Contact Dermatitis to Nail Cosmetics

Nail aesthetic procedures, particularly the fashion of nail sculpting, gel nails and long-lasting polishes, have been expanding over the last years, with an increasing number of cases of allergic contact dermatitis both in aestheticians and customers. Clinical suspicion and interpretation of nail cosmetics patch test results require a general knowledge of the main current manicure techniques and chemicals used. Allergic contact dermatitis (ACD) to nail cosmetics, previously attributed mostly to tosylamide formaldehyde resin (TSFR), is now mainly caused by (meth)acrylates. In addition to pulpitis, periungual dermatitis, and lesions involving the face, neck, and chest, nail dystrophy can occur from (meth)acrylate-based techniques. The diagnosis of ACD can be confirmed by patch-testing suspected nail care product ingredients, namely, methacrylates, cyanoacrylates and TSFR. Hydroxyethyl methacrylate (HEMA), which detects most cases of ACD from nail (meth)acrylates, has been recently introduced in many baseline patch test series all over the world. Ingredients in nail cosmetics may lead to allergic and/or irritant contact dermatitis. Irritant dermatitis is mostly associated with nail hardeners and cuticle and nail polish removers. The “epidemic” of ACD to nail cosmetics has increased likely due to its expansion to untrained home users. Preventive measures and stricter regulation in the field are key measures to reduce ACD in this setting. Avoidance of the culprit is not always possible, particularly in the occupational setting. Sensitization to (meth)acrylates may have further health implications.