INTRODUCTION
Allergic contact dermatitis is a type IV delayed hypersensitivity. It is triggered by contact with an allergen by individuals who have been previously sensitized via allergen-specific T cell activation. If the allergen triggering allergic contact dermatitis is not found and eliminated, the dermatitis can become chronic, which can significantly decrease the patient's quality of life. For example, allergic contact dermatitis can lead to long term workplace leaves of absence negatively impact the socioeconomic state of the patient. UV nail light radiation exposure and damage to the nail bed itself are also dermatologic concerns of nail product use.1
Composition of Nail Polish: Toxic Ingredients and Their Potential Effects
Dermatological Impacts of Nail Polish
Allergic contact dermatitis is the most studied adverse effect from nail polish. This has been documented as early as the 1940s and 1950s. Symptoms include paronychia, subungual swelling, severe pruritus, nail dystrophy, scaling, vesicular dermatitis,1 thickened and dried nail plates, and hemorrhagic onycholysis with complete nail detachment.2 Additionally, allergic contact dermatitis can lead to fingertip eczema, onychodystrophy, onycholysis, and leukonychia. Allergic contact dermatitis secondary to nail product use can also be seen in other anatomic locations including the dorsum of the hands, face, eyelids, and trunk3 due to hand transfer. In fact, a study on periorbital eczema found that 4% of the patients studied had periorbital dermatitis due nail polish use. Allergic contact dermatitis usually presents 7-10 after current exposure. Patch testing is the standard diagnostic and confirmatory test for allergic contact dermatitis-causing allergens.2
Allergic contact dermatitis from traditional nail polish may be due to the toluene/formaldehyde resin, formaldehyde, polyester resin, pigments, or nitrocellulose. The most common allergen being tosylamide/formaldehyde resin.3 In fact, 4% of positive patch tests involve sensitivity to toluene/formaldehyde resin.2 Allergic contact dermatitis due to toluene/formaldehyde resin can involve the head, neck, nose, ears, and eyelids. Allergic contact dermatitis secondary to phthalic and trimellitic anhydride/glycols copolymer, which is present in traditional nail polish typically presents on the head and neck but there are cases of the dermatitis affecting the face, neck, and periorbital area as well as swelling of the eyelids that can last several months.3 Additionally, allergic contact dermatitis is the most common cause of eyelid dermatitis, causing 46-74 cases of eyelid dermatitis.4
Methyl Methacrylate (MMA) is the monomer used with acrylic nails, but MMA has been found to cause severe contact dermatitis as well.1 In fact, there has been a global allergic contact dermatitis from (meth)acrylic monomers (ACDMA) epidemic over the past 10 years, and nail polish has been identified as a trigger to this epidemic. Nail technicians, nail salon patrons, and at home nail product users have been identified as having ACDMA. Methacrylates are also present in dental materials, prostheses, and glucose sensors and while data on the immediate and long
