounds healed without scarring or pigmentation.
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Discussion |
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TopAbstractIntroductionCase HistoryDiscussionReferences |
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Normal adult skin tolerates at least 10 consecutive applications and removal of adhesive tapes without disruption of the skin-barrier function (2). However, adhesive tapes can injure fragile skin. Susceptible conditions include prematurity (3), chronic steroid treatment (4), zinc deficiency, amyloidosis (5), and epidermolysis bullosa. Adhesion between the epidermis and dermis is weaker than that between the adhesive tape and epidermis in these patients. On removal of the adhesive tape, epidermolysis occurs as the epidermis is stripped off the dermis. This complication can be minimized. Adhesive tapes should be applied to minimal skin areas without tension. Solvents can be applied to dissolve the adhesives before removal. Adhesive tapes should also be removed slowly with the skin supported (5).
Skin fragility is a complication of exfoliating agents such as retinoic acid, 
-hydroxy acids, and phenol (6). These agents produce varying depths of facial skin peels depending on the concentration and duration of exposure. Other skin resurfacing techniques include laser and dermabrasion. Skin resurfacing is indicated for acnes, aged, and sun-damaged skin. Topical retinoic acid produces mild superficial peel of the epidermis and is the most popular agent (7). After use for approximately six months, it is able to thin the stratum corneum, thicken the epidermis, disperse melanocytes, and stimulate deposition of dermal collagen, leading to smoother and lighter skin with fewer wrinkles (7). Facial exfoliating agents have gained popularity in those seeking more youthful facial skin. Moreover, these agents and their analogs, such as retinol, are marketed as natural ingredients in cosmetics not subject to pharmaceutical regulations.
In summary, we reported a young woman with fragile facial skin after the use of topical retinoic acid. She developed skin injuries from adhesive tapes used on her face during anesthesia. The complication was avoidable. Alternatives to adhesive tapes could have been used to fix the tracheal tube and to protect the eyes. We recommend that physicians prescribing facial exfoliating agents warn patients of skin injuries by adhesive tapes. Anesthesiologists should also inquire about the use of facial exfoliating agents before applying adhesive tapes to patients’ faces. Patients might not be aware of the presence of facial exfoliant in the cosmetics. Adhesive tapes on the face should be avoided.
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Footnotes |
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The authors have no financial and personal relationships with other people or organizations that could inappropriately influence the work in this case report.
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References |
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TopAbstractIntroductionCase HistoryDiscussionReferences |
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- White E, Crosse MM. The aetiology and prevention of peri-operative corneal abrasions. Anaesthesia 1998; 53: 157–61.[Web of Science][Medline]
- Lo J, Oriba H, Maibach H, Bailin P. Transepidermal potassium ion, chloride ion, and water flux across delipidized and cellophane tape-stripped skin. Dermatologica 1990; 180: 66–8.[Web of Science][Medline]
- Lund C, Kuller J, Lane A, et al. Neonatal skin care: the scientific basis for practice. J Obstet Gynecol Neonatal Nurs 1999; 28: 241–54.[Medline]
- Sadiq ZA, Allan M, Malik T. Peri-orbital bruising as a complication of taping eyes. Anaesthesia 1999; 54: 619.
- Campos JH. A reaction to tape after tracheal extubation in a patient with systemic amyloidosis. J Clin Anesth 1999; 11: 126–8.[Web of Science][Medline]
- Humphries JD, Parry EJ, Watson RE, et al. All-trans retinoic acid compromises desmosome expression in human epidermis. Br J Dermatol 1998; 139: 577–84.[Web of Science][Medline]
- Griffiths CE. The role of retinoids in the prevention and repair of aged and photoaged skin. Clin Exp Dermatol 2001; 26: 613–8.[Web of Science][Medline]
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