Severe Onychodystrophy due to Allergic Contact Dermatitis from Acrylic Nails

Abstract

Acrylic nails, including sculptured nails and the new ultraviolet-curable gel polish lacquers, have been associated with allergic contact dermatitis (ACD). We report 2 cases of ACD to acrylic nails with severe onychodystrophy and psoriasiform changes including onycholysis and subungual hyperkeratosis. In both cases, the patients did not realize the association between the use of acrylate-based manicures and nail changes. One patient had been previously misdiagnosed and treated unsuccessfully for nail psoriasis. The informed clinician should elicit a history of acrylic manicure in patients with these nail changes, especially in cases of suspected nail psoriasis refractory to treatment. Patch testing is a useful tool in confirming diagnosis.

Patterns of clinical nail appearances in patients with cutaneous psoriasis

“…We have also excluded patients who had had used artificial nails, at any time of their lives, due to the fact that acrylic nails can induce severe onychodystrophy and psoriasiform changes including onycholysis and subungual hyperkeratosis [ 18 ].…”

Pterygium inversum unguis secondary to gel polish

“…Nevertheless, accounts of undesirable nail changes due to recurrent and/or prolonged use of gel polish continue to surface. As shown in previous reports, gel polish has been documented to cause pincer nail deformities, yellowish chromonychia, nail thinning, paronychia, pseudoleukonychia, onychoschizia lamellina, allergic contact dermatitis and psoriasiform nail changes . Possible increased risk of non‐melanoma skin cancer on the dorsum of hands exposed to chronic UV light for gel polish application has also been discussed, prompting recommendations for physical‐blocking sunscreen and/or anti‐UV gloves when placing hands under the UV nail lamp .…”

Safety and Efficacy of Nail Products

“…Onycholysis and subungual hyperkeratosis may also be manifestations of allergies to sculptured nails, and may be difficult to distinguish from nail psoriasis or onychomycosis [47,53]. In addition to these findings, paresthesias [34,42,54] and nail infection [34], likely superinfection of eczematous tissue, have been reported concomitant with dermatitis.…”