Adhesive in Acrylic Nails, Glucose Monitors Triggers Allergy

Emily Willingham

October 07, 2019

People with acrylic nails have experienced reactions on their fingers, and reports of rashes from patients with continuous glucose monitors attached to their skin have physicians taking notice.

Although the general cause, when this happens, can be obvious — the reactions are localized to where adhesives stick — it takes time to track down the specific agent. And if the agent is not part of the common skin-patch panel used to test for allergens, it can take even longer, Margarida Gonçalo, MD, PhD, from Coimbra University Hospital in Portugal, told Medscape Medical News.

The hidden culprit, dermatologists report, is isobornyl acrylate, a component of the glue used in cosmetics and bandages. The American Contact Dermatitis Society has named this chemical the allergen of the year for 2020.

One reason there has been a lag in pinpointing isobornyl acrylate is that the rash does not always show up during early use. People can be exposed for years before the immune system responds to these materials and targets inflammation to exposed areas.

2020 Allergen of the Year

It is not uncommon that a chemical will be in use for 5 or 10 years before we start to really find out it's a problem, said Matthew Zirwas, MD, associate professor of dermatology at Ohio State University School of Medicine in Columbus.

Now that it has been identified in medical device adhesives, some new versions are coming onto the market that do not contain the adhesive, said Gonçalo, who is former president of the European Society of Contact Dermatitis.

Zirwas said he tells his patients that if their genetic susceptibility is low, they might wear one of these devices for a decade before seeing a reaction. But, if they are "really super predisposed," they might see a reaction in a month. Most commonly, though, reactions show up in the first couple of years.

For patients who are not able to find an acrylate-free alternative for their devices, placing a barrier between the skin and the adhesive can help, said Zirwas. His patients have had some success with a protective spray (Cavilon, 3M) that is usually used to prevent chronic friction in bedbound patients, he reported.

Although it is not part of the standard patch-testing panel, a separate test is available when allergy is suspected, said Alina Goldenberg, MD, from the Dermatologist Medical Group of North County in San Diego. The association should be obvious because of where the rash breaks out, she explained.

Separate Test Available

Gonçalo, who will talk about this problem at the upcoming 28th European Academy of Dermatology and Venereology Congress, also plans to discuss isothiazolinone preservatives, specifically methylisothiazolinone. When it earned the dubious distinction of allergen of the year in 2013, it was best known as a component of cosmetics, paint, and wallpaper glue, and was often used as a substitute for parabens.

The latest problems related to methylisothiazolinone come from children's play slime, which contains glue. Youngsters are turning up with severe rashes on their hands after making slime or playing with it, as reported by Medscape Medical News.

Clinicians also should be on the lookout for contact dermatitis related to wall paint.

Preservatives in acrylic paints are released into the room air, so patients might develop rashes on the face and hands after sleeping in a freshly painted bedroom for just a few hours. The air release can last up to 6 months, and the best solution is to not spend too much time in the affected room, said Zirwas.

"They can try sleeping in their bedroom after a month," he suggested, "and if they break out, they can wait another month and try again."

Other isothiazolinones are found in gloves that medical workers use and in some treated leather products, such as shoes, belts, and sofas, said Gonçalo.

Another preservative in gloves is sodium metabisulfite — best known for its association with white wines — which causes allergic reactions in up to 4% of people tested in Europe. It is also a component of intravenous drugs and can cause reactions at the IV site.

Even systemic reactions have been seen in people who are highly sensitized to sodium metabisulfite, said Gonçalo. Many cases of contact dermatitis related to sodium metabisulfite occur in patients with known allergy to sulfites, so "we have to be aware of these new uses."

The rate of allergy to this preservative is so high that its addition to a baseline series of allergy testing is being considered in Europe, Gonçalo reported.

But whether specific testing is available or not, if the general source can be identified, the main treatment is avoidance, Goldenberg said. Primary care physicians can watch for any dermatitis that persists or relapses under standard treatment and consider a referral for testing to identify a specific culprit, she added.

Gonçalo reports working on advisory board meetings with Sanofi-Genzyme, Novartis, and Roche. Zirwas and Goldenberg have disclosed no relevant financial relationships.

28th European Academy of Dermatology and Venereology (EADV) Congress: Spotlight presentation October 11, 2019.

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