Contact dermatitis to adhesive
Question:
10/15/2020
I have a patient who reacts to gel nails and some adhesives. I am trying to decide what to patch to and smartpractice has a list of 45 acrylates and adhesive allergens. I am just not sure if I need to test all of these or if there is a good way to know if any are cross-reactive or redundant.
Answer:
We have asked our contact dermatitis colleagues to comment:
Contact dermatitis with gel nails is usually due to acrylate monomers, patch testing with 2-hydroxyethyl methacrylate and ethyl cyanoacrylate should hopefully capture the allergen in the gel nail polish. Methyl metacrylate is more useful for bone cements. However, if a full acrylate panel is desired since there is some reaction to adhesives, then testing with methyl metacrylate, 2-hydroxymethyl methacrylate, ethyl acrylate, ethylene dimethacrylate, triethylene glycol diacrylate, and ethyl cyanoacrylate should be more comprehensive.
I found this reference helpful:
Atwater AR, Reeder M. Trends in nail services may cause dermatitis: not your mother's nail polish. Cutis. 2019 Jun;103(6):315-317. PMID: 31348454.
Dr. Kanwaljit Brar
There are issues to consider with acrylates patch testing 1. Acrylate & methacrylate are volatile and rapidly evaporate 2. Some recommend storing the allergen in freezer 3. Also, you cannot pre load acrylates. After loading on the chamber, the PT should be applied right away Screening with these 3 acrylates may identify >91% of patients with acrylic allergy. They are 1. methyl methacrylates (2%) 2. HEMA (2%) 3. ethyl acrylate (0.1%) Further testing depends on patient exposure which is usually occupational. Reference: Fisher's Contact Dermatitis 7th edition 2019 p 378.
Dr. Luz Fonacier
I hope this is helpful.
Andrew Murphy, MD, FAAAAI