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

[Nail cosmetics-risks and opportunities]

The use of nail cosmetics has experienced a strong upswing in recent years, particularly due to product innovations and the increasing popularity in social media. The market value of nail cosmetics amounted to USD 24.55 billion in 2024 with a forecast annual growth rate of almost 5%. It is therefore also important for dermatologists to be aware of the most common complications, risks, and areas of application associated with nail cosmetics and to provide appropriate guidance and care to affected patients.

Metal-Free Prosthodontic Treatment of Periungual Allergic Contact Dermatitis: A Case Report

Prosthodontic treatments utilize various procedures and materials such as gold, silver, copper, palladium, cobalt, chromium, and titanium to restore oral function; however, these materials are known to induce allergic contact dermatitis (ACD). We present herein a case in which a patient showed improvement in ACD after undergoing prosthetic treatment using metal-free dental materials. A 53-year-old female patient with periungual inflammation was referred to our department due to instability with her maxillary prosthesis, which was attributed to severe peri-implantitis. Skin tests were conducted due to the suspicions of a metal allergy, and patch testing revealed positive reactions to dental metals, specifically cobalt and palladium. As a result of this finding, all of the patient's metal-based prostheses were systematically replaced with provisional crowns. During this period, any teeth and dental implants affected by severe periodontitis were extracted, after which the patient was fitted with zirconia-based prostheses, resulting in a significant reduction in periungual inflammation. In this case, therefore, the utilization of metal-free prostheses facilitated improvement of the patient's ACD, providing valuable insights for dental practitioners managing patients with ACD.

Contact Allergy to Methacrylate Containing Nail Products: Lack of Impact of EU Legislation. An Audit on Behalf of the European Environmental Contact Dermatitis Research Group (EECDRG)

BACKGROUND

There is a current fashion for the use of methacrylate-containing nail cosmetics that can induce allergic contact dermatitis. European Union (EU) legislation was introduced in 2021 that had the aim of preventing its development.

OBJECTIVES

To assess prevalence and exposures causing contact allergy to 2-hydroxyethyl methacrylate (HEMA) prior to and following implementation of the legislation.

METHODS

A retrospective audit was conducted by 7 European centres patch testing to HEMA prior to the legislation and for 2 years afterwards.

RESULTS

A total of 26 297 patients were tested to HEMA in the baseline series between 2016 and 2023. The prevalence of contact allergy to HEMA from all sources amongst females was 2.82% compared to 0.34% amongst males. The prevalence of nail related contact allergy rose from 0.91% in 2016 (2 centres) to: 0.99% in 2017 (3 centres); 1.24% in 2018 (5 centres); 1.23% in 2019 (6 centres); 1.36% in 2020 (7 centres); 1.30% in 2021 (7 centres); 1.52% in 2022 (7 centres) and 1.98% in 2023 (7 centres). Contact allergy to HEMA from exposure to nail cosmetics accounted for 3.4% of all occupational skin disease.

CONCLUSIONS

EU legislation appears not to have had the intended impact on controlling allergic contact dermatitis from methacrylates in nail cosmetics. There is an urgent need to revisit Scientific Committee on Consumer Safety (SCCS) opinion to reconsider exposure to methacrylates and cross-reactions between them. A strategy needs to be developed and implemented to better control the current outbreak.

Allergic contact dermatitis caused by glucose sensors and insulin pumps: A full review: Part 2. Case reports and case series, clinical features, patch test procedures, differentiation from irritant dermatitis, management of allergic patients and (proposed) legislation

During the past 8 years, a large number of reports have appeared on allergic contact dermatitis to glucose sensors and insulin pumps in paediatric and adult patients with type 1 diabetes mellitus. Isobornyl acrylate in one particular sensor sensitised many hundreds of (published) individuals, and many other allergens were discovered in a large number of sensors and pumps. Diagnostic procedures with patch tests proved very complicated, as manufacturers showed a serious lack of cooperation with dermatologists in providing information on the ingredients of their products and samples for patch testing. This two part article provides a full and detailed review of all aspects of the subject of allergic contact dermatitis to glucose sensors and insulin pumps. Part 1 provided a general introduction to sensors and pumps, a survey of the cutaneous adverse reactions that they have caused, a full account of the allergens in the diabetes devices and an overview of the glucose sensors and insulin pumps that have caused allergic contact dermatitis. This part 2 presents all published case reports and case series, clinical features of allergic contact dermatitis, patch test procedures, differentiation from irritant dermatitis, management of allergic patients and (proposed) legislation.

Incidence of allergic contact dermatitis in Finland 1998-2021: A nationwide registry-based study

BACKGROUND

Allergic contact dermatitis (ACD) may be chronic and can cause distress, disability, and absence from work. Nationwide epidemiological studies of ACD are sparse.

OBJECTIVES

To use national registry data to study the incidence and aetiology of ACD in the working age population of Finland.

METHODS

Patient records from the years 1998-2021 were obtained from the Finnish Care Register for Health Care. Study subjects aged 18-65 years were selected on the basis of a diagnosis of ACD.

RESULTS

Total number of study subjects was 26 701. The incidence of ACD increased until 2016 after which it started to decrease. The increase was more marked in females and ACD was particularly common in women reporting reactions to cosmetics and other chemical products and in people of both sexes reacting to adhesives. The incidence 'ACD of unspecific cause' has decreased since 2016. The most commonly reported allergens were metals, followed by cosmetics. One fourth of subjects had ≥2 ACD diagnoses.

CONCLUSIONS

The incidence of ACD in working age subjects rose from 1998 to 2016, especially in females. However, the incidence has been decreasing since 2016. Our findings highlight the ongoing and even increasing burden of ACD among the working age population.

Is the Use of the Extended (Meth)acrylate Series - Nails Justified? Characterization of Nail Acrylate Allergy in a Tertiary Medical Centre

Methacrylate allergy is a common cause of allergic contact dermatitis, and its incidence has surged over the past decade. Consequently, the primary sensitizing agent, 2-hydroxyethyl methacrylate, was recently added to the European Baseline Series of contact allergens. This study aimed to assess the added value of testing for allergens included in the (Meth)Acrylate Series - Nails, in addition to 2-hydroxyethyl methacrylate, as well as to characterize patients who may benefit from more extensive testing. A retrospective analysis of medical records of patch-tested patients was conducted between June 2013 and July 2022. Among the 3,828 patients who underwent patch testing, 396 were tested with the (Meth)Acrylate Series - Nails; 153 (38.6%) of those patients tested positive for at least 1 acrylate. The most common hapten was 2-hydroxyethyl methacrylate (85.6%), followed by hydroxypropyl methacrylate (85.0%) and ethylene glycol dimethacrylate (80.4%). In our study, 22/153 patients (14.4%) would have been missed if tested only for 2-hydroxyethyl methacrylate. The analysis showed that including hydroxypropyl methacrylate and ethylene glycol dimethacrylate improved detection rate to 98%, rendering the use of the entire tray unnecessary in most cases.

Results of patch testing 2-hydroxyethyl methacrylate (HEMA) in the European baseline series: A 4-year retrospective study

BACKGROUND

2-Hydroxyethyl methacrylate (HEMA) was added to the European baseline series (EBS) in 2019. Few recent data are available on the frequency and relevance of positive reactions to this hapten.

OBJECTIVES

To investigate the frequency and relevance of positive patch tests to HEMA in the EBS in a university hospital in Amsterdam, The Netherlands.

PATIENTS AND METHODS

Retrospective study in patients with positive patch tests to HEMA investigated between June 2019 and August 2023.

RESULTS

Of 2927 consecutive patients, 88 (79 women and 9 men; 3.0%) had a positive reaction to HEMA. The prevalence in women was 3.9%, in men 1.0%. Forty-three (49%) reactions were judged to be of current clinical relevance and 21 (24%) of past relevance. In this group of 64 patients with relevant reactions, 18 (28%) had occupational contact with (meth)acrylate-containing products, of who 11 (61%) were nail stylists. In 46 patients with non-occupational allergic contact dermatitis, 31 (67%) had allergic reactions to nail cosmetics. Glues and glue-containing products accounted for 22% of the materials causing allergic contact dermatitis and dental products for 8%.

CONCLUSIONS

Allergic reactions to HEMA are very frequent in women investigated in Amsterdam. Nearly two thirds of cases were caused by nail cosmetics.