The bitter side of nail art: A teenage girl's encounter with (meth)acrylate‐induced allergic contact dermatitis from nail glue

Packer L, Kaufmann R. Activity of alpha-lipoic acid in the protection against oxidative stress in skin. Curr Probl Dermatol. 2001; 29:43-51. 6. Rizzi A, Nucera E, Buonomo A, Schiavino D. Delayed hypersensitivity to α-lipoic acid: look at dietary supplements. Contact Dermatitis. 2015; 73:62-63. How to cite this article: Corazza M, Arlotti E, Schettini N, Pacetti L, Bianchi A, Borghi A. Allergic contact dermatitis due to α-lipoic acid in a topical over-the-counter product: A case report. Contact Dermatitis. 2023;89(4):297‐299. doi:10.1111/ cod.14381

Cosmetic glues, widely available as home kits, are known to cause (meth)acrylate contact allergies in adults. 1 However, their impact on children and adolescents is less clear.

CASE REPORT
A 13-year-old girl was referred to our dermatology clinic on suspicion of acrodermatitis continua of Hallopeau. For the past 9 months, she suffered from a painful rash on her fingers and disfiguring nail changes. Her medical history included grass allergy, but not atopic dermatitis. When asked about exposure, she described enjoying creative hobbies, including nail art. She regularly applied nail polish and pre-formed, press-on nails which were attached with nail glue. As the rash and nail changes appeared, she increased the use of press-on nails and nail polish to conceal the unsightly nail changes. Physical examination revealed severe pulpitis, with erythema, oedema, fissures, and scaling around the nails and dorsal aspects of her fingers and severe nail dystrophy ( Figure 1). Mild nummular dermatitis was noted on the forearms but no skin changes on the elbows or knees.
According to the ingredient list, the nail glue (Super Strong Nail glue from Depend Cosmetic AB ® ) contained several allergens: poly methyl methacrylate (MMA), poly ethylene glycol dimethacrylate (EGDMA), 2-bromo-2-nitropropane-1,3-diol/bronopol, 2-tert-butyl-F I G U R E 1 Severe pulpitis and nail dystrophy in a 13-year-old girl allergic to (meth)acrylates contained in a nail glue.  (Table 1), and a diagnosis of allergic contact dermatitis caused by (meth)acrylates in nail glue was established.

DISCUSSION
Press-on nails are becoming increasingly popular among the younger population. They are available as home kits including both nail tips, glue, and a cleaning agent. 3 ECA is a strong adhesive found in household "super glue" and often the primary component in nail glues. 1 Contact allergy caused by ECA-based glue has been reported in adults 1 but to our knowledge not in children. Contact allergy to (meth) acrylates in other nail cosmetic products have been reported in children and adolescents [4][5][6][7] and there are multiple reports of chemical burns in children resulting from accidental ECA nail glue spillage. 8,9 Apart from ECA and ethyl acrylate, the patient was also sensitised to the methacrylate monomers MMA and HEMA, and to the dimethacrylate monomer EGDMA. Methacrylate monomers are potent allergens, whereas polymerised methacrylates are not. 10 In the ingredients list of the product, MMA and EGDMA were declared as polymerised, whereas HEMA, a marker allergen for contact allergy to methacrylates, was not declared. As ECA does not cross-react with methacrylates, 11 we suspect that the patient was sensitised to residual monomers contained in the nail glue. In a random sample of nine nail glues sold within the European Union, Symanzik et al. 1 found that all glues contained ECA and poly MMA. Although acrylate polymers are generally considered safe with a low risk of allergic sensitization, potential residual monomers in nail glues might pose a risk, as illustrated by this case.
As all positive patch test reactions became evident on Day 7, the contact allergy would have been missed had readings only been performed on Days 2 and 3, highlighting the importance of late readings.
The ectopic eczema lesions on the patient's forearms were likely caused by transfer from contaminated hands.
Children, particularly girls, exhibit curiosity towards cosmetics such as artificial nails but are unaware of the associated risks. The increasing use and accessibility of (meth)acrylate-containing nail cosmetics pose a significant risk. Currently, there is an alarming lack of adequate information on potential hazards. (FFE). 1 We report a case of FFE to Moringa oleifera with positive rechallenge. Written consent for permission to publish was obtained from the patient reported.