Allergic onycholysis and paronychia caused by cyanoacrylate nail glue, but not by photobonded methacrylate nails

ARTICLE

Nail cosmetics may induce side effects such as sensitization [1-3]. The most common side effect is allergic contact dermatitis from nail lacquer caused by toluene sulphonamide formaldehyde resin [3]. Other causes are allergy to methacrylates and cyanoacrylates from acrylic nails [1, 2]. We present a patient who had become allergic to cyanoacrylates used in nail cosmetics, but who could nevertheless use photobonded sculptured nails.

Case report and methods

A 33-year-old hairdresser was sent for investigations because she had had work-related hand dermatitis for 5 years, especially in the fingerwebs. She had a family history of atopy and signs of atopic rhinitis, but had not had atopic dermatitis herself. When off work her hand dermatitis healed in 1 to 2 weeks. She performed all kinds of hairdresser's tasks. She considered the permanent wave chemicals and the hair styling mousses to be the most irritant. When seen by us for the first time she had no hand dermatitis, but paronychia and artificial nails on all fingers.

She was patch tested according to the recommendations of ICDRG with a modified European standard series, a rubber chemical series, and two hairdresser series (N = 40), and 43 "own" products that she had used in hairdressing. All testings were negative. Prick tests with standard environmental allergens revealed her atopic background; she had a 3+ reaction to dermatofagoides pteroronyssinus and 2+ reaction to cat epithelium and dermatophagoides farinae. Prick tests with protein hydrolysates, own hairdressing products, (meth)acrylates and colophony were negative.

She had used artificial nails for one year. When seen for the first time she had glued on her nails 3 weeks earlier, and this had caused paronychia. She used preformed plastic nails, glued on with 2-ethylcyanoacrylate (ECA) adhesive. When she removed the preformed nails, onycholysis was revealed (Fig. 1).

Patch testing with her own nail glue 10% pet provoked a 2+ allergic patch test reaction, as did ECA 10% pet. Her paronychia healed completely when she did not use artificial nails. On a follow-up visit 6 months later, she informed us that she had used photobonded sculptured nails for 3 months with no side effects (Fig. 2).

It was concluded that she had occupational irritant dermatitis from permanent wave chemicals, hair styling mousses, hair gels and wet work. Furthermore, she had onycholysis and paronychia caused by allergic contact from ECA. She was able to use photobonded sculptured nails indicating that the methacrylates in the sculptured nails did not cross-react with ECA.

Discussion

In the United States, artificial nails based on (meth)acrylates have for decades been a popular method of improving the cosmetic appearance of natural nails [1-9]. During the past decade they have been increasingly used in Europe, too. Allergic contact dermatitis from acrylic nails was already reported in the 1950s [8]. Furthermore, acrylic nails may induce side effects such as fingertip dermatitis, periungual dermatitis, onycholysis, paresthesiae, Raynaud's phenomenon, and ectopic facial involvement [4].

Acrylate nails are available in two main forms: preformed plastic nails to be glued on with a cyanoacrylate adhesive, and sculptured nails. The latter are not preformed, and are made of two-component products containing a powder and a liquid [1, 2, 5, 6]. They are available in two varieties: (i) chemically cured nails containing various methacrylate monomers and polymers that polymerize in the presence of hydroquinone and (ii) photo-bonded acrylate sculptured nails that harden in the presence of light, similarly to dental resins [1, 6]. Our patient had first used nails that were glued with a cyanoacrylate adhesive, and then photobonded sculptured nails (Fig. 2).

The two-component products contain a powder and a liquid. A typical powder formula contains ca 97% polymethylmethacrylate and 3% polymerization inhibitor such as benzoyl peroxide [1, 6]. The liquid formula may contain ca 99% methyl methacrylate monomer and ca 1% stabilizer e.g. hydroquinone or p-dimethylaminochlorobenzene [1, 6]. Also other components such as plasticizers, solvents, accelerators and pigments may be included [1, 6]. Other methacrylates such as ethyl methacrylate, triethylene glycol dimethacrylate (TREGDMA) [1] and urethane (meth)acrylates may also be used [1, 7].

Methacrylates in chemically cured sculptured nails have caused allergy to the customers [1, 4, 5-10) and on rare occasions, occupational allergy [1, 8-10]. Cyanoacrylates may cause allergic contact dermatitis [2, 11-13] and asthma [14]. Photo-bonded acrylate sculptured nails have induced allergic reactions [1, 7].

Onycholysis refers to the detachment of the nail from its bed at its distal and/or lateral attachments. Guin et al. [2] reported eczema of the fingertips and nail beds with prominent nail dystrophy, onycholysis and subungual hyperkeratosis in three patients from ECA glue. Allergic onycholysis has also been reported from hydroxylamine sulphate in colour developer [15-17], from anaerobic acrylic sealants [18], from toluene sulphonamide formaldehyde resin used in nail hardener [19] and from benzalkonium in nail lacquer [20]. Onycholysis may also develop from chemicals without an allergic mechanism [21].

On a control visit our patient informed us that she had made sculptured nails for herself three months earlier. These had not caused any harm (Fig. 2). Photobonded sculptured nails contain various types of (meth)acrylates [1, 7] but not cyanoacrylates. Our patient was allergic to cyanoacrylate but apparently not to (meth)acrylates. Unfortunately, our patient refused to participate in a further patch test session with a (meth)acrylates series. She probably tolerated the photobonded sculptured nails because cyanoacrylates and (meth)acrylates apparently did not cross-react [22] even though some authors believe that they do [23, 24].

Article accepted on 12/10/99

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