CONTACT SENSITIZATION TO CYANOACRYLATE ADHESIVE AS A CAUSE OF SEVERE ONYCHODYSTROPHY

Background The technology used for artificial nails, the chemistry of cyanoacrylates and the reported reactions to these products are briefl y reviewed. Materials and methods We studied three patients with promi nent fingernail dystrophy, nail bed hyperkeratosis, fingertip eczema, and onycholysis, two of whom also had eczematous lesions at distant si tes, ostensibly from hand transfer. Patch testing was performed with a standard screening tray, dried cyanoacrylate adhesives, and, in one c ase, with fingernail clippings. Results All three patients were promin ently patch-test positive to the polymerized 2-ethylcyanoacrylate, use d as an adhesive on artificial (plastic) fingernails. One patient was also mildly formaldehyde sensitive, one was mildly reactive to two acr ylate allergens, and one was extremely allergic to toluenesulfonamide formaldehyde resin. One patient had a positive patch test to her finge rnail clippings 2 months after use of the adhesive was discontinued an d an attempt was made to remove it. Conclusions Reactions to cyanoacry late adhesives used for artificial nails can cause both nail dystrophy and fingertip eczema, and may produce eczema elsewhere, probably from hand transfer. Persistence is likely due to retained polymer, which s lowly degrades in the presence of water probably releasing antigens. P atch testing with the dried adhesive on an adhesive plaster seems to b e reliable.