Allergic to nail varnish

The story of a woman who became allergic to nail varnish has been shared at the Australasian College of Dermatologists conference

Dr Philippa Dickison presented on hand dermatitis and chronic urticaria secondary to gel nail varnish at the ACD Annual Scientific Meeting in Sydney.

“A 50-year-old woman presented with a six-month history of irritation, erythema and tenderness on her fingers,” Dr Dickson said.

“She reported that the symptoms worsened when she reapplied her ‘gel’ or Shellac nails. She had been using gel nails for over two years before noticing the inflammation.”

The patient’s presentation occurred on an 18-month background of idiopathic chronic urticaria, the conference heard. At the time of review she was taking mycophenolate for her CU with modest improvement.

On examination she had erythema of her hands and fingers bilaterally with mild swelling of most fingertips. She also had splits on several fingers and her finger nails appeared thickened.

On subsequent examination without nail varnish, all of the finger nails appeared significantly dystrophic and discoloured. The provisional diagnosis was allergic contact dermatitis.

Associate Professor Saxon Smith, dermatologist with the ACD said: “Allergic contact dermatitis secondary to the acrylates in nail varnish had been well described, but to the best of our knowledge this is the first reported case of chronic urticaria secondary to acrylates and methacrylates in gel nails.”

Patch testing was performed on the patient using the Australian Baseline Series and the acrylate and methacrylate series for nails. The patient had significant reactions to all but three nail allergens and was subsequently advised to stop using any nail varnish.

Dr Dickison said: “On follow-up examination, approximately eight weeks after cessation of gel nail application, the patient’s nails were growing normally, the erythema of her fingers had completely subsided.

“She had also noticed her CU had resolved four weeks after eliminating gel nails from her environment.”

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