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Kocabas G, Ipenburg NA, de Groot AC, Rustemeyer T. 2-Hydroxyethyl methacrylate (HEMA) 1% versus 2. Contact Dermatitis 2024; 91:171-172. [PMID: 38715145 DOI: 10.1111/cod.14571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Gizem Kocabas
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Norbertus A Ipenburg
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anton C de Groot
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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2
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Gatica-Ortega ME, Pastor-Nieto MA, Giménez-Arnau AM, Mercader-García P, Sanz-Sánchez T, Carrascosa-Carrillo JM, Córdoba-Guijarro S, Sánchez-Pérez J, Silvestre JF, Frutos FJOD, Tous-Romero F, Fernández-Redondo V, Serra-Baldrich E, Ruíz-González I, González Pérez R, Miquel-Miquel J, Guillén PSP, Hervella-García M, Heras-Mendaza F, Gómez-de-la-Fuente E, Zaragoza-Ninet V, Gilo AS, Rodríguez-Serna M, Melé-Ninot G, Descalzo MÁ, de-Vega M, García-Doval I, Borrego L. 2-Hydroxyethyl methacrylate (2-HEMA) sensitization, a global epidemic at its peak in Spain? Contact Dermatitis 2024; 90:507-513. [PMID: 38351475 DOI: 10.1111/cod.14520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND A global epidemic of allergic contact dermatitis to (meth)acrylates has been described in relation to the widespread use of manicure products. OBJECTIVES To evaluate the frequency of sensitization to 2-hydroxyethyl methacrylate (2-HEMA) among consecutively patch tested patients with eczema in Spain; the percentage of current relevance; the MOAHLFA index; and, the potential sources of exposure to (meth)acrylates. METHODS From January 2019 to December 2022, 2-HEMA 2% pet. was prospectively patch tested in 24 REIDAC (Spanish Allergic Contact Dermatitis Registry) centres. RESULTS Six thousand one hundred thirty-four patients were consecutively patch tested with 2-HEMA 2% pet. 265/6134 (4.3%) were positive. Positive reactions of current relevance were identified to involve 184/265 (69%). The efficiency (number of patch tests needed to detect relevant positive patch test reactions) was 34 (6134/184). The variable 'occupational' was found to be significantly associated with a higher risk for relevant positive reactions to 2-HEMA (OR: 10.9; 95% CI: 8.1-14.9). CONCLUSION (Meth)acrylate sensitization is a prevalent health issue in Spain. 2-HEMA 2% pet. has been identified to be a highly effective (meth)acrylate allergy marker in the GEIDAC baseline series. The responsible authorities should implement policies guaranteeing accurate labelling of industrial, medical, and consumer materials while ensuring the enforcement of said labelling through appropriate legal means.
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Affiliation(s)
- Maria Elena Gatica-Ortega
- Dermatology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
- Escuela Internacional de Doctorado, Universidad de Castilla-La-Mancha, Toledo, Spain
| | - Maria Antonia Pastor-Nieto
- Escuela Internacional de Doctorado, Universidad de Castilla-La-Mancha, Toledo, Spain
- Dermatology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Dermatology Department, Hospital Universitario Fundacion Jiménez Díaz, Madrid, Spain
- Faculty of Medicine and Health Sciences, Medicine and Medical Specialties Department, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Ana María Giménez-Arnau
- Dermatology Department, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | - Pedro Mercader-García
- Dermatology Department, Hospital General Universitario José Mª Morales Meseguer, Murcia, Spain
| | | | | | | | | | | | | | - Fátima Tous-Romero
- Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | | | | | | | - Felipe Heras-Mendaza
- Dermatology Department, Hospital Universitario Fundacion Jiménez Díaz, Madrid, Spain
| | | | | | | | | | - Gemma Melé-Ninot
- Dermatology Department, Hospital Universitari Sagrat Cor - Grupo Quirónsalud, Barcelona, Spain
| | - Miguel Ángel Descalzo
- Unidad de Investigación of the Fundación Piel Sana AEDV of the Spanish Academy of Dermatology, Madrid, Spain
| | - Marina de-Vega
- Unidad de Investigación of the Fundación Piel Sana AEDV of the Spanish Academy of Dermatology, Madrid, Spain
| | - Ignacio García-Doval
- Unidad de Investigación of the Fundación Piel Sana AEDV of the Spanish Academy of Dermatology, Madrid, Spain
| | - Leopoldo Borrego
- Dermatology Department, Hospital Universitario Insular de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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3
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Kocabas G, Steunebrink IM, de Groot A, Rustemeyer T. Results of patch testing 2-hydroxyethyl methacrylate (HEMA) in the European baseline series: A 4-year retrospective study. Contact Dermatitis 2024; 90:466-469. [PMID: 38146793 DOI: 10.1111/cod.14488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND 2-Hydroxyethyl methacrylate (HEMA) was added to the European baseline series (EBS) in 2019. Few recent data are available on the frequency and relevance of positive reactions to this hapten. OBJECTIVES To investigate the frequency and relevance of positive patch tests to HEMA in the EBS in a university hospital in Amsterdam, The Netherlands. PATIENTS AND METHODS Retrospective study in patients with positive patch tests to HEMA investigated between June 2019 and August 2023. RESULTS Of 2927 consecutive patients, 88 (79 women and 9 men; 3.0%) had a positive reaction to HEMA. The prevalence in women was 3.9%, in men 1.0%. Forty-three (49%) reactions were judged to be of current clinical relevance and 21 (24%) of past relevance. In this group of 64 patients with relevant reactions, 18 (28%) had occupational contact with (meth)acrylate-containing products, of who 11 (61%) were nail stylists. In 46 patients with non-occupational allergic contact dermatitis, 31 (67%) had allergic reactions to nail cosmetics. Glues and glue-containing products accounted for 22% of the materials causing allergic contact dermatitis and dental products for 8%. CONCLUSIONS Allergic reactions to HEMA are very frequent in women investigated in Amsterdam. Nearly two thirds of cases were caused by nail cosmetics.
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Affiliation(s)
- Gizem Kocabas
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Anton de Groot
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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de Groot AC, Rustemeyer T. 2-Hydroxyethyl methacrylate (HEMA): A clinical review of contact allergy and allergic contact dermatitis. Part 2. Cross- and co-sensitization, other skin reactions to HEMA, position of HEMA among (meth)acrylates, sensitivity as screening agent, presence of HEMA in commercial products and practical information on patch test procedures. Contact Dermatitis 2024; 90:1-16. [PMID: 37778325 DOI: 10.1111/cod.14430] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
This is the second part of a literature review of the clinical aspects of contact allergy to and allergic contact dermatitis from 2-hydroxyethyl methacrylate (HEMA). Topics include cross- and co-sensitization, atypical manifestations of contact allergy, frequency of positive patch tests to HEMA compared with other (meth)acrylates, sensitivity of HEMA as a screening agent, the presence of HEMA in commercial products, and practical information on patch testing procedures. Primary sensitization to methacrylates including HEMA may result in methacrylate and acrylate cross-sensitization. There is a strong cross-allergy between HEMA, ethylene glycol dimethacrylate (EGDMA), and hydroxypropyl methacrylate; many reactions to EGDMA are cross-reactions to primary HEMA sensitization. Rare atypical manifestations of HEMA-allergy include lichen planus, lymphomatoid papulosis, systemic contact dermatitis, leukoderma after positive patch tests, and systemic side effects such as nausea, diarrhoea, malaise, and palpitations. The occurrence of respiratory disease caused by methacrylates such as asthma is not infrequent. HEMA is the most frequently patch test-positive methacrylate. It is a good screening agent for allergy to other (meth)acrylates. Patch test sensitization to HEMA 2% pet. is extremely rare. There are (some) indications that HEMA is frequently used in dental products and nail cosmetics.
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Affiliation(s)
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Johnson W, Bergfeld WF, Belsito DV, Cohen DE, Klaassen CD, Liebler DC, Marks JG, Peterson LA, Shank RC, Slaga TJ, Snyder PW, Fiume M, Heldreth B. Methacrylate Ester Monomers. Int J Toxicol 2023; 42:61S-73S. [PMID: 37794531 DOI: 10.1177/10915818231204572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The Expert Panel for Cosmetic Ingredient Safety reviewed newly available studies since their original assessment in 2005, along with updated information regarding product types and concentrations of use, and confirmed that these 22 methacrylate ester monomers are safe as used in nail enhancement products in the practices of use and concentration as described in this report, when skin contact is avoided.
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Affiliation(s)
- Wilbur Johnson
- Cosmetic Ingredient Review Former Senior Scientific Analyst/Writer
| | | | | | | | | | | | - James G Marks
- Expert Panel for Cosmetic Ingredient Safety Former Member
| | | | - Ronald C Shank
- Expert Panel for Cosmetic Ingredient Safety Former Member
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de Groot AC, Rustemeyer T. 2-Hydroxyethyl methacrylate (HEMA): A clinical review of contact allergy and allergic contact dermatitis-Part 1. Introduction, epidemiology, case series and case reports. Contact Dermatitis 2023; 89:401-433. [PMID: 37752620 DOI: 10.1111/cod.14405] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/28/2023]
Abstract
2-Hydroxyethyl methacrylate (HEMA) has been increasingly recognised as a contact allergen and was added to the European baseline series in 2019. In this article (2 parts), the results of an extensive literature review of the clinical aspects of contact allergy/allergic contact dermatitis to HEMA are presented. In part 1, the epidemiology of HEMA contact allergy is discussed and detailed information on published case series and case reports presented. HEMA is an important cause of contact allergy/allergic contact dermatitis in North America and Europe with recent prevalences of >3% in the USA + Canada and 1.5%-3.7% in Europe. Currently, most cases are caused by nail cosmetics, both in consumers and professional nail stylists. In our literature review, we have found 24 studies presenting case series of patients with allergic contact dermatitis attributed to HEMA and 168 case reports. However, the presence of HEMA in the products causing ACD was established in only a minority. Part 2 will discuss cross- and co-sensitisation, and other skin reactions to HEMA, will assess whether HEMA is the most frequent (meth)acrylate allergen and how sensitive HEMA as a screening agent is, investigate the presence of HEMA in commercial products and provide practical information on patch testing procedures.
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Affiliation(s)
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, AZ, The Netherlands
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Havmose M, Thyssen JP, Zachariae C, Johansen JD. Artificial Nails and Long-lasting Nail Polish in Danish Hairdressers: Self-use, Occupational Exposure and Related Eczema. Acta Derm Venereol 2022; 102:adv00818. [PMID: 36317860 PMCID: PMC9811296 DOI: 10.2340/actadv.v102.4524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
Artificial nail modelling systems (ANMS), encompassing artificial nails and long-lasting nail polish, are sources of acrylate exposure in beauticians and users of ANMS. Hairdressers' exposure to ANMS from self-use and occupational exposure is currently unknown. In 2020 a questionnaire was sent to all hairdressers graduating during 2008 to 2018 in Denmark (n = 4,830). Self-use of ANMS was reported by 87.6% of respondents (1,251/1,428), and application of ANMS to others was reported by 22.1% (316/1,428). Of these, application to others was performed in a salon by 37.1% (109/294), privately by 51.0% (150/294) and in both settings by 11.9% (35/294). Compliance with glove use was seen in 23.0% (67/291) among those applying ANMS to others. Among hairdressers exposed to ANMS, 4.3% (52/1,218) reported ANMS-related hand eczema. Being a trained beautician (adjusted odds ratio 3.26, 95% confidence interval 1.06-9.99) and having had a positive patch-test to acrylates (adjusted odds ratio 7.70, 95% confidence interval 1.44-41.13) were associated with ANMS-related hand dermatitis. In conclusion, hairdressers have a high prevalence of exposure to ANMS and ANMS-related hand dermatitis. Compliance with glove use when applying ANMS to others is poor. Patch-testing with acrylates is valuable in the diagnostic work-up of hand eczema in hairdressers.
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Affiliation(s)
- Martin Havmose
- National Allergy Research Center, Department of Dermatology and Allergy, Gentofte Hospital, Gentofte Hospitalsvej 20A, DK-2900 Hellerup, Denmark.
| | - Jacob P Thyssen
- National Allergy Research Center, Department of Dermatology and Allergy, Gentofte Hospital, Gentofte Hospitalsvej 20A, DK-2900 Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jeanne D Johansen
- National Allergy Research Center, Department of Dermatology and Allergy, Gentofte Hospital, Gentofte Hospitalsvej 20A, DK-2900 Hellerup, Denmark
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8
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Havmose M, Blomberg M, Zachariae C, Johansen JD. Local and systemic contact dermatitis elicited by dental plastic fillings in a patient allergic to 2-hydroxyethyl methacrylate. Contact Dermatitis 2022; 87:106-108. [PMID: 35307853 DOI: 10.1111/cod.14111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Martin Havmose
- National Allergy Research Center, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Maria Blomberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jeanne D Johansen
- National Allergy Research Center, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Symanzik C, Weinert P, Babić Ž, Hallmann S, Havmose MS, Johansen JD, Kezic S, Macan M, Macan J, Strahwald J, Turk R, van der Molen HF, John SM, Uter W. Allergic contact dermatitis caused by 2-hydroxyethyl methacrylate and ethyl cyanoacrylate contained in cosmetic glues among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications: a systematic review. Contact Dermatitis 2022; 86:480-492. [PMID: 35088905 DOI: 10.1111/cod.14056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
Abstract
Current cosmetic regulations primarily focus on protecting consumers, not the professional user who is subjected to a partly different, and certainly more intense exposure to hazardous substances. Against this background, the present systematic review aims to compile and appraise evidence regarding skin toxicity of 2-hydroxyethyl methacrylate (HEMA; CAS no. 212-782-2) and ethyl cyanoacrylate (ECA; CAS no. 7085-85-0) contained in cosmetic glues used among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications. This systematic review followed the PRISMA 2020 recommendations for reporting systematic reviews and meta-analysis. In total, 6 publications from 6 countries were eligible for this systematic review. Meta-analysis revealed that hairdressers and beauticians have a 9-fold increased risk of developing contact allergy to HEMA compared to controls who are not hairdressers and beauticians. Results for ECA are lacking. The present systematic review clearly shows that - regarding contact allergy to acrylates - it is not appropriate to apply risk assessment for consumers to hairdressers and beauticians who occupationally handle cosmetic glues. The regulations in existence do not adequately address occupational risks for hairdressers and beauticians connected with the use of acrylate-containing cosmetic substances and need reconsideration. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cara Symanzik
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Patricia Weinert
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Željka Babić
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Sarah Hallmann
- University of Erlangen, Department of Medical Informatics, Biometry and Epidemiology, Erlangen, Germany
| | - Martin S Havmose
- National Allergy Research Centre, Department of Skin and Allergy, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Skin and Allergy, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark
| | - Sanja Kezic
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marija Macan
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Jelena Macan
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Julia Strahwald
- University of Erlangen, Department of Medical Informatics, Biometry and Epidemiology, Erlangen, Germany
| | - Rajka Turk
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Henk F van der Molen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Swen M John
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Wolfgang Uter
- University of Erlangen, Department of Medical Informatics, Biometry and Epidemiology, Erlangen, Germany
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The Present and Future Burden of Contact Dermatitis from Acrylates in Manicure. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00272-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bishop S, Roberts H. Methacrylate perspective in current dental practice. J ESTHET RESTOR DENT 2020; 32:673-680. [PMID: 32744420 DOI: 10.1111/jerd.12633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide a current perspective concerning dental personnel sensitivity to methacrylate materials. OVERVIEW Methacrylate related sensitivity and allergies are currently beyond traditional thoughts concerning denture base resins and methyl methacrylate provisional materials. Methacrylates are now ubiquitous in current dental practice and dental personnel should be aware that dental adhesives contain potent sensitizers that may also cross-sensitize individuals to other methacrylates not experienced. The growing sensitivity to 2-hydroxyethyl methacrylate (HEMA) has been described to be epidemic in nature due to the artificial nail industry with dental patients and dental personnel may be more susceptible to dental methacrylate sensitization. While contact dermatitis remains the most prevalent methacrylate-related clinical presentation, respiratory complications and asthma are increasing associated with methacrylate exposure. While additional personal protective equipment (PPE) is thought to be first protective choice, the National Institute for Occupational Safety and Health (NIOSH) considers PPE overall largely ineffective and should be considered only as a last resort. CONCLUSION Dental personnel need to be more aware of methacrylate sources and use workplace control measures to limit methacrylate exposures to both dental personnel and patients. CLINICAL SIGNIFICANCE Sensitivity to methacrylate materials is a growing dental workplace major concern and dental personnel should be aware of both the methacrylate content of current materials and the products that contain ingredients with the most sensitization potential.
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Affiliation(s)
- Susan Bishop
- Division of Restorative Dentistry, University of Kentucky College of Dentistry, Lexin1gton, Kentucky, USA
| | - Howard Roberts
- Director of Graduate Studies, University of Kentucky College of Dentistry, Lexington, Kentucky, USA.,USAF Postgraduate Dental College, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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