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Keskinkaya Z, Işık Mermutlu S, Kaya Ö, Çakır H. Artificial nail modelling systems in healthcare workers: An emerging risk of contact sensitization to a well-known occupational allergen in an alternative way. Contact Dermatitis 2024; 91:38-44. [PMID: 38561321 DOI: 10.1111/cod.14548] [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: 01/16/2024] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Artificial nail modelling systems (ANMS) pose a significant risk for nail stylists and their clients regarding acrylate sensitization, which might jeopardize the use of acrylate-containing medical devices. OBJECTIVES To evaluate the frequency of artificial nail practices among female healthcare workers (HCWs) compared with controls and assess ANMS-related side effects. METHODS In this comparative, cross-sectional, single-centre study, a face-to-face interview with 200 female HCWs and 200 age-matched female dermatology patients (controls) was conducted regarding the use of ANMS between March and November 2023. RESULTS Among 400 participants (median age: 25), 85 (21.3%) have applied ANMS at least once. The prevalence of ANMS application was significantly higher in HCWs (n = 54/200, 27%) compared with controls (n = 31/200, 15.5%) (p < 0.05). Long-lasting nail polish was the most commonly preferred technique (n = 82/85, 96.5%). ANMS were mainly performed in nail studios by nail stylists (n = 79/85, 92.9%), while three participants were using home kits. Nail brittleness was the most frequently reported side effect (n = 19/85, 22.4%). No case of allergic contact dermatitis (ACD) was detected. CONCLUSIONS The popularity of ANMS among young female HCWs is growing. This striking trend might further put these individuals not only at risk of medical device-related adverse events but also occupational ACD.
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Affiliation(s)
- Zeynep Keskinkaya
- Department of Dermatology and Venereology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Selda Işık Mermutlu
- Department of Dermatology and Venereology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Özge Kaya
- Department of Dermatology and Venereology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Haile Çakır
- Department of Dermatology and Venereology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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2
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Lahouel I, Trimeche K, Smida S, Youssef M, Belhadjali H, Zili J. Pseudo-psoriatic nail dystrophy revealing contact allergy to nail cosmetics. J Cosmet Dermatol 2024; 23:706-707. [PMID: 37638554 DOI: 10.1111/jocd.15982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Ines Lahouel
- Dermatology Department, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Khaoula Trimeche
- Dermatology Department, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Salma Smida
- Dermatology Department, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Monia Youssef
- Dermatology Department, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Hichem Belhadjali
- Dermatology Department, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Jameleddine Zili
- Dermatology Department, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
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3
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Meek B, Bridges JW, Fasey A, Sauer UG. Evidential requirements for the regulatory hazard and risk assessment of respiratory sensitisers: methyl methacrylate as an example. Arch Toxicol 2023; 97:931-946. [PMID: 36797432 PMCID: PMC10025211 DOI: 10.1007/s00204-023-03448-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/17/2023] [Indexed: 02/18/2023]
Abstract
This review addresses the need for a framework to increase the consistency, objectivity and transparency in the regulatory assessment of respiratory sensitisers and associated uncertainties. Principal issues are considered and illustrated through a case study (with methyl methacrylate). In the absence of test methods validated for regulatory use, formal documentation of the weight-of-evidence for hazard classification both at the level of integration of individual studies within lines of evidence and across a broad range of data streams was agreed to be critical for such a framework. An integrated approach is proposed to include not only occupational studies and clinical evidence for the regulatory assessment of respiratory sensitisers, but also information on structure and physical and chemical factors, predictive approaches such as structure activity analysis and in vitro and in vivo mechanistic and toxicokinetic findings. A weight-of-evidence protocol, incorporating integration of these sources of data based on predefined considerations, would contribute to transparency and consistency in the outcome of the assessment. In those cases where a decision may need to be taken on the basis of occupational findings alone, conclusions should be based on transparent weighting of relevant data on the observed prevalence of occupational asthma in various studies taking into account all relevant information including the range and nature of workplace exposures to the substance of interest, co-exposure to other chemicals and study quality.
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Affiliation(s)
| | - James W Bridges
- Emeritus Professor, University of Surrey, Guildford, Surrey, UK
| | | | - Ursula G Sauer
- Scientific Consultancy-Animal Welfare, Hallstattfeld 16, 85579, Neubiberg, Germany.
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4
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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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5
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Symanzik C, Johansen JD, Weinert P, Babić Ž, Hallmann S, Havmose MS, Kezic S, Macan M, Macan J, Strahwald J, Turk R, van der Molen HF, John SM, Uter W. Differences between hairdressers and consumers in skin exposure to hair cosmetic products: a review. Contact Dermatitis 2022; 86:333-343. [PMID: 35088418 DOI: 10.1111/cod.14055] [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: 11/29/2022]
Abstract
Hairdressers are at high risk of developing occupational hand eczema. Opinions on the health and safety concerns of non-food consumer products, such as cosmetics and their ingredients, consider the exposure of a 'common consumer', which may not account for occupational exposure of hairdressers. As result, there is a parlous scenario in which serious safety concerns about occupational exposures are present. The purpose of this review is to compare the frequency of exposure to various types of hair cosmetic products among hairdressers and consumers. Database searches for this review yielded a total of 229 articles. 7 publications were ultimately included. The analysis showed that - dependent on the task - hairdressers were exposed 4 to 78 times more than consumers regarding a wide spectrum of hair cosmetic products used in the daily working life ranging from shampoo, conditioner, oxidative and non-oxidative hair colours, and bleaching agents. The highest frequency was found for colouring hair with oxidative hair colour. Consumer usage frequency does not appear to be appropriate for representing hairdresser exposure. The current standards do not effectively address the occupational risks associated with hairdressers' use of cosmetics. The findings of this study should cause current risk assessment procedures to be reconsidered. 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
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Skin and Allergy, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark
| | - 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
| | - 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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6
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Acrylates as a significant cause of allergic contact dermatitis: new sources of exposure. Postepy Dermatol Alergol 2021; 38:555-560. [PMID: 34658693 PMCID: PMC8501444 DOI: 10.5114/ada.2020.95848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/11/2020] [Indexed: 11/22/2022] Open
Abstract
Acrylate monomers have a wide range of applications. Since the 1950s, many reports of occupational origin allergic contact dermatitis due to (meth)acrylate monomers have been published. During last decades, (meth)acrylate allergy has undergone an occupational shift from dentistry toward beauty industry and medical devices. The aim of the study was to conduct a literature review on acrylates as a cause of allergic contact dermatitis, current sources of exposure as well as identification of professional groups with an increased risk of this allergy and methods of effective prevention. Database review: Medline search (PubMed), Wiley Online Library and Web of Science base in years 1956–2019 using the following keywords: acrylates, manicurists, dentists, dental technicians, medical devices, occupational exposure, and allergic contact dermatitis. 204 346 articles containing the term ‘acrylates‘ have been found. They include 2 042 articles with the word ‘manicurists’, 169 919 – ‘dentists’, 218 236 – ‘dental technicians’, 2 427 418 – ‘medical devices’. Fifty-nine articles were chosen based on analysis of abstracts and full texts. In the past allergy to acrylates was mainly of occupational origin and dental technicians were the most often affected professional group. Since the long-lasting manicure has become popular, this problem concerns both manicurists and their customers. Moreover, the new significant trend is non-occupational allergic contact dermatitis caused by medical devices especially dedicated to diabetes patients.
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7
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Occupational Methacrylate Allergy in Dental Personnel. ALLERGIES 2021. [DOI: 10.3390/allergies1020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose of the article: Acrylate and methacrylate (MA) use in the dental industry is widespread, being utilized in dental prostheses and composite resins, dentin bonding materials, and glass ionomers. However, occupational methacrylate allergy in dental personnel is a growing phenomenon. The aims of this retrospective observational study are to evaluate the risk of occupational contact dermatitis following exposure to methacrylates in dental personnel and to identify possible preventive measures. Materials and Methods: A total of 126 subjects exposed to acrylic and methacrylic resins in their professional context and who reported clinical manifestations were included from our outpatient department database. These were subdivided into two groups: 81 dental technicians and 45 dental hygienists. All the subjects had undergone patch testing with a “methacrylate series” (FIRMA) and readings were taken after 2 days (D2), 4 days (D4), and 7 days (D7). Results: A significantly higher incidence of methacrylate allergy was found in the dental technician group compared to the dental hygienists. Among the dental technicians, 40.7% of the subjects presented skin manifestations. The hands were the most frequently affected sites. Conclusion: Our results confirm the high sensitizing potential of MA in the workplace for dental personnel and in particular an increased professional risk in work where the hands are directly involved (dental technicians). Patch testing as an integrated part of a screening tray is needed for a complete evaluation of occupational skin allergy due to MA in dental personnel. The adoption of proper primary preventive measures, including gloves, protective eyewear, face shields, and disposable gowns, can be useful in preventing new cases of contact dermatitis, which may lead to a change of occupation in dental personnel.
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8
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Contact Allergy to Plastic Materials and Glues. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_79] [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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9
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Blood plasma levels of biomarkers of liver status and lipid profile among nail technicians occupationally exposed to low-level mixture of volatile organic compounds. Int Arch Occup Environ Health 2020; 94:487-494. [PMID: 33156392 PMCID: PMC8032578 DOI: 10.1007/s00420-020-01599-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Nail technicians (NTs) are exposed to a low-level mixture of volatile organic solvents (VOCs), yet the health hazards related to such exposure are unknown. This study thus aimed to compare the blood plasma levels of selected biomarkers related to liver status and lipid profile among occupationally exposed NTs and unexposed controls. Associations between out-of-normal-range levels of such biomarkers and occupational exposure to VOCs mixture have also been investigated. METHODS The study enrolled 145 female NTs and 152 unexposed controls. Biochemical analyses were performed using spectrophotometric assays and obtained data were analyzed using general linear model and Poisson regression modelling adjusted to multiple confounders. RESULTS Compared to controls, NTs presented significantly increased plasma activities of ALT (2.04 ± 0.63 ln-U/l vs. 1.25 ± 0.71 ln-U/l; p < 0.0001) and AST (2.73 ± 0.25 ln-U/l vs. 2.08 ± 0.95 ln-U/l; p < 0.0001), and significantly increased plasma levels of TG (4.38 ± 0.53 ln-mg/dl vs. 4.21 ± 0.42 ln-mg/dl; p < 0.05) and TC/HDL ratio (1.18 ± 0.36 vs. 1.02 ± 0.27; p < 0.0005). Plasma levels of HDL were significantly lower among NTs (4.02 ± 0.29 ln-mg/dl vs. 4.21 ± 0.26 ln-mg/dl; p < 0.0001). Moreover, NTs were found to present significantly increased risk of occurrence of clinically relevant plasma HDL levels below 3.91 ln-mg/dl (i.e., 50 mg/dl; RR = 1.58, 95% CI 1.07-2.32, p < 0.05), as well as increased risk of clinically relevant TC/HDL ratio above the normal range limit of 3.5 (RR = 1.68, 95% CI 1.19-2.35, p < 0.005), as compared to unexposed controls. CONCLUSION Nail technicians are subject to adverse changes in selected plasma biomarkers related to liver functions, some of which may be of clinical relevance.
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10
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Exposure to Nail and False Eyelash Glue: A Case Series Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124283. [PMID: 32549349 PMCID: PMC7345203 DOI: 10.3390/ijerph17124283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 01/13/2023]
Abstract
The use of artificial nail tips in professional manicure services and the application of false eyelashes are a growing trend among young women. Often, this “beauty routine” is performed at home without the supervision of an expert beautician, raising health problems due to either the spillage of these products or to accidental exposure to children. The aim of this study is to review the Pavia Poison Control Centre clinical records to identify the frequency, the most common route of exposure, and the possible risks associated to these events to support the decision-making process in emergency departments. The Pavia Poison Control Centre database was retrospectively searched for records reporting nail or false eyelash glue exposure from January 2007 to April 2020, and 42 patients were identified. Among the patients, 76% presented symptoms from mild to severe, while 24% were asymptomatic. The most common route of exposure was dermal, through cutaneous contact, as determined for 19 patients involved. Among these, seven patients presented with second-degree chemical burns, cutaneous erythema, and ocular symptoms. The most dangerous glue component was cyanoacrylate, leading to symptoms in 16 out of 22 patients, while three cases remained asymptomatic. Even if this exposure is relatively rare, nail and false eyelash glue can be seriously harmful, especially when exposure occurs via dermal or ocular routes. In the case of emergency, it is important to treat the patient as fast as possible to limit the damage caused by a burn. Moreover, even though these products are often perceived as harmless, safety precautions should be taken to prevent children from accidental contact.
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11
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Voller L, Warshaw E. Acrylates: new sources and new allergens. Clin Exp Dermatol 2020; 45:277-283. [DOI: 10.1111/ced.14093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/10/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- L.M. Voller
- Department of Dermatology Park Nicollet Health Services Minneapolis MN USA
- University of Minnesota Medical School Minneapolis MN USA
| | - E.M. Warshaw
- Department of Dermatology Park Nicollet Health Services Minneapolis MN USA
- Department of Dermatology University of Minnesota Minneapolis MN USA
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12
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Contact Allergy to Plastic Materials and Glues. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_79-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Parsi K, Roberts S, Kang M, Benson S, Baker L, Berman I, Bester LJ, Connor DE, Dinnen P, Grace J, Stirling A, Ibrahim N, Lekich C, Lim A, Matar L, Nadkarni S, Paraskevas P, Rogan C, Thibault PK, Thibault S, van Rij A, Yang A. Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology. Phlebology 2019; 35:153-175. [PMID: 31368408 DOI: 10.1177/0268355519864755] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure. 1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients. 2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety.
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Affiliation(s)
- Kurosh Parsi
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Mina Kang
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Luke Baker
- Department of Medical Imaging, Westmead Hospital, Sydney, Australia
| | | | | | - David E Connor
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | - Paul Dinnen
- Gold Coast Vascular Centre, Gold Coast, Australia
| | | | | | - Nabeel Ibrahim
- Sydney Centre for Venous Disease, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia
| | | | - Adrian Lim
- Department of Dermatology, The Royal North Shore Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | | | | | | | - Christopher Rogan
- Macquarie University Hospital, Sydney, Australia.,Department of Medical Imaging, Sydney Adventist Hospital, Sydney, Australia.,Department of Medical Imaging, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul K Thibault
- Central Vein and Cosmetic Medical Centre, Newcastle, Australia
| | - Simon Thibault
- Central Vein and Cosmetic Medical Centre, Newcastle, Australia
| | - Andre van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Anes Yang
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
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14
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15
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Parsi K, Kang M, Yang A, Kossard S. Granuloma formation following cyanoacrylate glue injection in peripheral veins and arteriovenous malformation. Phlebology 2019; 35:115-123. [PMID: 31204574 DOI: 10.1177/0268355519856756] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Cyanoacrylate adhesive closure is a technically simple alternative to endothermal ablation of peripheral
veins. N-butyl cyanoacrylate is delivered via catheters or by percutaneous injection resulting in occlusion of target veins. The local tissue reaction or the systemic immune response that may follow have not been characterised. Aim To characterise the late local tissue reaction to N-butyl cyanoacrylate glue injected in peripheral vessels. Methods Biopsies were obtained from two patients. In patient one, distal tributaries of the great saphenous vein were
injected with VenaBlock™ glue under ultrasound guidance. Ultrasound-guided incisional biopsies were performed at one week, six weeks and 12 months. In patient two, a peripheral arterio-venous malformation was injected with Venablock™ and biopsy was performed 12 months later. Histological analysis was performed using haematoxylin and eosin and immunofixation with CD-4, CD-31, CD-34, CD-68 and D2-40. Results Echogenic material with a strong shadow artefact consistent with the injected N-butyl cyanoacrylate was
observed on ultrasound on all follow-up occasions. Biopsies taken at one week showed intravascular glue without histiocytes. Biopsies at six weeks showed isolated foreign body histiocytes coating intravascular fibrillary glue spicules but no granuloma formation. The one-year biopsies showed extravascular changes including fibrosis, lymphoid aggregates and multiple extravascular foreign body cavitated granulomas. Some vessel lumens contained residual spicules of glue but no intravascular granulomas. The extravascular granulomas were deeply located, asymptomatic and not complicated by clinical ulceration. Histologically, there was no evidence of transepidermal elimination. Conclusion Extravascular foreign body cavitated granulomas containing spicules of glue with fibrosis and lymphoid
aggregates occur as a delayed finding following the use of N-butyl cyanoacrylate.
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Affiliation(s)
- Kurosh Parsi
- Dermatology, Phlebology, Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, Sydney, Australia.,Department of Dermatology, St. Vincent's Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Mina Kang
- Dermatology, Phlebology, Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Anes Yang
- Dermatology, Phlebology, Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research, Sydney, Australia.,University of New South Wales, Sydney, Australia
| | - Steven Kossard
- University of New South Wales, Sydney, Australia.,Kossard Dermatopathologists, Sydney, Australia
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16
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Determinants of Exposures to Hazardous Materials among Nail Cosmeticians in the Kampala City, Uganda. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2019; 2019:1925863. [PMID: 31061662 PMCID: PMC6466909 DOI: 10.1155/2019/1925863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/30/2019] [Accepted: 02/13/2019] [Indexed: 11/17/2022]
Abstract
Globally, nail salons represent a fast expanding industry and often with low-income cosmeticians. In general, cosmeticians have limited access to safety information about the hazardous materials they handle, which would potentially enable them to minimize workplace exposures. The problem is much pronounced in low- and middle-income countries due to weaknesses in regulation of the industry. We investigated determinants of exposures to hazardous materials among nail cosmeticians in Kampala District, Uganda. We employed a cross-sectional study design among a random sample of 243 participants. The sociodemographic characteristics, education and training status, knowledge about routes of exposure to hazardous chemicals, and personal protective material use of cosmeticians were assessed through face-to-face interviews. Most cosmeticians were aged 18–34 years, and more males were engaged in this work than females. Also, 82.7% believed inhalation was the major exposure route for the chemicals they handled. Participants who had attained secondary-level education and above were over three times more likely to wear masks (AOR = 3.19, 95% CI 1.58–6.41) and gloves (AOR = 3.48, 95% CI 1.55–7.81) and over two times more likely to use aprons (AOR = 2.50, 95% CI 1.18–5.32). Participants who had ever received safety training on hazardous chemicals were more likely to wear all four personal protective equipment: masks (AOR = 3.21, 95% CI 1.61–6.42), gloves (AOR = 4.23, 95% CI 2.05–8.75), goggles (AOR = 4.14, 95% CI 1.25–13.65), and aprons (AOR = 2.73, 95% CI 1.25–5.96). Participants who had spent more than two years in the nail cosmetics business were more likely to wear masks (AOR = 3.37, 95% CI 1.64–6.95). With the increasing demand for nail cosmetics, and many people in urban areas of low-income countries engaging in this industry, there is need for training and better workplace policies to promote a healthier urban workforce dealing in cosmetics.
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17
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Dinani N, George S. Nail cosmetics: a dermatological perspective. Clin Exp Dermatol 2019; 44:599-605. [DOI: 10.1111/ced.13929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2018] [Indexed: 01/01/2023]
Affiliation(s)
- N. Dinani
- Dermatology Department Brighton and Sussex University Hospitals NHS Trust Brighton UK
| | - S. George
- Dermatology Department Brighton and Sussex University Hospitals NHS Trust Brighton UK
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18
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George C, Walsh S. Periocular rash. BMJ 2018; 363:k5098. [PMID: 30578243 DOI: 10.1136/bmj.k5098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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Bogen KT, Garry MR. Risks of Allergic Contact Dermatitis Elicited by Nickel, Chromium, and Organic Sensitizers: Quantitative Models Based on Clinical Patch Test Data. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:1036-1051. [PMID: 29023909 DOI: 10.1111/risa.12902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/30/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
Risks of allergic contact dermatitis (ACD) from consumer products intended for extended (nonpiercing) dermal contact are regulated by E.U. Directive EN 1811 that limits released Ni to a weekly equivalent dermal load of ≤0.5 μg/cm2 . Similar approaches for thousands of known organic sensitizers are hampered by inability to quantify respective ACD-elicitation risk levels. To help address this gap, normalized values of cumulative risk for eliciting a positive ("≥+") clinical patch test response reported in 12 studies for a total of n = 625 Ni-sensitized patients were modeled in relation to observed ACD-eliciting Ni loads, yielding an approximate lognormal (LN) distribution with a geometric mean and standard deviation of GMNi = 15 μg/cm2 and GSDNi = 8.0, respectively. Such data for five sensitizers (including formaldehyde and 2-hydroxyethyl methacrylate) were also ∼LN distributed, but with a common GSD value equal to GSDNi and with heterogeneous sensitizer-specific GM values each defining a respective ACD-eliciting potency GMNi /GM relative to Ni. Such potencies were also estimated for nine (meth)acrylates by applying this general LN ACD-elicitation risk model to respective sets of fewer data. ACD-elicitation risk patterns observed for Cr(VI) (n = 417) and Cr(III) (n = 78) were fit to mixed-LN models in which ∼30% and ∼40% of the most sensitive responders, respectively, were estimated to exhibit a LN response also governed by GSDNi . The observed common LN-response shape parameter GSDNi may reflect a common underlying ACD mechanism and suggests a common interim approach to quantitative ACD-elicitation risk assessment based on available clinical data.
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20
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Gonçalo M, Pinho A, Agner T, Andersen KE, Bruze M, Diepgen T, Foti C, Giménez-Arnau A, Goossens A, Johanssen JD, Paulsen E, Svedman C, Wilkinson M, Aalto-Korte K. Allergic contact dermatitis caused by nail acrylates in Europe. An EECDRG study. Contact Dermatitis 2017; 78:254-260. [DOI: 10.1111/cod.12942] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/26/2017] [Accepted: 11/01/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital, and Faculty of Medicine; University of Coimbra; 3000-075 Coimbra Portugal
| | - André Pinho
- Department of Dermatology, Coimbra University Hospital, and Faculty of Medicine; University of Coimbra; 3000-075 Coimbra Portugal
| | - Tove Agner
- Dermatology Department, Bispebjerg Hospital; University of Copenhagen; 2400 Copenhagen Denmark
| | - Klaus E. Andersen
- Department of Dermatology and Allergy Centre; Odense University Hospital; 5000 Odense Denmark
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology; Lund University Skåne University Hospital; 205 02 Malmö Sweden
| | - Thomas Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology; University Hospital Heidelberg; 69115 Heidelberg Germany
| | - Caterina Foti
- Unit of Dermatology, Department of Biomedical Science and Human Oncology; University of Bari; 70121 Bari Italy
| | - Ana Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigations Mediques; Universitat Autonoma; 08003 Barcelona Spain
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology; University Hospital K. U. Leuven; 3000 Leuven Belgium
| | - Jeanne D. Johanssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Gentofte Hospital; University of Copenhagen; 2900 Hellerup Denmark
| | - Evy Paulsen
- Department of Dermatology and Allergy Centre; Odense University Hospital; 5000 Odense Denmark
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology; Lund University Skåne University Hospital; 205 02 Malmö Sweden
| | - Mark Wilkinson
- Dermatology; Leeds Teaching Hospitals NHS Trust; Leeds LS7 4SA UK
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21
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Abstract
Over the past several decades, the commercialization of nail cosmetics has increased. From nail polishes to artificial nails, different methods of nail beautification have become popularized. However, the impact of these products remains largely unknown. Governments have passed legislation in attempts to regulate nail cosmetics, but these regulations may not be adequate and are difficult to enforce. Knowledge of the safety and efficacy of nail products remains limited due to the relative dearth of literature published on the topic. This review serves to summarize and interpret the data available regarding common nail products and their safety and efficacy. Nail products such as nail polish, nail polish removers, and artificial nails have shown to have some adverse effects through case reports and studies. Harmful substances such as toluenesulfonamide-formaldehyde resin and methacrylates have been identified in commercial nail products, leading to several adverse effects, but in particular, allergic contact dermatitis. Exposure to substances such as acetonitrile found in removers may have more toxic and caustic effects, especially if ingested. In addition, for nail technicians there are negative effects linked with occupational exposure. Compounds used in nail products may become aerosolized and lead to asthma, eye and throat irritation, and even neurocognitive changes.
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22
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Moreira J, Gonçalves R, Coelho P, Maio T. Eyelid Dermatitis Caused by Allergic Contact to Acrylates in Artificial Nails. Dermatol Reports 2017; 9:7198. [PMID: 28603598 PMCID: PMC5452630 DOI: 10.4081/dr.2017.7198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 05/22/2017] [Indexed: 11/23/2022] Open
Abstract
Over the past few years, there has been an increase in cases of allergic contact dermatitis caused by acrylates, because of the growing popularity of artificial nails. Pathological reactions to artificial nails typically occur on or around the nail area. Eyelid contact dermatitis due to artificial nails is rarely seen, especially in a nonoccupational setting. The authors report the case of a 45-year-old female accountant who developed eyelid dermatitis due to artificial nails.
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Affiliation(s)
- Jorge Moreira
- Department of Ophthalmology, Hospital Pedro Hispano, Porto, Portugal
| | - Rita Gonçalves
- Department of Ophthalmology, Hospital Pedro Hispano, Porto, Portugal
| | - Pedro Coelho
- Department of Ophthalmology, Hospital Pedro Hispano, Porto, Portugal
| | - Tiago Maio
- Department of Ophthalmology, Hospital Pedro Hispano, Porto, Portugal
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23
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Raposo I, Lobo I, Amaro C, Lobo MDL, Melo H, Parente J, Pereira T, Rocha J, Cunha AP, Baptista A, Serrano P, Correia T, Travassos AR, Dias M, Pereira F, Gonçalo M. Allergic contact dermatitis caused by (meth)acrylates in nail cosmetic products in users and nail technicians - a 5-year study. Contact Dermatitis 2017; 77:356-359. [DOI: 10.1111/cod.12817] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/18/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Inês Raposo
- Department of Dermatology; Centro Hospitalar do Porto; 4099-001 Porto Portugal
| | - Inês Lobo
- Department of Dermatology; Centro Hospitalar do Porto; 4099-001 Porto Portugal
| | - Cristina Amaro
- Department of Dermatology; Centro Hospitalar Lisboa Central; 1169-050 Lisboa Portugal
| | - Maria de Lurdes Lobo
- Department of Dermatology; Centro Hospitalar Lisboa Central; 1169-050 Lisboa Portugal
| | - Helena Melo
- Department of Dermatology; Hospital CUF Descobertas; 1998-018 Lisboa Portugal
| | - Joana Parente
- Department of Dermatology; Hospital de Santarém; 2005-177 Santarém Portugal
| | - Teresa Pereira
- Department of Dermatology; Hospital de Braga; 4710 Braga Portugal
| | - Joana Rocha
- Department of Dermatology; Hospital Pedro Hispano; 4460 Matosinhos Portugal
| | - Ana P. Cunha
- Department of Dermatology; Centro Hospitalar São João; 4200-319 Porto Portugal
| | - Armando Baptista
- Department of Dermatology; Centro Hospitalar Vila Nova de Gaia; 4400-129 Vila Nova de Gaia Portugal
| | - Pedro Serrano
- Department of Dermatology; Hospital Garcia da Orta; 2801-951 Almada Portugal
| | - Teresa Correia
- Department of Dermatology, Hospital de Santa Maria; Centro Hospitalar Lisboa Norte; 1649-035 Lisboa Portugal
| | - Ana R. Travassos
- Department of Dermatology; Hospital CUF Descobertas; 1998-018 Lisboa Portugal
- Department of Dermatology, Hospital de Santa Maria; Centro Hospitalar Lisboa Norte; 1649-035 Lisboa Portugal
| | - Margarida Dias
- Department of Dermatology, Hospital Egas Moniz; Centro Hospitalar Lisboa Ocidental; 1349-019 Lisboa Portugal
| | - Fátima Pereira
- Department of Dermatology; Hospital CUF Infante Santo; 1350-070 Lisboa Portugal
| | - Margarida Gonçalo
- Clinic of Dermatology, University Hospital and Faculty of Medicine; University of Coimbra; 3000-075 Coimbra Portugal
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24
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Nilsen BW, Jensen E, Örtengren U, Michelsen VB. Analysis of organic components in resin-modified pulp capping materials: critical considerations. Eur J Oral Sci 2017; 125:183-194. [PMID: 28444854 DOI: 10.1111/eos.12347] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to elucidate the organic composition and eluates of three resin-based pulp-capping materials in relation to their indications and safety data sheets. Uncured samples of Theracal LC, Ultra-Blend Plus, and Calcimol LC were investigated using gas chromatography-mass spectrometry (GC-MS) and ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Identification/quantification of 7-d leachables of cured samples was performed using GC-MS for 2-hydroxyethyl methacrylate (HEMA), 2-(dimethylamino)ethyl methacrylate (DMAEMA), camphorquinone (CQ), ethylene glycol dimethacrylate (EGDMA), ethyl-4-(dimethylamino)benzoate (DMABEE), and triethylene glycol dimethacrylate (TEGDMA). A similar organic composition was found for Ultra-Blend and Calcimol; however, only Ultra-Blend is indicated for direct pulp-capping. In contrast to the other materials analysed, Theracal contained substances of high molecular weight. The safety data sheets of all materials were incomplete. We detected HEMA, CQ, and TEGDMA in eluates from Ultra-Blend and Calcimol, and it was considered that HEMA might have originated from decomposition of diurethane dimethacrylate (UDMA) in the GC-injector. For Theracal, additives associated with light curing (DMABEE and CQ) were detected in higher amounts (4.11 and 19.95 μg mm-2 ) than in the other materials. Pores were quantified in all samples by micro-computed tomography (micro-CT) analysis, which could influence leaching. The organic substances in the investigated materials might affect their clinical suitability as capping agents, especially for direct capping procedures.
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Affiliation(s)
- Bo W Nilsen
- Department of Clinical Dentistry, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Einar Jensen
- Department of Pharmacy, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ulf Örtengren
- Department of Clinical Dentistry, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Cariology, Institute of Odontology/Sahlgrenska Academy, Göteborg, Sweden
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25
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Moins L, Persoons R, Barbeau D, Balducci F, Maitre A, Bonneterre V. Évaluation de l’état de santé, des risques professionnels toxiques et de l’exposition aux métaux d’une population de prothésistes dentaires. ARCH MAL PROF ENVIRO 2016. [DOI: 10.1016/j.admp.2016.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Allergy to Surgical Implants. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:683-95. [PMID: 26362550 DOI: 10.1016/j.jaip.2015.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 01/26/2023]
Abstract
Surgical implants have a wide array of therapeutic uses, most commonly in joint replacements, but also in repair of pes excavatum and spinal disorders, in cardiac devices (stents, patches, pacers, valves), in gynecological implants, and in dentistry. Many of the metals used are immunologically active, as are the methacrylates and epoxies used in conjunction with several of these devices. Allergic responses to surgical components can present atypically as failure of the device, with nonspecific symptoms of localized pain, swelling, warmth, loosening, instability, itching, or burning; localized rash is infrequent. Identification of the specific metal and cement components used in a particular implant can be difficult, but is crucial to guide testing and interpretation of results. Nickel, cobalt, and chromium remain the most common metals implicated in implant failure due to metal sensitization; methacrylate-based cements are also important contributors. This review will provide a guide on how to assess and interpret the clinical history, identify the components used in surgery, test for sensitization, and provide advice on possible solutions. Data on the pathways of metal-induced immune stimulation are included. In this setting, the allergist, the dermatologist, or both have the potential to significantly improve surgical outcomes and patient care.
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27
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Grešner P, Świercz R, Król MB, Twardowska E, Gromadzińska J, Wąsowicz W. Does the Low-level occupational exposure to volatile organic compounds alter the seasonal variation of selected markers of oxidative stress? A case-control study in nail technicians. J Occup Med Toxicol 2016; 11:36. [PMID: 27453719 PMCID: PMC4957283 DOI: 10.1186/s12995-016-0125-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 07/07/2016] [Indexed: 01/26/2023] Open
Abstract
Background In this study we tested whether the seasonal variations in levels of selected biomarkers of oxidative stress in female nail technicians occupationally exposed to low levels of volatile organic compounds (VOCs) differ significantly from those observed among healthy unexposed controls. Airborne levels of selected VOCs in nail salons were also analyzed and tested for associations with seasonal variations of the levels of biomarkers among nail technicians. Methods The study enrolled 145 female nail technicians and 145 healthy unexposed female controls. The airborne VOCs and levels of biomarkers were assessed by GC-MS chromatography and absorption/fluorescence spectrophotometry, respectively. Results Plasma levels of thiobarbituric acid reactive species, ceruloplasmin, the activity of glutathione peroxidase (GPx1) and the SOD1/GPx1 activity ratio presented significant differences between the so-called “hot” and “cold” seasons in the case of nail technicians as well as in unexposed controls (p < <0.0001 for all four biomarkers). The pattern of these variations among nail technicians was found to be significantly different compared to that of the control subjects (p < <0.0001). Although such differences might intuitively be attributed to occupational exposure of nail technicians to VOCs, which was found to be higher during the “cold” season compared to the “hot” one, our study provided only limited evidence in favor of the hypothesis, that the different pattern of seasonal variations of biomarkers among nail technicians might have resulted from seasonal fluctuations in their occupational exposure to VOCs. Conclusion Further investigation is thus needed in order to elucidate the effect of low-level occupational exposure to VOCs on seasonal variations of biomarkers of oxidative stress. Electronic supplementary material The online version of this article (doi:10.1186/s12995-016-0125-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Grešner
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, 8, Sw. Teresy str., 91-348 Lodz, Poland
| | - Radosław Świercz
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, 8, Sw. Teresy str., 91-348 Lodz, Poland
| | - Magdalena Beata Król
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, 8, Sw. Teresy str., 91-348 Lodz, Poland
| | - Ewa Twardowska
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, 8, Sw. Teresy str., 91-348 Lodz, Poland
| | - Jolanta Gromadzińska
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, 8, Sw. Teresy str., 91-348 Lodz, Poland
| | - Wojciech Wąsowicz
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, 8, Sw. Teresy str., 91-348 Lodz, Poland
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28
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Gavazzoni-Dias MFR, Rochael M, Vilar E, Tanus A, Tosti A. Eczema-Like Psoriasiform Skin Reaction due to Brazilian Keratin Treatment. Skin Appendage Disord 2016; 1:156-62. [PMID: 27172059 DOI: 10.1159/000442529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The use of formaldehyde and formaldehyde releasers in hair-straightening formulations started in Rio de Janeiro in 2003. The technique is known as BKT, Brazilian keratin treatment. The aim of this study was to analyze the types of skin reactions presented by patients due to BKT. We describe 7 patients with severe erythema and scurf on the scalp which developed shortly after BKT. The lesions were eczema-like psoriasiform, located mainly on the scalp. Some patients also developed eczema-like lesions and pustules on the face, neck, upper arms, and upper trunk. Dermatoscopic findings included erythema, perifollicular and interfollicular scurf. The peripilar desquamation resembled the outer skin of an onion bulb. Scalp biopsies revealed psoriasiform and spongiotic psoriasiform patterns, one of them similar to anti-TNFα biologic drug psoriasiform alopecia. The possible consequences of the absorption of formaldehyde by hairdressers or clients are still to be verified by the scientific community; however, the skin and scalp reactions observed in our cases suggest a drug reaction phenomenon and not only eczemas of irritant or allergic origin.
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Affiliation(s)
| | - Mayra Rochael
- Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Enoï Vilar
- Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Aline Tanus
- Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami L. Miller School of Medicine, Miami, Fla., USA
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29
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Mattos Simoes Mendonca M, LaSenna C, Tosti A. Severe Onychodystrophy due to Allergic Contact Dermatitis from Acrylic Nails. Skin Appendage Disord 2015; 1:91-4. [PMID: 27170940 DOI: 10.1159/000434686] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 05/29/2015] [Indexed: 11/19/2022] Open
Abstract
Acrylic nails, including sculptured nails and the new ultraviolet-curable gel polish lacquers, have been associated with allergic contact dermatitis (ACD). We report 2 cases of ACD to acrylic nails with severe onychodystrophy and psoriasiform changes including onycholysis and subungual hyperkeratosis. In both cases, the patients did not realize the association between the use of acrylate-based manicures and nail changes. One patient had been previously misdiagnosed and treated unsuccessfully for nail psoriasis. The informed clinician should elicit a history of acrylic manicure in patients with these nail changes, especially in cases of suspected nail psoriasis refractory to treatment. Patch testing is a useful tool in confirming diagnosis.
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Affiliation(s)
| | - Charlotte LaSenna
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Fla., USA
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Fla., USA
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30
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Vázquez-Osorio I, Espasandín-Arias M, García-Gavín J, Fernández-Redondo V. Allergic contact dermatitis due to acrylates in acrylic gel nails: a report of 3 cases. ACTAS DERMO-SIFILIOGRAFICAS 2015; 105:430-2. [PMID: 24784931 DOI: 10.1016/j.adengl.2013.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/27/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- I Vázquez-Osorio
- Servicio de Dermatología, Complejo Hospitalario Universitario, Santiago de Compostela, A Coruña, Spain.
| | - M Espasandín-Arias
- Servicio de Dermatología, Complejo Hospitalario Universitario, Santiago de Compostela, A Coruña, Spain
| | - J García-Gavín
- Servicio de Dermatología, Complejo Hospitalario Universitario, Vigo, Pontevedra, Spain
| | - V Fernández-Redondo
- Servicio de Dermatología, Complejo Hospitalario Universitario, Santiago de Compostela, A Coruña, Spain
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31
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Ramos L, Cabral R, Gonçalo M. Allergic contact dermatitis caused by acrylates and methacrylates - a 7-year study. Contact Dermatitis 2014; 71:102-7. [DOI: 10.1111/cod.12266] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Leonor Ramos
- Dermatology Department; Centro Hospitalar e Universitário de Coimbra; 3000 Coimbra Portugal
| | - Rita Cabral
- Dermatology Department; Centro Hospitalar e Universitário de Coimbra; 3000 Coimbra Portugal
| | - Margarida Gonçalo
- Dermatology Department; Centro Hospitalar e Universitário de Coimbra; 3000 Coimbra Portugal
- Faculty of Medicine, University of Coimbra; 3000 Coimbra Portugal
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Vázquez-Osorio I, Espasandín-Arias M, García-Gavín J, Fernández-Redondo V. Allergic contact dermatitis due to acrylates in acrylic gel nails: a report of 3 cases. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.ad.2013.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Airborne contact dermatitis and asthma in a nail art operator. Int J Occup Med Environ Health 2014; 27:137-40. [PMID: 24488773 DOI: 10.2478/s13382-014-0226-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/20/2013] [Indexed: 11/20/2022] Open
Abstract
Nail art (creation and decoration of artificial nails) is a growing fashion trend. Proportionally to its popularity, the number of allergic reactions to the materials used has recently increased. We report the case of a nail art operator who developed occupational allergy to acrylates, manifested with the unusual simultaneous presence of asthma and dermatitis. Cutaneous lesions only affected areas not covered by individual protection devices or clothes, even if such areas were not in direct contact with acrylates, suggesting airborne allergic contact dermatitis. While respiratory problems were solved with the correct use of a mask at the workplace, facial dermatitis proved impossible to avoid or control and, for this reason, the patient had to change her work.
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1064 Nd:YAG laser for the treatment of chronic paronychia: a pilot study. Lasers Med Sci 2013; 30:1623-6. [PMID: 24326744 DOI: 10.1007/s10103-013-1506-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
Paronychia, which can be acute or chronic, is characterized by erythema, edema, and tenderness at the proximal and occasionally lateral nail folds. Causes of chronic paronychia include excessive moisture, contact irritants, trauma, and candida infection. Chronic paronychia is usually multifactorial and difficult to treat. The aim of the present work was to assess the role of neodymium-doped yttrium aluminium garnet (Nd:YAG) laser as a new modality for the treatment of chronic paronychia. In this interventional pilot study, eight female patients suffering from long-standing paronychia received 2-5 Nd:YAG laser sessions (4 weeks apart). Fluences ranged between 70 to 80 J/cm(2), using a 2.5-mm spot size handpiece, and pulse duration was set at 0.7 ms. Patients were digitally photographed and clinically evaluated before starting the treatment and at each session. Seven of our patients showed various degree of improvement regarding erythema and swelling of their proximal nail folds. Nail plate abnormalities also improved in six patients. These preliminary results document the efficacy and feasibility of Nd:YAG laser as one of the treatments that could ameliorate chronic paronychia.
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Natsch A, Ryan CA, Foertsch L, Emter R, Jaworska J, Gerberick F, Kern P. A dataset on 145 chemicals tested in alternative assays for skin sensitization undergoing prevalidation. J Appl Toxicol 2013; 33:1337-52. [PMID: 23576290 DOI: 10.1002/jat.2868] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 02/04/2013] [Accepted: 02/04/2013] [Indexed: 12/12/2022]
Abstract
Skin sensitization is a key endpoint for cosmetic ingredients, with a forthcoming ban for animal testing in Europe. Four alternative tests have so far been submitted to ECVAM prevalidation: (i) MUSST and (ii) h-Clat assess surface markers on dendritic cell lines, (iii) the direct peptide reactivity assay (DPRA) measures reactivity with model peptides and (iv) the KeratinoSens(TM) assay which is based on detection of Nrf2-induced luciferase. It is anticipated that only an integrated testing strategy (ITS) based on a battery of tests might give a full replacement providing also a sensitization potency assessment, but this concept should be tested with a data-driven analysis. Here we report a database on 145 chemicals reporting the quantitative endpoints measured in a U937- test, the DPRA and KeratinoSens(TM) . It can serve to develop data-driven ITS approaches as we show in a parallel paper and provides a view as to the current ability to predict with in vitro tests as we are entering 2013. It may also serve as reference database when benchmarking new molecules with in vitro based read-across and find use as a reference database when evaluating new tests. The tests and combinations thereof were evaluated for predictivity, and overall a similar predictivity was found as before on three-fold smaller datasets. Analysis of the dose-response parameters of the individual tests indicates a correlation to sensitization potency. Detailed analysis of chemicals false-negative and false-positive in two tests helped to define limitations in the tests but also in the database derived from animal studies.
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Affiliation(s)
- Andreas Natsch
- Givaudan Schweiz AG, Ueberlandstrasse 138, CH-8600, Dübendorf, Switzerland
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Bhargava K, White JM, White IR. Eyelid allergic contact dermatitis caused by ethyl cyanoacrylate-containing eyelash adhesive. Contact Dermatitis 2012; 67:306-7. [DOI: 10.1111/j.1600-0536.2012.02150.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pesonen M, Kuuliala O, Henriks-Eckerman ML, Aalto-Korte K. Occupational allergic contact dermatitis caused by eyelash extension glues. Contact Dermatitis 2012; 67:307-8. [DOI: 10.1111/j.1600-0536.2012.02128.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lyons G, Nixon R. Allergic contact dermatitis to methacrylates in ECG electrode dots. Australas J Dermatol 2012; 54:39-40. [DOI: 10.1111/j.1440-0960.2012.00918.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 04/27/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation; Melbourne; Victoria; Australia
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Cousen PJ, Ramsay HM, Gawkrodger DJ. An unusual cause of fingernail dystrophy. Clin Exp Dermatol 2012; 37:589-90. [DOI: 10.1111/j.1365-2230.2011.04290.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maio P, Carvalho R, Amaro C, Santos R, Cardoso J. Allergic contact dermatitis from sculptured acrylic nails: special presentation with an airborne pattern. Dermatol Reports 2012; 4:e6. [PMID: 25386316 PMCID: PMC4212667 DOI: 10.4081/dr.2012.e6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 03/07/2012] [Accepted: 03/12/2012] [Indexed: 11/22/2022] Open
Abstract
Methylmethacrylate was first reported in 1941 as a cause of contact dermatitis. Since then, occupational contact allergies to acrylates in dentistry, orthopedic surgery, printing industry and industry have been reported, but few reports are found in the literature as a consequence of the contact with sculptured artificial acrylic nails which are increasingly popular. We describe here 3 patients with contact allergy to acrylates in artificial sculptured nails. Patch tests were performed with the Portuguese baseline series of contact allergens and an extended series of acrylates were applied. In particular, we tested three female patients with allergic contact dermatitis from sculptured acrylic nails. Two of these patients were both customers and also technical nail beauticians. Two patients developed periungual eczema; one presented only with face and eyelid dermatitis had no other lesions. The tests showed positive reaction to 2-hydroxyethylmethacrylate (2-HEMA) and 2-hydroxypropylmethacrylate (2-HPMA) in all the three patients. Our cases demonstrate the variety of clinical presentations of allergic contact dermatitis from acrylic sculptured nails. They show the need to warn patients of persistent and sometimes permanent side effects of these products. They also emphasize the importance of cosmetic ingredient labeling.
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Affiliation(s)
- Paula Maio
- Contact Dermatitis Unit, Dermatology and Venereology Department, Curry Cabral Hospital, Lisbon, Portugal
| | - Rodrigo Carvalho
- Contact Dermatitis Unit, Dermatology and Venereology Department, Curry Cabral Hospital, Lisbon, Portugal
| | - Cristina Amaro
- Contact Dermatitis Unit, Dermatology and Venereology Department, Curry Cabral Hospital, Lisbon, Portugal
| | - Raquel Santos
- Contact Dermatitis Unit, Dermatology and Venereology Department, Curry Cabral Hospital, Lisbon, Portugal
| | - Jorge Cardoso
- Contact Dermatitis Unit, Dermatology and Venereology Department, Curry Cabral Hospital, Lisbon, Portugal
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Michelsen VB, Kopperud HBM, Lygre GB, Björkman L, Jensen E, Kleven IS, Svahn J, Lygre H. Detection and quantification of monomers in unstimulated whole saliva after treatment with resin-based composite fillings in vivo. Eur J Oral Sci 2012; 120:89-95. [PMID: 22288926 DOI: 10.1111/j.1600-0722.2011.00897.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Resin-based dental restorative materials contain allergenic methacrylate monomers, which may be released into saliva after restorative treatment. Monomers from resin-based composite materials have been demonstrated in saliva in vitro; however, studies analyzing saliva after restorative therapy are scarce. The aim of this study was to quantify methacrylate monomers in saliva after treatment with a resin-based composite filling material. Saliva was collected from 10 patients at four start points--before treatment, and 10 min, 24 h, and 7 d after treatment--and analysed by combined chromatography/mass spectrometry. The monomers bisphenol-A diglycidyl methacrylate (Bis-GMA), 2-hydroxyethyl methacrylate (HEMA), and urethane dimethacrylate (UDMA) were detected and quantified in the samples collected shortly (10 min) after treatment. The amounts detected ranged from 0.028 to 9.65 μg ml(-1) for Bis-GMA, from 0.015 to 0.19 μg ml(-1) for HEMA, and from 0.004 to 1.2 μg ml(-1) for UDMA. Triethyleneglycol dimethacrylate (TEGDMA) was detected in four of the samples. Ethoxylated bisphenol-A dimethacrylate (Bis-EMA) was not detected. Monomers were not detected in saliva samples collected before treatment, or 24 h or 7 d after treatment, with the exception of one sample, 24 h after treatment, in which HEMA was detected. In conclusion, monomers from the investigated resin-based composite and adhesive system were present in saliva shortly after treatment. One week after treatment, no monomers could be detected in patients' saliva samples.
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Henriks-Eckerman ML, Korva M. Exposure to airborne methacrylates in nail salons. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2012; 9:D146-D150. [PMID: 22746219 DOI: 10.1080/15459624.2012.696023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Narayan S, Swift A. Otitis externa: a clinical review. Br J Hosp Med (Lond) 2011; 72:554-8. [DOI: 10.12968/hmed.2011.72.10.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article provides a clinical overview of otitis externa, focusing on clinical aspects of the aetiology, diagnosis and management of this important and debilitating condition.
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Affiliation(s)
- Surya Narayan
- East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn BB2 3HH
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Goulding JMR, Finch TM. Acrylates tooth and nail: coexistent allergic contact dermatitis caused by acrylates present in desensitizing dental swabs and artificial fingernails. Contact Dermatitis 2011; 65:47-8. [DOI: 10.1111/j.1600-0536.2010.01867.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sobol M, Nebesářová J, Hozák P. A method for preserving ultrastructural properties of mitotic cells for subsequent immunogold labeling using low-temperature embedding in LR White resin. Histochem Cell Biol 2010; 135:103-10. [DOI: 10.1007/s00418-010-0771-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
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Comparison of methods of high-pressure freezing and automated freeze-substitution of suspension cells combined with LR White embedding. Histochem Cell Biol 2010; 134:631-41. [DOI: 10.1007/s00418-010-0757-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
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50
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Eluted substances from unpolymerized and polymerized dental restorative materials and their Nernst partition coefficient. Dent Mater 2010; 26:91-9. [DOI: 10.1016/j.dental.2009.08.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 06/02/2009] [Accepted: 08/21/2009] [Indexed: 01/09/2023]
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