Severe Onychodystrophy due to Allergic Contact Dermatitis from Acrylic Nails

Artificial nail modelling systems in healthcare workers: An emerging risk of contact sensitization to a well-known occupational allergen in an alternative way

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.

Adverse Effects of Do-It-Yourself Nail Cosmetics: A Literature Review

Background

As self-applied manicures have gained popularity, it is important for physicians to remain informed about potential associated side effects. Traditional polish remains most popular among nail enthusiasts, but the pursuit of durability and convenience accelerated development of other nail cosmetic products, including gel polish, acrylic nails, and press-on nails. Despite documented adverse effects among beauty professionals and salon customers, individuals practicing at-home nail care routines may face similar, if not more, frequent complications due to misinformation, inadequate training, and social media trends.

Summary

This review provides an overview of adverse effects associated with different at-home nail cosmetics. Allergic contact dermatitis is the most prevalent adverse event, primarily attributed to (meth)acrylates found in nail glue, gel polish, and acrylic nails. Other adverse effects include infections, chemical burns, and complications from ultraviolet nail lamps.

Key Message

The review highlights the importance of transparent product labeling and appropriate warning labels from manufacturers, as well as physician education and awareness for minimizing risks related to at-home nail cosmetic applications.

Contact allergy caused by acrylates in nail cosmetics: A pilot study from Greece

BACKGROUND

The growing popularity of nail techniques based on acrylates has led to a higher frequency of sensitization in both nail technicians and users.

OBJECTIVES

The study aimed to assess cases of allergic contact dermatitis (ACD) caused by acrylates in individuals with occupational or non-occupational exposure to nail techniques.

METHODS

A preliminary study was conducted on 30 patients with ACD caused by acrylates in nail techniques, who were patch tested from September 2022 to March 2023 at the First Department of Dermatology and Venereology of Andreas Syggros Hospital, Athens, Greece.

RESULTS

Thirty female patients with ACD to acrylates were documented (15 users and 15 nail technicians and users). The most common allergens were: 2-hydroxyethyl methacrylate (HEMA), 2-hydroxypropyl methacrylate (HPMA) and ethyleneglycol dimethacrylate (EGDMA), which tested positive in all 30 patients (100.0%). Twenty patients (66.7%) had been exposed to dental procedures involving acrylates, before the onset of ACD. Nail technicians exhibited extensive skin lesions, 40.0% experienced ACD within the first year of work and 13.3% during their professional practice. Three of them (20.0%) had to discontinue their work.

CONCLUSION

Acrylates have been identified as potent allergens, necessitating the implementation of safety measures for the use of these chemicals in nail techniques.

Allergic Contact Cell-Mediated Hypersensitivity in Psoriasis: A Narrative Minireview

The dysfunctionality of the protective skin barrier in psoriasis allows easier cutaneous penetration of various contact haptens; thus, such patients can develop allergic contact hypersensitivity as a comorbidity. Both skin conditions involve T-cell-mediated mechanisms. Dermatologists and allergists should consider assessing allergic contact cell-mediated hypersensitivity in selected psoriasis patients, especially those with palmoplantar psoriasis and who are refractory to topical treatments, and in patients with psoriasis, with or without arthritis, treated with biologics that present skin lesions clinically suggestive of contact dermatitis.

Acrylates as a significant cause of allergic contact dermatitis: new sources of exposure

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.

Pathology of the Nail Unit

This article discusses the histologic findings in key nail unit diseases, including inflammatory, infectious, and neoplastic conditions. The emphasis is on clinicopathologic correlates, best practices to demonstrate the relevant histopathologic features, and pitfalls in diagnosis. Understanding the pathology of these disorders enhances clinical acumen and may affect the choice of biopsy procedures and treatment measures, with the outcome of better clinical care for patients with nail disease.

Psoriasiform Onychodystrophy Induced by Photobonded Acrylic Nails

Multiple cases have reported onychodystrophy secondary to acrylic nails. We present a case of onychodystrophy with psoriasiform nail changes, including onycholysis, splinter hemorrhages, hyperkeratosis, and nail plate thinning, caused by gel manicures. Histopathological analysis of the nail plate and subungual debris revealed neutrophils in the absence of fungal elements. Although the presence of neutrophils in the nail plate material in conjunction with characteristic psoriatic nail changes suggested a diagnosis of psoriasis, certain key features of nail psoriasis, including oil spots, salmon patches, and pitting, were notably absent. The development of these nail changes following gel manicure and pedicure application and the improvement of the onychodystrophy with topical and intralesional steroids support the diagnosis of psoriasiform onychodystrophy.

Side-effects Associated with Gel Nail Polish: A Self-questionnaire Study of 2,118 Respondents

Gel nail polish is commonly used in manicures; how-ever, research into the side-effects of gel nail polish is scarce and focusses mainly on allergic contact dermatitis. The aim of this study was to assess the frequency and characteristics of side-effects associated with use of gel nail polish. A self-questionnaire survey was conducted on a representative sample of individuals (n = 2,118, all female). Of these, 48.3% reported side-effects while applying gel nail polish, approximately 20% during wearing it, and more than 75% after removing the polish. Frequency of changes in the nail plates was significantly higher after removing the gel nail polish than when applying or wearing it (p < 0.0001). Frequency of changes in the nail plates was associated with whether the procedure was performed by professionals or non-professionals. Education about the risk of side-effects and sensitization is crucial for people using gel nail polish.

Development of a bioaction complex for the onychodystrophy treatment

This article is devoted to the problem of onychodystrophy treatment. The purpose of the study was to develop a bioactive complex for the external treatment of onychodystrophies. We conducted a prospective cohort study to determine the emotional status and life quality of patients with onychodystrophies. The optimal composition and technology for producing a complex for the onychodystrophy treatment was determined in vitro. We made a literature review using the PubMed, eLibrary, Scopus, Web of Science search engines. The structure of onychodystrophies in patients of the study group was determined, clinical forms such as leukonychia, paronychia, onycholysis were diagnosed the most frequently. A significant decrease in life quality was found in 86.8% of patients. A new method of onychodystrophies treatment using the innovative medical complex, which includes an emulsion for external use and camouflage nail polish is proposed. The developed bioactive complex for patients with onychodystrophy will contribute to the rapid regeneration of the changed nail plate due to improved microcirculation and trophic innervation. More viscous and thick consistency physiological colour nail polish which does not require polymerization, will create a visual effect of a healthy nail plate, which will improve the life quality of patients with onychodystrophy.

What's New in Nail Disorders

Various advancements in the diagnosis and management of nail diseases have transpired in recent years. To provide the best care for patients with nail complaints, it is essential that physicians be updated on new diagnostic and treatment modalities. The purpose of this article is to discuss new and oncoming diagnostic and management options for nail disorders, including nail psoriasis, retronychia, brittle nails, onychotillomania, trauma, trachyonychia, and pyogenic granulomas.

Pterygium inversum unguis secondary to gel polish

BACKGROUND

Pterygium inversum unguis (PIU) is characterized by the abnormal adherence of the hyponychium to the ventral surface of the nail plate. It can be both unsightly and painful, resulting in morbidity for patients. Gel polish is a popular nail cosmetic that has been reported to cause several complications. PIU may be another adverse outcome.

OBJECTIVE

To highlight a newly recognized adverse effect of a popular beauty technique.

METHODS

This retrospective and prospective case series reports 17 women who developed PIU after gel polish use. All study-related activities occurred at a University of Miami dermatology outpatient clinic.

RESULTS

All 17 subjects developed PIU after two to five years of gel polish application. Nine of 17 patients reported using both UVA and LED light to cure gel polish. Of the remaining eight, five used LED light only and three did not know or could not remember. All but two patients had a resolution of PIU a few weeks after switching from gel polish to regular polish manicures.

CONCLUSION

While it remains undiscerned whether PIU is related to chemicals present in the gel polish or to the application and/or removal process of such, patients and dermatologists should be aware of the potential risks of gel manicures.

Safety and Efficacy of Nail Products

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.

Psoriasis for the primary care practitioner

Primary care practitioners (PCPs) are playing an increasingly important role in the management and care of psoriasis. Thus, it is important for PCPs to be knowledgeable about the disease and to be able to differentiate between common myths and facts related to diagnosis and treatment. By building relationships with their patients and working collaboratively with dermatology health professionals and other specialists, PCPs can facilitate communication about the patient's treatment preferences and expectations for symptom relief, and they may be better able to work with the patient to optimize treatment adherence. This review aims to provide PCPs with a primer on psoriasis, its associated comorbidities, and its impact on patients' quality of life. Discussion topics include psoriasis epidemiology, triggering factors, clinical presentation, differential diagnosis, comorbidities, and approaches to treatment. This review also highlights the importance of staying abreast of advances in the understanding of psoriasis pathogenesis as well as emerging therapeutic treatment options, because these advances may change the treatment landscape and increase patients' expectations for skin clearance.

Patterns of clinical nail appearances in patients with cutaneous psoriasis

Background and aim

Nail manifestations are often an overlooked aspect in psoriatic disease, cutaneous and joint involvement being far more often reported and investigated. The reported prevalence of nail changes varies in literature, specific fingernail clinical features having different degrees of occurrence. The aim of this study was to describe specific clinical patterns of fingernail alterations in adult patients with plaque-type psoriasis in a university hospital in the North-West of Romania.

Methods

Clinical data of 35 patients with fingernail psoriasis were collected and analyzed. Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores were used to quantify disease extension in each patient.

Results

PASI score proved linearly correlated with NAPSI score (p<0.05). The age of onset of fingernail psoriasis was positively correlated with age of onset cutaneous psoriasis (p<0.0001). Furthermore, the duration of cutaneous involvement and NAPSI proved significantly related (p<0.05). The third fingernail in the right hand and first fingernail in the left hand were in most of the cases severely affected. The most common observed nail pattern was pitting, followed by salmon patches and subungual hyperkeratosis.

Conclusion

Important nail changes appear even in moderate forms of cutaneous psoriasis. Particular localization of specific fingernail psoriasis pattern enables the possibility of detecting early stage disease.