Paediatric burns secondary to nail adhesives: a case series

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.

Social media influenced self-application of cyanoacrylate for double chin reduction in an adolescent girl: an unusual case of post-inflammatory hyperpigmentation

Introduction

Cyanoacrylate, used as a topical adhesive for wound closure in clinical settings, can result in poor cosmetic outcome on application to skin. Lack of formal medical or dermatological training among social media influencers poses risks of improper diagnosis, incorrect treatments, ineffective home remedies, and potential self-injury or long-term skin effects, especially among adolescents.

Case presentation

The authors present a case of a young girl with a persistent post-inflammatory hyperpigmentation after using cyanoacrylate on her chin as a home remedy to reduce her double chin problem after learning from a video on social media. Biopsy findings were consistent with post-inflammatory hyperpigmentation in dermis.

Clinical discussion

Application of cyanoacrylate over skin can result in allergic reactions, burn injuries, infections, itching, skin blistering, and aesthetic issues. Persistent post-inflammatory hyperpigmentation can be a poor cosmetic outcome on application of cyanoacrylate over skin.

Conclusion

Inadequate social media safety regulations require healthcare professionals to be aware of social trends among adolescents and to encourage them for open conversations and professional help-seeking during times of distress in this digital era.

Too Hot to Handle? Full-Thickness Burn Injury in a Child Caused by Cyanoacrylate Glue and Cotton-A Case Report and Experimental Study

Domestic superglue (cyanoacrylate) in the hands of children can have devastating consequences, especially when cotton clothing is involved. When cotton comes into contact with cyanoacrylate, an intense exothermic reaction occurs, creating temperatures high enough to cause significant thermal injury. A literature review found 16 such cases of burns documented (2 adult and 14 pediatric). This article presents a case report of a 4-year-old child sustaining a full-thickness burn injury to her leg requiring skin grafting when superglue was spilt onto cotton pants. She was sitting near a fan heater at the time. An experiment was conducted to replicate the exothermic reaction between superglue and cotton and to determine if the addition of radiant heat would have any significant effect. The maximum temperature reached with one 3-g tube of superglue onto cotton pyjamas was 91°C (196°F) and occurred approximately 90 seconds postapplication. It took more than 3 minutes for the temperature to cool below 40°C (104°F). The addition of radiant heat from a fan heater placed 60 cm from the clothing found that the temperature peak was similarly reached and cooled, but the temperature did not reduce below 52°C (126°F) for over 20 minutes, proving that potential harm may be amplified if first aid is not appropriately sought. Product labeling and the knowledge of potential harm from such mechanism of injury remain inadequate. It is hoped that the reporting of this case contributes to an increase in public education and awareness of such dangers and may contribute to preventing avoidable future incidences.

Paediatric chemical burns: a clinical review

Although they account for a small proportion of burns in paediatrics, injuries from chemicals can be just as devastating as other mechanisms of burn injury. At least 25,000 chemicals exist which can cause burns: in children, they are often caused by household chemicals via accidental exposure. The mechanism by which corrosive substances produce chemical burns highlights the importance of early and plentiful irrigation of the burn area, removal of contaminated clothes and careful clinical assessment. Surgical intervention is uncommon but often follows the principles for thermal burns. This article reviews the aetiology, incidence, clinical presentation, management, complications and prevention of chemical burns. What is Known • Chemical burns in paediatrics are often caused by accidental exposure to chemicals available at home • Differences in the pathophysiology of chemical burns reinforces the need for early irrigation What is New • New irrigation fluids show promise in adults and need further study in children • The nature of chemical cutaneous burns can make assessment of wound depth difficult. Laser Doppler Imaging (LDI) is an accurate technique that can be used clinically to determine burn depth in thermal burns and is an area of future interest in the assessment of chemical burns.

Pediatric burns with cyanoacrylate glue - an inconspicuous danger

Burns are a common cause of pediatric injury and represent significant morbidity and mortality in this age group. In children, most burns are thermal, resulting from exposure to a hot surface, liquid, or fire. Cyanoacrylate is a liquid compound commonly found in households, mainly in "superglue" and nail glue. This compound solidifies through an exothermic reaction that is magnified when in contact with certain fibers that act as catalysts, such as cotton. In these circumstances, intense heat is produced in the contact area, potentially causing severe thermal burns. Despite its widespread availability, there is a paucity of safety information about cyanoacrylate and its role as a cause for burns. In the literature, only 18 cases of cyanoacrylate burns are reported in children. We present 2 cases of pediatric burns with cyanoacrylate and a review of the literature.

Burn Injury Due to Cyanoacrylate-Based Nail Glue: A Case Report and Literature Review

Cyanoacrylate is used in the manufacturing of surgical adhesives, nail glue, and super glue. After contact with cotton or wool, among other catalysts, an exothermic reaction is ignited, inflicting thermal damage to the skin underlying clothes. Nine papers have been published about such an incidence, majority of which involve children. This is the first paper that presents the case of such a burn condition in Saudi Arabia. A four-year-old girl suffered a mix of first- and second-degree burns due to cyanoacrylate spillage over the digits, anterior aspect of the right thigh, and a patch of the skin on the left upper abdomen, spanning 4% of the total body surface area. The clothes were forcefully removed by the mother, and shampoo was applied over the area. At the emergency department, irrigation with normal saline was performed followed by dressing with paraffin-impregnated gauzes and silver sulfadiazine. Volar slabs were placed on the hands. The dressing in the hands was later changed to fusidic acid as the burn healed. Silicone sheet dressing was initiated 28 days later after the burned skin had healed. At one-year follow-up, the wounds were fully healed with no abnormal scar formation. This paper aims to improve awareness about proper first-aid burn management, which determines the quality of the outcome. Further emphasis is required on providing a safe environment for the children and clear, comprehensible warning of hazards on the label of the cyanoacrylate based-products.

Cyanoacrylate Nail Glue and the Pajama Catalyst

Nail glues are routinely used for the application of false nails and are readily available for unrestricted purchase from highstreet and online retailers. We present the case of a young lady who accidentally spilled her nail glue on to her cotton pajama trouser leg setting off a violent exothermic reaction that resulted in a full-thickness burn injury to her foot. She ultimately went on to require surgical debridement and skin grafting. We intend to remind both healthcare workers and members of the public that while nail glue alone in contact with the skin is relatively harmless, contact together with natural fibers such as cotton clothing produces a dangerous chemical reaction, which is too often underestimated and can lead to serious burn injuries. Our patient and the surgical team agree that more must be done to raise awareness of the risks these products pose, and retailers must ensure consumers are responsibly informed.

Exposure to Nail and False Eyelash Glue: A Case Series Study

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.

Determinants of Exposures to Hazardous Materials among Nail Cosmeticians in the Kampala City, Uganda

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.

Full-thickness Pediatric Burn following Reaction between Cyanoacrylate Nail Adhesive and Cotton Shirt

Cyanoacrylate is an acrylic resin that is used as an adhesive in acrylic nail glues and various other strong, rapidly acting adhesives, such as “Dermabond” and “Super Glue.” This adhesive is very effective in a variety of settings; however, when cyanoacrylate comes into contact with cotton fibers, an exothermic reaction occurs that is severe enough to cause a full-thickness burn to the underlying skin. Full-thickness burns requiring excision and skin grafting can be psychologically devastating for patients, especially the pediatric population and their parents, who may believe they are to blame for their child’s burn. We present the case of a 2-year-old boy who developed a full-thickness burn after spilling acrylic nail glue onto his cotton shirt. Fortunately, his burn was small enough that excision with primary closure was able to be performed. However, he unfortunately developed hypertrophic scarring postoperatively. Owing to the widespread use of cyanoacrylate adhesives in the general population, it is important to spread awareness of the potential dangers associated with these adhesives to prevent potential physical and psychological injuries related to improper use of these adhesives.