A case of contact dermatitis from 'hypoallergenic' nail varnish

Occupational allergic contact dermatitis from unsaturated polyester resin in a car repair putty

BACKGROUND

Unsaturated polyester (UP) resins are widely used as cements in car repair painting to produce a smooth surface before the final painting. We report two car painters with hand and face dermatitis who were sensitized to a UP resin used for car repair cements.

METHODS

Patch testing with commercial substances and ingredients and extracts from UP resins was used to verify the sensitivity.

RESULTS

Both patients showed an allergic patch test reaction to a UP resin. They also had an allergic patch test reaction to diethyleneglycol maleate (DEGM), an extract of a UP resin.

CONCLUSIONS

Both patients had been patch tested elsewhere with negative results because UP resins had not been used for patch testing. Accordingly, patients with dermatitis who have been exposed to UP resins need to be patch tested with UP resins. The specific chemical causing allergic contact dermatitis in our patients was DEGM.

The allergens of nail polish. (I). Allergenic constituents of common nail polish and toluenesulfonamide-formaldehyde resin (TS-F-R)

Nail polish that has completely dried on the fingernails contains water-soluble components that attain the skin during extensive but transient contact. This was proven by water extraction of thin layers of nail polish that had been painted onto glass plates and allowed to dry for 3 days. Comparing the isolated fractions and compounds with known nail polish ingredients revealed that the water-soluble substances are para- and ortho-toluenesulfonamide, dibutyl phthalate and 3 constituents of toluenesulfonamide-formaldehyde resin (TS-F-R), which is the basic material of almost all nail polishes sold worldwide. 12 female patients with proven nail polish allergy were patch tested with 21 nail polish components, including those isolated. Only 2 fractions were positive. These contained a monomer and a dimer created during condensation of TS-F-R. Their structures were elucidated. The 3rd compound, a trimer, remained negative, except in 1 case.

Occupational contact allergy to unsaturated polyester resin cements

6 men contracted occupational allergic contact dermatitis from unsaturated polyester (UP) cements. 4 of the men were employed in car repair painting and the remaining 2 in mold manufacturing. The exposure time to UP cements ranged from 6 to 32 years before onset of skin symptoms. All patients had eczema on their hands; in addition, 4 had skin symptoms on airborne areas, i.e., wrists, neck and face. All 6 patients developed allergic reactions when patch tested with UP resin at 0.5-10% in petrolatum (pet.). None of the tested patients reacted to auxiliary or cross-linking chemicals of the cements. Diethylene glycol maleate (DGM) was purified and identified from the UP resin of a cement. 1 patient reacting to UP resin was also patch test positive to DGM and he produced an allergic reaction to DGM down to a concentration of 0.0032% pet. DGM was found in both uncured and cured UP resin. None of the patients could continue their work with UP cements after their sensitization.

Nail varnish allergy with far-reaching consequences

Contact allergy to nail varnish is well-known, and toluene-sulphonamide formaldehyde resin (TSAfr) was identified as the main allergen in 1943. During the period October 1989-December 1991 we identified 18 cases of contact allergy to nail varnish. The aim of the study was to describe the clinical picture, patch-test results, course and socio-medical consequences. Seventeen of the 18 patients were patch-test positive to TSAfr and 17/18 were positive to their own nail varnishes. Fourteen of the 18 were also positive to one or more substances in the standard patch-test series. The lesions were scattered, involving the face, eyelids, neck and hands. Periungual lesions were recorded in 11/18. The dermatitis resolved within a few weeks when the use of nail varnish was stopped. The socio-medical consequences of contact allergy to nail varnish had been severe: sick leave (nine cases), hospitalization (four cases), cessation of visual-display-unit (VDU) work (two cases), and job-loss (two cases). Our conclusions are that contact allergy to nail varnish and TSAfr is common; the socio-medical consequences may be severe; periungual lesions occur more frequently than previously stated, and the presence of other contact allergies makes the diagnosis easy to miss. TSAfr should be included in the standard patch-test series and patients should also be tested with their own nail varnishes. The study illustrates the need for mandatory declaration of the ingredients of cosmetics, as is required in the U.S.A.