Irritant nail dermatitis of chemical depilatory product presenting with koilonychia

Abstract

Chemical hair removal products are available as creams, gels, powders, aerosols and roll-ons and all of these forms work in the same way by breaking chemical bonds between sulfur atoms in the protein. Currently, the common active ingredients of these products are calcium thioglycolate, potassium thioglycolate, arsenic and sulfur minerals. Sulfur and arsenic containing products are important toxic chemicals which are mainly used for removing hair in developing countries. Irritant contact dermatitis accounts for 80% of all contact dermatitis reactions which are often occupation-related. Toluene sulfonamide, formaldehyde resin, acrylates and ethylcyanoacrylate are the most common irritants. Irritant nail dermatitis with plants has been well defined with Lobelia richardii flower, Compositae family and garlic. Although allergic dermatitis, irritant dermatitis and irritant nail dermatitis have been well demonstrated with chemicals, koilonychia is unusual presentation of irritant dermatitis. Here we describe a case of nail irritant dermatitis due to application of chemical depilatory product for hair removal presented with koilonychias. To our knowledge this is the first case of such presentation with koilonychia in the English literature.

Unilateral Koilonychia Secondary to Chemical Depilatory Product

“…Depilation is the sole removal of the hair shaft, not affecting the hair bulb, which lasts for 2 weeks, whereas epilation is the removal of the entire hair shaft and bulb with results lasting 6–8 weeks [3]. Chemical hair removal products are an inexpensive, fast, and painless method of depilation [4]. The most commonly used depilatory agents are thioglycolates and to a lesser extent, sulphides [5].…”

“…In developing countries, arsenic- and sulphur-containing products are increasingly being used for hair removal after misnaming them purposely as plant or natural products so that they become preferable agents. Arsenic attaches to the sulphydryl group and accumulates in keratinized tissue, and can have serious lethal effects [4]. The most common side effect of chemical depilatory products is irritant contact dermatitis [4].…”

“…Arsenic attaches to the sulphydryl group and accumulates in keratinized tissue, and can have serious lethal effects [4]. The most common side effect of chemical depilatory products is irritant contact dermatitis [4]. However, allergic contact dermatitis is rare and may be related to lanolin, fragrance, or thioglycolate itself [5].…”

Koilonychia: an update on pathophysiology, differential diagnosis and clinical relevance

“… Petrol, solvents, engine oils (mechanics, cabinet‐makers, homemakers, railway workers, oil‐burner repairers) Acids, alkalis (cement workers/ brick‐layers), thioglycolate (hairdressers), sulphur and arsenic (chemical hair removal products) Mechanical trauma (rickshaw boys, butchers, mushroom growers, coil winders, slaughterhouse workers, pin threaders) Thermal burns Nail biting, thumb/finger sucking, poorly fitting shoes High altitude ‘Ladakhi koilonychia’ Avitaminosis/Nutritional Nutrients Protein deficiency/low albumin Vitamin C Vitamin B12 Niacin, zinc, copper Sulphur‐containing amino acids: methionine, cystine Populations Kidney transplantation, End stage renal disease Alcoholism Poor nutrition, cachexia Post‐gastrectomy …”