Tackling Acrylate Allergy: The Sticky Truth
Acrylates are synthetic thermoplastic resins used in numerous industries since their discovery in the mid-19th century. Known for their versatility in formulating various consumer, health care, and industrial products, acrylates also have come under scrutiny for their potential to cause allergic contact dermatitis (ACD). Allergic contact dermatitis to acrylates previously was largely occupational in nature, but the expanded use of acrylates in products ranging from nail cosmetics to medical devices has increasingly brought this allergy to the general population. Herein, we discuss the chemistry and allergenicity of acrylates and highlight common sources of exposure, clinical presentations, pertinent considerations for patch testing, and tips for the management/prevention of acrylate ACD. We hope to emphasize the shifting trend of exposure sources from the workplace to consumers, underlining the need for increased vigilance from physicians. Collaborative efforts among health care providers and patient education about allergen avoidance strategies are essential to mitigate potential complications arising from acrylate sensitization.
Practice Points
- Acrylates are thermoplastic resins used in a variety of products ranging from cosmetics to adhesives and industrial materials. Acrylic monomers are strong contact allergens, whereas fully polymerized forms are inert, provided they are completely cured.
- The use of home gel nail kits may increase the risk for sensitization to acrylates, which are the most common modern nail cosmetic allergens.
- When patch testing for suspected acrylate allergy, 2-hydroxyethyl methacrylate (HEMA) is the most important screening allergen. Expanded testing to additional acrylates should be considered depending on the clinical scenario.
With regard to tissue adhesives, the actual product should be tested as-is because these are not commercially available patch test substances.48 Occasionally, patients who are sensitized to the tissue adhesive will not react when patch tested on intact skin. If clinical suspicion remains high, scratch patch testing may confirm contact allergy in cases of negative testing on intact skin.49
Management and Prevention
Once a diagnosis of ACD secondary to acrylates has been established, counseling patients on allergen avoidance strategies is essential. For (meth)acrylate-allergic patients who want to continue using modern nail products, cyanoacrylate-based options (eg, dipped, press-on nails) can be considered as an alternative, as they do not cross-react, though independent sensitization is still possible. However, traditional nail polish is the safest option to recommend.
The concern with acrylate sensitization extends beyond the immediate issue that brought the patient into your clinic. Dermatologists must counsel patients who are sensitized to acrylates on the possible sequelae of acrylate-containing dental or orthopedic procedures. Oral lichenoid lesions, denture stomatitis, burning mouth syndrome, or even acute facial swelling have been reported following dental work in patients with acrylate allergy.50-53 Dentists of patients with acrylate ACD should be informed of the diagnosis so acrylates can be avoided during dental work; if unavoidable, all possible steps should be taken to ensure complete curing of the monomers. In the surgical setting, patients sensitized to cyanoacrylate-based tissue adhesives should be offered wound closure alternatives such as sutures or staples.34
In patients with diabetes mellitus who develop ACD to their glucose monitor or insulin pump, ideally they should be switched to a device that does not contain acrylates. Problematically, these devices are constantly being reformulated, and manufacturers do not always divulge their components, which can make it challenging to determine safe alternative options.32,54 Various barrier products may help on a case-by-case basis.55Preventative measures should be implemented in workplaces that utilize acrylates, including dental practices and nail salons. Acrylic monomers have been shown to penetrate most gloves within minutes of exposure.56,57 Double gloving with nitrile gloves affords some protection for no longer than 60 minutes.6 4H gloves have been shown to provide true protection but result in a loss of dexterity.58 The fingerstall technique involves removing the fingers from a 4H glove, inserting them on the fingers, and applying a more flexible glove on top to hold them in place; this offers a hybrid between protection and finger dexterity.59
Final Interpretation
In a world characterized by technological advancements and increasing accessibility to acrylate-containing products, we hope this brief review serves as a resource and reminder to dermatologists to consider acrylates as a potential cause of ACD with diverse presentations and important future implications for affected individuals. The rising trend of acrylate allergy necessitates comprehensive assessment and shared decision-making between physicians and patients. As we navigate the ever-changing landscape of materials and technologies, clinicians must remain vigilant to avoid some potentially sticky situations for patients.
