Allergic contact dermatitis to (meth)acrylates involving nail technicians and users: Prognosis and differential diagnosis

Acrylates and Methacrylates Sensitization in Patients with Orthopedic and Dental Prostheses: Asymptomatic Pre-Implant and Symptomatic Post-Implant Testing

Acrylates and methacrylates are widely used in dental and orthopedic prostheses, false nails, adhesives, glues, and paints, and are strong sensitizers. The aim of our study was to assess the prevalence of acrylate sensitization in patients before the application of dental or orthopedic prostheses or after the application in case of potentially related contact dermatitis. Methods: The subjects were tested according to haptens reported in safety data sheets, including methyl methacrylate (MMA) 5%, methyl acrylate (MA) 1%, ethyl methacrylate (EMA) 2%, ethyl acrylate (EA) 1%, butylacrylate 0.1%, 2 hydroxyethyl methacrylate (HEMA) 5%, ethylene glycol dimethacrylate 2% (EGDMA), tetraethylene glycol dimethacrylate 2% (TEGDMA), and dimethyl amino ethyl methacrylate 0.2% (DAEMA). Multivariable logistic regression was used to study the factors associated with (meth)acrylate sensitization. Results: Six hundred sixty-five patients (75.4% of the total sample) without contact dermatitis before the placement of any dental or orthopedic prosthesis and 217 patients (24.6% of the total sample) with contact dermatitis potentially due to already placed prostheses were involved. In total, 37 cases of patch test positivity to at least 1 acrylate (4.2%) were found. In the pre-implant population, previous dermatitis and respiratory allergy were associated with increased sensitization to acrylates in multivariable regression analysis (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.05-5.39; OR 2.96, 95% CI 1.32-6.64, respectively). The prevalence of sensitization was 3.5% for EGDMA, 2.7% for EA, 1.5% for 2-HEMA, 1.4% for both MA and MMA, 1.28% for DAEMA, and 0.8% for EMA. No statistically significant difference was found in the prevalence of sensitization between the pre- and post-implant groups. Discussion: Our study found a similar profile of sensitization in pre-implant and post-implant patients, suggesting the need to better study the specificity and sensitivity of patch tests to (meth)acrylate and to define relevance considering a detailed history of exposure.

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.

2-Hydroxyethyl methacrylate (2-HEMA) sensitization, a global epidemic at its peak in Spain?

BACKGROUND

A global epidemic of allergic contact dermatitis to (meth)acrylates has been described in relation to the widespread use of manicure products.

OBJECTIVES

To evaluate the frequency of sensitization to 2-hydroxyethyl methacrylate (2-HEMA) among consecutively patch tested patients with eczema in Spain; the percentage of current relevance; the MOAHLFA index; and, the potential sources of exposure to (meth)acrylates.

METHODS

From January 2019 to December 2022, 2-HEMA 2% pet. was prospectively patch tested in 24 REIDAC (Spanish Allergic Contact Dermatitis Registry) centres.

RESULTS

Six thousand one hundred thirty-four patients were consecutively patch tested with 2-HEMA 2% pet. 265/6134 (4.3%) were positive. Positive reactions of current relevance were identified to involve 184/265 (69%). The efficiency (number of patch tests needed to detect relevant positive patch test reactions) was 34 (6134/184). The variable 'occupational' was found to be significantly associated with a higher risk for relevant positive reactions to 2-HEMA (OR: 10.9; 95% CI: 8.1-14.9).

CONCLUSION

(Meth)acrylate sensitization is a prevalent health issue in Spain. 2-HEMA 2% pet. has been identified to be a highly effective (meth)acrylate allergy marker in the GEIDAC baseline series. The responsible authorities should implement policies guaranteeing accurate labelling of industrial, medical, and consumer materials while ensuring the enforcement of said labelling through appropriate legal means.

Contact allergy to acrylate-containing nail cosmetics: A retrospective 8-year study

BACKGROUND

Over the last 10 years, allergic contact dermatitis (ACD) from acrylate-containing nail cosmetics (acrylic nails, gel nails, gel nail polish) has been reported repeatedly.

OBJECTIVES

To investigate the frequency and clinical features of ACD in nail cosmetics in a university hospital in Amsterdam, The Netherlands.

PATIENTS AND METHODS

A retrospective study in patients diagnosed with ACD from acrylate-containing nail cosmetics at the Amsterdam University Medical Centers between January 2015 and August 2023.

RESULTS

Sixty-seven patients, all women, were diagnosed with ACD from nail cosmetics, representing 1.6% of all individuals and 2.3% of all women patch tested in this period. Sixty-five of sixty-seven (97%) subjects had a positive patch test to 2-hydroxyethyl methacrylate (HEMA). Forty-nine patients (73%) were consumers and 18 (27%) were professional nail stylists. The sites most frequently affected with dermatitis were the fingers (79%), hands (40%) and the head and/or neck. Avoidance of contact with acrylate-containing products resulted in complete clearing of dermatitis in 80% of patients.

CONCLUSIONS

ACD from acrylate-containing nail cosmetics is frequent in women patch tested in Amsterdam. Nearly all were identified by a positive patch test to 2-hydroxyethyl methacrylate in the (meth)acrylate series or the European baseline series.

2-Hydroxyethyl methacrylate (HEMA): A clinical review of contact allergy and allergic contact dermatitis. Part 2. Cross- and co-sensitization, other skin reactions to HEMA, position of HEMA among (meth)acrylates, sensitivity as screening agent, presence of HEMA in commercial products and practical information on patch test procedures

This is the second part of a literature review of the clinical aspects of contact allergy to and allergic contact dermatitis from 2-hydroxyethyl methacrylate (HEMA). Topics include cross- and co-sensitization, atypical manifestations of contact allergy, frequency of positive patch tests to HEMA compared with other (meth)acrylates, sensitivity of HEMA as a screening agent, the presence of HEMA in commercial products, and practical information on patch testing procedures. Primary sensitization to methacrylates including HEMA may result in methacrylate and acrylate cross-sensitization. There is a strong cross-allergy between HEMA, ethylene glycol dimethacrylate (EGDMA), and hydroxypropyl methacrylate; many reactions to EGDMA are cross-reactions to primary HEMA sensitization. Rare atypical manifestations of HEMA-allergy include lichen planus, lymphomatoid papulosis, systemic contact dermatitis, leukoderma after positive patch tests, and systemic side effects such as nausea, diarrhoea, malaise, and palpitations. The occurrence of respiratory disease caused by methacrylates such as asthma is not infrequent. HEMA is the most frequently patch test-positive methacrylate. It is a good screening agent for allergy to other (meth)acrylates. Patch test sensitization to HEMA 2% pet. is extremely rare. There are (some) indications that HEMA is frequently used in dental products and nail cosmetics.

Prognosis and sequelae of meth(acrylate) sensitization in beauticians and consumers of manicure materials

BACKGROUND

Allergic contact dermatitis from (meth)acrylic monomers (ACDMA) in manicure products is increasing.

OBJECTIVE

To evaluate the prognosis, work performance impairment and sequelae of a cohort of beauticians and manicure consumers with ACDMA sensitized from the exposure to manicure products.

METHODS

We conducted a telephone survey with patients diagnosed with ACDMA.

RESULTS

One hundred and six patients were evaluated, including 75 (70.8%) beauticians and 31 (29.2%) consumers. All were women with a mean age of 39 (19-62). Thirty-seven of 75 beauticians (49.3%) continued to work. Twenty-seven of 106 (25.5%) patients continued to use manicure products with (meth)acrylates regularly. Seventeen of 51 (33.3%) patients who discontinued the exposure described ongoing nail/periungual changes. Nine of 58 (15.5%) patients who required dental restoration, orthodontic or occlusal splint materials recalled reactions from them; and, 25 of 96 (26%) who used sanitary napkins recalled intolerance to them starting after the diagnosis of ACDMA. Fifteen of 25 (60%) discontinued the use of sanitary napkins.

CONCLUSION

49.3% beauticians continued to work; most patients stopped wearing acrylic manicure materials; reactions from dental materials were not uncommon, however, removal of dental materials was never required; and, reactions to sanitary napkins developing after the diagnosis of ACDMA were common most leading to discontinuation of use.

2-Hydroxyethyl methacrylate (HEMA): A clinical review of contact allergy and allergic contact dermatitis-Part 1. Introduction, epidemiology, case series and case reports

2-Hydroxyethyl methacrylate (HEMA) has been increasingly recognised as a contact allergen and was added to the European baseline series in 2019. In this article (2 parts), the results of an extensive literature review of the clinical aspects of contact allergy/allergic contact dermatitis to HEMA are presented. In part 1, the epidemiology of HEMA contact allergy is discussed and detailed information on published case series and case reports presented. HEMA is an important cause of contact allergy/allergic contact dermatitis in North America and Europe with recent prevalences of >3% in the USA + Canada and 1.5%-3.7% in Europe. Currently, most cases are caused by nail cosmetics, both in consumers and professional nail stylists. In our literature review, we have found 24 studies presenting case series of patients with allergic contact dermatitis attributed to HEMA and 168 case reports. However, the presence of HEMA in the products causing ACD was established in only a minority. Part 2 will discuss cross- and co-sensitisation, and other skin reactions to HEMA, will assess whether HEMA is the most frequent (meth)acrylate allergen and how sensitive HEMA as a screening agent is, investigate the presence of HEMA in commercial products and provide practical information on patch testing procedures.

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.