Contact Dermatitis

Trends in Nail Services May Cause Dermatitis: Not Your Mother’s Nail Polish

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The advent of acrylate-based nail treatments—known as gels, dips, or shellac—has resulted in an uptick in nail-related acrylate allergy. Acrylate dermatitis related to nail services can affect both clients and technicians and can present on the hands, fingers, and wrists, as well as on the face and neck. Nail acrylate allergy occurs from sensitization to acrylate monomers; 2-hydroxyethyl methacrylate (HEMA), 2-hydroxypropyl methacrylate, ethyl cyanoacrylate, and others have been identified as relevant allergens. Patch testing with HEMA and ethyl cyanoacrylate can screen for nail acrylate allergy. Avoidance is key, and we recommend less-permanent, acrylate-free nail polishes as alternatives.

Practice Points

  • Changing trends in nail services mean new exposures for consumers. Traditional nail polish has been replaced by semipermanent nail polish, which contains acrylates.
  • Acrylates are a common cause of allergic contact dermatitis from nail polish. Acrylates can be found in gel, dip, and shellac nail polishes, among others.
  • Patch testing with 2-hydroxyethyl methacrylate and ethyl cyanoacrylate can screen many patients for allergy due to nail services.


 

References

In 2017, consumers spent an average of $8.53 billion on nail services.1 This booming industry is set to grow to more than $15.5 billion by 2024.2 Nail polishes and other nail cosmetic trends can present new exposures for consumers, including chemicals that can elicit allergic contact dermatitis. In this article, we discuss new nail trends and their associated allergens, the acrylates.

Tosylamide/Formaldehyde Resin

Traditionally, the most widely recognized nail polish allergen has been tosylamide/formaldehyde resin (TSFR). However, there now are many touted TSFR-free nail polishes on the market, and the rate of positive reactions to this chemical has been declining in recent years. The North American Contact Dermatitis Group reported a positive reaction rate of 1.3% from 2005 through 2006,3 and rates decreased to 0.9% from 2015 through 2016.4 An Australian study demonstrated a similar reduction in positive reaction rates to nail polish chemicals, with only 0.7% of patients reacting to TSFR from 2014 to 2016 and 0% in 2017. It is theorized that this reduction occurred from replacing TSFR in traditional nail polishes with other chemicals such as polyester resins and cellulose acetate butyrate.5

Acrylate-Based Nail Treatments

Consumers recently have been gravitating toward acrylate-based nail treatments vs traditional nail polishes for a variety of reasons. Often referred to as gels, dips, or shellac, acrylate-based nail treatments represent a hot new trend in nail cosmetics. These manicures are resistant to chipping and scratches, creating a like-new look that lasts for weeks after application. The long-lasting nature of acrylate-based nail polishes has made them wildly popular with consumers.

Traditional acrylic nails consist of a powder polymer mixed with a liquid monomer, which polymerizes when a catalyst is added.6 The procedure is time consuming and can take up to 2 hours for application. In contrast, the newer gel manicure can be completed faster and includes application of acrylate-based nail polish, including a base coat, 2 coats of color, and a top coat. Exposure to either a light-emitting diode (30–60 seconds) or UVA (2 minutes) lamp is necessary after each coat is applied for polymerization (Figure 1).6 This long-lasting, semipermanent manicure typically is what patients are referring to when they say they have “gel nails.”

Figure 1. Gel manicure technique. A, Application of base coat. B, Polymerization of base coat using a light-emitting diode lamp (left) and application of first coat of color (right).

Gel dipping powders (referred to as dips) are another long-lasting acrylate-based nail treatment. This type of polish uses ethyl cyanoacrylate, a slightly different acrylate (yes, that IS super glue). After the nail is prepared, a base polish is applied to three-quarters of the nail and it is dipped into a natural color dip powder. The base polish is then applied to the entire nail, followed by a dip into the polish color of choice. This process is completed twice, followed by shaping and application of a top coat (Figure 2).

Figure 2. Gel dipping powder technique. A, Application of gel polish
base coat. B, Application of dip powder to gel polish. Note the entire
distal finger and nail are dipped into the powder. C, Shaping of the
nail after the second coat of color is applied.

Finally, there are nail wraps, which are similar to stickers placed over or extending the nail plate. The wraps can be made from linen, silk, vinyl, or other material. Ethyl cyanoacrylate and isopropyl-2-cyanoacrylates have been identified in nail wrap adhesive.7 The heated product is directly applied to the prepared nail, and the excess wrap is filed off. Additional nail polish and a top coat usually are applied to finish the nail. Many of these products are available for in-salon use as well as online purchase and home application by consumers.

Acrylate Allergy

Patients who are allergic to acrylates can present with different patterns of dermatitis. Although the majority of patients present with dermatitis on the hands, fingers, or wrists, up to 10% may only have facial and neck dermatitis.8 Less commonly, the abdomen and thighs can be involved.6,8 Nail technicians most commonly present with pulpitis with cutaneous fissures.8 Other symptoms can include subungual hyperkeratosis, onycholysis, and nail dystrophy. Paresthesia, urticaria, and upper respiratory tract symptoms can occur but are less common.6,8

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