Nail Acrylate Allergy: The Beauty, the Beast and Beyond

M. Gonçalo


The British Journal of Dermatology. 2019;181(4):663-664. 

Nail beauty is not a new fashion, but with the new highly accessible techniques based on acrylates, methacrylates or cyanoacrylates, it has become really popular. It is common to see individuals next to you, particularly females, using acrylate-based ultraviolet-cured gel nails or long-lasting nail varnish. In some individuals these 'beautiful' nails come with pain, paraesthesia and when the artificial cover is removed we can see the beast below. Adverse effects can be long lasting (nail fragility, onycholysis, nail dystrophy, paronychia, even anonychia) or life-long, like sensitization to acrylates with important implications in future life. Actually, sensitized patients can have problems in other occupational settings (dentistry, dental prosthesis manufacture), after medical procedures (oral lesions from acrylates in dentistry or prosthesis loosening in cemented arthroplasty),[1] use of cosmetics (eyelash/hair extensions) or medical devices (surgical glues). Happily, nail (meth)acrylates do not seem to cross-react with isobornyl acrylate contained in glucose sensors or insulin pumps, which nevertheless have been shown to be a significant problem for diabetic patients.[2]

In recent years multiple cases of allergic contact dermatitis (ACD) from (meth)acrylates in nail aesthetics have been reported.[3–6] Technicians who perform acrylate-based techniques in nail salons and consumers, namely those also exposed through home kits, are at high risk. A short-duration contact with 2-hydroxyethyl methacrylate at 2% pet (HEMA) is enough to induce a skin reaction in a sensitized patient, as we have shown using only a 30-min patch test application.[7] Moreover, most gloves used to perform the very fine tasks of nail aesthetics are permeable to (meth)acrylates. Nitrile gloves seem to be better, but if contact is longer than 30–60 min reactions develop in highly sensitized patients, as shown by patch testing over glove fragments.[7] So, apart from measures to avoid contact with contaminated instruments and working surfaces, it is mandatory to change gloves frequently during aesthetic procedures.[8] This may allow a substantial percentage of workers to go on with their job with minor lesions on their hands, but does not prevent facial lesions [ectopic or airborne dermatitis from (meth)acrylate evaporation] or respiratory complaints.

Diagnosis of (meth)acrylate ACD is often evident (pulpitis and finger dermatitis or paronychia), but there is a substantial number of cases with atypical localizations (face, forearms), which would have been missed if testing with HEMA or an acrylate series had not been performed.[3] Patch testing with HEMA was shown to confirm the diagnosis of (meth)acrylate allergy in the nail setting in more than 90% of cases,[3,4,6] and the study by Raposo et al.[3] as well as that by Rolls et al.[6] have shown that > 1% of consecutive patients test positive to this allergen. Therefore, HEMA inclusion in the British baseline patch tests series was considered cost-effective, which is in agreement with the new European recommendations.[9] It is important, nevertheless, to patch test all HEMA-negative suspected cases with an extended acrylate series in order not to miss this important and frequent cause of ACD.