Case notes

A 34-year-old woman underwent robotic-assisted lysis of adhesions, vaporization of endometriosis, and a myomectomy. She had a vague history of an allergic reaction to an unknown stimulus during anesthesia. The patient was prepped with 2% chlorhexidine gluconate and 70% isopropyl alcohol scrub (ChloraPrep; CareFusion Corp, San Diego, CA) for the abdomen and 10% povidone iodine preparation solution (Aplicare Inc, Meriden, CT) for the perineum and draped.

After the operative procedure, we noted erythema and what appeared to be disruption of the deep dermal skin layer in areas where the adhesive tape had been applied. A noticeable contrast in skin pigmentation existed in the affected areas, raising further concern for skin damage and denudement ( Figure ). Bacitracin ointment was applied. Postoperatively, the patient revealed that she had undergone a spray tan 2 days before her operation. Consultation with a wound-care specialist confirmed that the spray tan had been removed in the areas where the adhesive tape was in direct contact with the skin. Although apoptotic layers may have been removed, the skin was intact.

At first glance, it appeared that the skin in the right upper quadrant of the patient’s abdomen might have been denuded.

Krause. Discourage the presurgical spray tan. Am J Obstet Gynecol 2013 .

Conclusion

As far as we can tell, this is the first report of an interaction between spray-tanning agents, presurgical antiseptic solutions, and the adhesive tape that was used in surgical drapes. However, local and systemic allergic reactions to preoperative skin preparations have been reported in up to 20% of patients.

Spray tanning, which has become increasingly popular, produces an effect similar to a suntan through the application of chemicals (usually dihydroxyacetone) that react with amino acids in the apoptotic layer of the skin surface. Sometimes erythrulose is used, which generates a similar but slower effect. Tyrosine-based products (oral and topical) are used to darken the skin by stimulating melanin formation.

To avoid unnecessary costly interventions, medical professionals should be aware that spray-tanning chemicals might interact with preoperative antiseptics and adhesive tape. Although bacitracin was the only treatment used in this patient’s case, the wound-care consult resulted in an extra expenditure. Concurrent use, including the chemical effects on the antiseptic activity of surgical scrubs, has yet to be studied. Nonetheless, patients should be advised not to undergo spray tanning in close proximity to a surgical intervention.