1Department of Dermatology, University of Gent,
Belgium.
2Department of Dermatology, Katholieke
Universiteit Leuven, Belgium
Correspondence address:
Dr Lieve Constandt
Department of Dermatology
Allergy and Professional Skin
Diseases
University Hospital
De Pintelaan 185
B-9000 Gent
Belgium
Tel +32 (9) 240 22 87
e-mail: lieveconstandt@yahoo.com
Running head: Patch testing for artificial nails
ABSTRACT
Key Words: acrylics,
acrylates, artificial nails, contact dermatitis, cyanoacrylate,
(meth)acrylates, nail cosmetics
The main risk from artificial nails
is contact allergy. Our first aim was
to determine, based on a retrospective study, a screening series (as limited as
possible) to diagnose contact allergy to artificial nails in a dermatologist’s
practice. Secondly, we wanted to
optimize an acrylic series for advising an allergic patient who wants to
continue to apply artificial nails.
This series is compared with 2 other screening series for artificial
nail allergy, previously proposed in the literature.
Normally the customer knows which
type of artificial nails has been applied : tips, silk, acrylic or gel. However, it is important to realize that
different types of artificial nails are usually combined and that nail tips and
glue are nearly always needed.
The preformed nail : a plastic
tip (press-on nail)
Nail tips are preformed pieces of plastic to be
glued on a broken, previously applied artificial nail. They thus have a repair function. Normally, only a small piece of plastic
covers the distal part of the natural nail.
Further finishing with nail lacquer or with silk and cyanoacrylate glue
is needed, since the unfinished colorless plastic does not have a beautiful
appearance.
There also exists another type of nail tips
that are ‘trendy’ and more appreciated by the younger public; they are sold as
a “do-it-self kit”, which contains 10 nail tips, a glue and a cleaning
agent. This type of ‘glue-and-go-nails’
allows the customer to apply the nails at home in a very easy and cheap
way. They are colored (usually with oil
paints or with nail lacquer) and do not need further finishing. After 2 or 3 days they are removed by
applying acetone or another solvent. As
the solvent destroys the plastic, the tips cannot be re-used. This type of disposable artificial nail is
not useful if the customer wants to wear permanent artificial nails. Indeed, repeated application of glue and
solvent every 2 or 3 days is too damaging to both the nails and the skin. Moreover, the permanent occlusion by a piece
of plastic of the full length of the natural nail irritates and is able to
destroy the nail plate. For permanent
artificial nails, the customer should choose sculptured nails.
Dermatological complications of nail tips are
rare. Contact allergy to tricresyl
ethyl phthalate in the plastic is exceptional (1).
A nail wrap is a piece of silk (less often
cotton or fiber) that is glued on the natural nail. Its first aim is to strengthen the nail plate, but by using a
disposable shield, one can also lengthen the nail. The sculptured silk nail needs finishing, mostly with nail
lacquer.
Silk nails do not cause contact allergy and are
an excellent alternative for the patient who is allergic to acrylic
compounds. The only condition is that
the patient is not sensitive to cyanoacrylate nor to tosylamide/ formaldehyde
resin.
The application of silk nails is not easy and
some experience in the beautician is needed.
This is the reason why they are not as popular as acrylic nails.
Nail glue
Nail glue is an important accessory
to all applied artificial nails. In the
past, phenol-formaldehyde resins were used and did cause contact allergy (1,
2), but nowadays the main component is ethyl cyanoacrylate (more than
90 %); other ingredients are hydroquinone and organic sulfonic acid. Contamination with monomers of other
acrylics is possible. Contact allergy to
cyanoacrylate is more common than hitherto believed, as it was seldom
considered for patch testing and thus not included in test series. The clinical symptoms include peri-ungual
and (severe) onychodystrophy, as well as ectopic contact eczema. Onycholysis and paraesthesia are rare. Ethyl cyanoacrylate does not cross-react
with (meth)acrylates (3).
Sculptured nails
Acrylic nail (powder + liquid)
A monomer liquid and polymer powder
are mixed on the nail plate, from which polymerization starts in the presence
of hydroquinone and normal daylight. By
using a disposable shield the artificial acrylic nail can be sculptured,
lengthening the natural nail. Acrylic
nails are more ‘trendy’ than they used to be, since they smell less, are less
heavy than earlier and have a nicer shine than gel nails. They are, however, less flexible and not
useful while doing manual or wet work.
Photobonded nail (‘gel’ nail)
Acrylic gel nails are the newest
type of artificial nails and are applied as an ordinary nail lacquer. Polymerization starts by a photo-bonding
technique in the presence of a weak UV source, with benzophenone-3 and -4 as
light absorbing activators (this is similar to restorative dental
bonding). Different layers of gel are
needed: the nail is lengthened by using a builder gel on a disposable shield;
the sculptured gel nail is colored by a color gel or by normal nail lacquer;
finally a final gloss gel layer is applied.
Each layer needs separate polymerization for some minutes. (The application of 10 new gel nails takes
about 2 h.) The acrylic compounds in
gel nails are similar to those used in acrylic nails, except for 2-HEMA, which
is not present in all acrylic nails.
PATIENTS, MATERIALS AND METHODS
The population tested
comprised 27 patients (26 women, 1 man), all in contact with artificial
nails. 16 were professional
beauticians, of whom all had contact with nail tips, gel and/or acrylic nails,
glue, and nail lacquer. 11 were
customers, of whom some had used only gel nails, some only acrylic nails, while
others had used both types; only 1 out of the 27 patients had used silk wraps.
Most of the patients had fingertip
and/or nailfold dermatitis, sometimes accompanied by serious nail destruction:
out of the 27, 4 had onycholysis, 6 onycho-dystrophy, 3 a nail infection (1
proven Pseudomonas aeruginosa, others not identified), 8 with periungual
eczema, and 8 with fingertip eczema.
Some of them also had lesions elsewhere: 7 with eczema on the fingers, 6
out of 27 (5 of whom professionals) from hand eczema, and 2 professionals also
on the forearms; from the 9 who presented with facial dermatitis, particularly
on the eyelids, 8 were professionals.
In the client, dermatitis could have been due to transfer of the allergen
(ectopic dermatitis) or, as with the professionals, to airborne contact with
the dust released when polishing the nails; this was certainly also the case
for 5 patients (4 professionals) who had presented with lesions on the cheeks,
tip of the nose and chin, and 4 professionals in whom the neck was also
involved. There was no widespread
eczema. 2 patients (1 professional and
1 client) complained of paraesthesia.
All subjects were patch tested in
Gent or Leuven with the Belgian standard series including
tosylamide/formaldehyde resin, with acrylic compounds and, if indicated, also
with a cosmetic and hairdresser series.
Table 1 summarizes the acrylics
tested: 12 subjects were tested with various substances, 9 with the complete
Chemotechnique( Malmö, Sweden) printing series (24 acrylic compounds), 7 with
ethyl cyanoacrylate, 5 with a small series of 5 acrylics (MMA, 2-HEMA, EGDMA,
BIS-GMA and UEDMA; Table 1), and 1 with 2-HEMA only. 20 patients were also
tested with their own nail preparations in a semi-open method (4); this
consists of applying with a Q-tip of a minute amount of the preparation
directly on the skin (1 cm2), leaving it to dry completely and
then covering it with acrylic tape.
The patch tests were applied with
van der Bend patch-test chambers (van der Bend, Brielle, the Netherlands)
applied on the back with Micropore (3M Health Care, Neuss, Germany) and fixed
with Mefix (Mölnlycke Health Care, Göteborg, Sweden) or Hypafix (BSN Medical,
Hamburg, Germany) as adhesive tape. The
patch-test chambers were removed at D2.
Readings (ICDRG guidelines) were performed at D2 and D4 (exceptionally
on D3), and sometimes later. If
relevant, prick testing with a latex extract (Stallergènes, Antony, France) was
also carried out (4 patients).
In our experience, in order to detect contact
allergy to acrylic-containing nail cosmetics, only 2 allergens, i.e. 2-HEMA and
ECA, are sufficient. Only 1 patient
reacting to her own nail preparation did not react to any of the acrylics
tested. Testing with the nail product
itself can thus also be useful (14 out of 17 patients reacted), but it should
only be done in the semi-open way (4) to avoid irritancy and active
sensitization on patch testing (5).
However, in order to advise patients
allergic to certain acrylic compounds about alternative products to use, a more
extensive test series is needed.
Indeed, taking into account our patch test results as well as the
ingredients labeled on the packaging or mentioned on the material safety data
sheets (MSDS), as far as they can be relied on (6), and taking into account the
ingredients mentioned by Kanerva (7), we suggest patch testing 10 acrylics
(Table 2).
There are other screening series
that have previously been suggested.
Koppula et al. (8) proposed a selection of the following 5 acrylics,
i.e. EA, 2-HEA, EGDMA, ECA and TREGDA, because they are the most frequently
used in nail preparations; besides, they belong to the group of the 10 acrylics
that most often produce positive tests in patients wearing artificial nails
(EA, 2-HEMA, 2-HEA, DEGDMA, EMA, EGDMA, 2-HPMA, 2-HPA, ECA and TREGDA, (8). 2-HEMA has not been considered to be used frequently in nail-product
manufacturing, which is in contrast with our experience: especially in gel
products, in particular, 2-HEMA is a constant ingredient, hence, it needs to be
tested in a screening series.
In the artificial nail series of
Chemotechnique (Table3) there are 13 acrylics, from which we eliminated 5, i.e.
TREGDMA (all were detected with EGDMA), BMA, BA, HDDA, and TMPTA, because of
the lack of positive results to these.
Of course, if these compounds are labeled as ingredients of a patient’s
product, they can still be tested. We
did add 2 acrylics, i.e. ECA to which contact allergy has been seldom described
but, as is MMA, is frequently mentioned as an ingredient of nail products. We replaced 2-HPMA by 2-HPA in our series,
since we found it to be a better screening agent.
With regard to the
advice to the allergic patient, all our patients (except 1) were positive to
2-HEMA, and thus could not continue to apply gel nails, except for IBD Dual
Advantage Gel® (International Beauty Design INC, Gardena, California, USA),
which does not contain 2-HEMA. It is a
colorless gel that needs finishing with normal nail lacquer and is manufactured
by IBD for the ‘allergic’ patient. It
is not clear which other acrylics might be present, but 3 2-HEMA-positive
patients, who had reacted positively (semi-open) to their own gel products,
remained negative to it. This
alternative gel is useful only for individual customers because of the
disadvantage that it cannot be combined with any other type of bonder gel or
builder gel that contain 2-HEMA. The
allergic beautician cannot limit her ‘palette’offer to this one product, which
is also of inferior quality compared to the other gels.
In our experience, some
acrylic nails did not contain 2-HEMA on their ingredient list. For these patients it is useful to test the
screening series with the 10 acrylic compounds. Depending on the test results, certain acrylic nails can still be
recommended, although one cannot always rely on the ingredients listed.
The best alternative is to apply
silk nails, provided that the patient is not sensitive to ECA, which, according
to our experience, is present in all nail glues. Many customers are very pleased with this solution and some
beauticians, having learned the application technique, have even decided to
offer only this type of artificial nails to their customers. Allergic beauticians who want to continue
their job as before have to be advised to use no-touch techniques and to wear
nitrile gloves that have to be changed at least every half hour.
The patient allergic to ECA and not
to other acrylics can still use gels and acrylic nails, provided that no tips
to repair broken nails nor full tips are glued. There might be glues based on other acrylics or epoxy resin, but
in our experience all nail glues are based on ethyl cyanoacrylate.
The main risk from artificial nails
is contact allergy. Both customers and
professionals should be aware of the sensitizing capacity of acrylics present
in them and for which cross-sensitivity varies greatly between individuals. Other side-effects, such as nail dystrophy,
onycholysis , permanent loss of fingernails, paraesthesia, transmission of
infection, and Raynaud’s phenomenon, are less frequent (9).
The patch test results obtained in
27 patients demonstrated 2-HEMA and ECA to be the only allergens needed to
diagnose contact allergy to acrylic-containing nail cosmetics, except for 1
case in which the patient reacted only to her nail preparation used and in
which we were not able to identify the allergen. For practicing dermatologists, these 2 substances thus seem
indicated to screen for such reactions.
With regard to the advice to be given to allergic patients who want to
continue with nail cosmetics, i.e. artificial nails, a series of 10 acrylics is
needed, i.e. 2-HEMA, ECA, EGDMA, 2-HEA, TEGDA, EA, EMA, MMA, THFM, and 2-HPA.
REFERENCES
1.
Burrows
D, Rycroft RJG. Contact dermatitis from
PTBP resin and tricresyl ethyl phtalate in a plastic nail adhesive. Contact
Dermatitis 1981: 7: 336-337.
2.
Rycroft
RJG, Wilkinson JD, Holmes R, Hay RJ.
Contact sensitization to p-tertiary butylphenol (PTBP) resin in plastic
nail adhesive. Clinical and Experimental
Dermatology 1980: 5: 441-445.
3.
Kanerva
L. Ethyl cyanoacrylate does not
cross-react with methacrylates and acrylates.
Am J Cont Dermatitis 1997: 8:
54-55.
4.
Dooms-Goossens
A. Patch testing without a kit. In: Guin JD (ed.). Practical Contact Dermatitis.
A handbook for the practitioner.
New York, McGraw-Hill Inc, 1995, pp. 63-74.
5. Cavelier C, Jelen G, Herve-Bazin B, Foussereau J. Irritation et allergie aux acrylates et methacrylates simples. Ann Dermatol Venereol 1981: 108: 549-558.
6. Henriks-Eckerman ML, Kanerva L. Product analysis of acrylic resins compared to information given in material safety data sheets. Contact Dermatitis 1997: 36: 164-165.
7.
Kanerva
L. Occupational allergic contact dermatitis caused
by photo-bonded sculptured nails and a review of (meth)acrylates in nail
cosmetics. Am J Cont Dermatitis 1996: 7: 109-115.
8.
Koppula
S, Fellman J, Storrs F. Screening
allergens for acrylate dermatitis associated with artificial nails. Am J
Cont Dermatitis 1995: 6: 78-85.
9.
Jay M.
Barnett, Richard K. Scher . Nail
cosmetics. Int. J. of Dermatology 1992: 31: 675-681.
|
(meth)acrylates |
abbreviation |
patch test concentration (% pet.) |
positive/ tested in pet. |
|
ethyl acrylate |
EA |
0.1 |
5/10 |
|
2-ethylhexyl acrylate |
2-EHA |
0.1 |
0/6 |
|
2-hydroxyethyl acrylate |
2-HEA |
0.1 |
10/12 |
|
2-hydroxypropyl acrylate |
2-HPA |
0.1 |
7/9 |
|
methyl methacrylate |
MMA |
2.0 |
4/21 |
|
ethyl methacrylate |
EMA |
2.0 |
2/13 |
|
n-butyl methacrylate |
BMA |
2.0 |
0/12 |
|
2-hydroxyethyl methacrylate |
2-HEMA |
2.0 |
25/27 |
|
2-hydroxypropyl methacrylate |
2-HPMA |
2.0 |
6/11 |
|
ethyleneglycol dimethacrylate |
EGDMA |
2.0 |
20/26 |
|
triethyleneglycol dimethacrylate |
TREGDMA |
2.0 |
3/12 |
|
2,2-bis[4-(2-methacryloxyethoxy) phenyl]propane |
BIS-EMA |
1.0 |
0/7 |
|
1,4-butanediol diacrylate |
BUDA |
0.1 |
4/8 |
|
1,6-hexanediol diacrylate |
HDDA |
0.1 |
2/8 |
|
diethyleneglycol diacrylate |
DEGDA |
0.1 |
7/9 |
|
tripropyleneglycol diacrylate |
TPGDA |
0.1 |
0/6 |
|
trimethylolpropane triacrylate |
TMPTA |
0.1 |
0/10 |
|
pentaerythritol triacrylate |
PETA |
0.1 |
0/7 |
|
oligotriacrylate 480 |
OTA 48O |
0.1 |
0/8 |
|
epoxy acrylate |
- |
0.5 |
0/10 |
|
urethane diacrylate (aliphatic) |
al-UDA |
0.1 |
0/8 |
|
urethane diacrylate (aromatic) |
ar-UDA |
0.05 |
0/8 |
|
triethyleneglycol diacrylate |
TREGDA |
0.1 |
5/10 |
|
N,N-methylene bis-acrylamide |
MBAA |
1.0 |
0/1 |
|
urethaandimethacrylate |
UEDMA |
2.0 |
2/20 |
tetrahydrofurfuryl
methacrylate
|
THFMA
|
2.0
|
1/4
|
|
N,N-dimethylaminoethyl methacrylate |
- |
0.2 |
0/1 |
|
2,2-bis [4-(methacryloxy)phenyl] propane |
BIS-MA |
2.0 |
0/7 |
|
2,2-bis [4-(2-hydroxy-3-methacryloxy- propopxy)phenyl]propane |
BIS-GMA |
2.0 |
0/16 |
|
ethyl cyanoacrylate |
ECA |
10.0 |
1/7 |
|
|
(meth)acrylates |
patch test concentration (% pet.) |
|
1. |
2-hydroxyethyl
methacrylate |
2.0 |
|
2. |
ethyl
cyanoacrylate |
10 |
|
3. |
ethyleneglycol
dimethacrylate |
2.0 |
|
4. |
2-ethylhexyl
acrylate |
0.1 |
|
5. |
triethyleneglycol
diacrylate |
0.1 |
|
6. |
ethyl
acrylate |
0.1 |
|
7. |
ethyl
methacrylate |
2.0 |
|
8. |
methyl
methacrylate |
2.0 |
|
9. |
tetrahydrofurfuryl
methacrylate |
2.0 |
|
10. |
2-hydroxypropyl
acrylate |
0.1 |
|
|
(meth)acrylates |
patch test concentration (% pet.) |
|
1. |
butyl
acrylate |
0.1 |
|
2. |
ethyl
methacrylate |
2.0 |
|
3. |
n-butyl
methacrylate |
2.0 |
|
4. |
2-hydroxyethyl
methacrylate |
2.0 |
|
5. |
2-hydroxypropyl
methacrylate |
2.0 |
|
6. |
ethyleneglycol
dimethacrylate |
2.0 |
|
7. |
triethyleneglycol
dimethacrylate |
2.0 |
|
8. |
1,6-hexanediol
diacrylate |
0.1 |
|
9. |
trimethylolpropane
triacrylate |
0.1 |
|
10. |
tetrahydrofurfuryl
methacrylate |
2.0 |
|
11. |
ethyl
acrylate |
0.1 |
|
12. |
2-hydroxyethyl
acrylate |
0.1 |
|
13. |
triethyleneglycol
diacrylate |
0.1 |