This blog is written by our clinicians and aims to keep patients informed with up to date information on medical conditions.
Earlier in the year the British Association of Dermatologists warned over an epidemic of contact allergies stemming from use of nail varnishes and gels. Whilst having attractive looking nails, have you ever wondered what is causing that rash on your face?
What is Allergic Contact Dermatitis
Allergic Contact Dermatitis is a form of eczema caused by a delayed allergic reaction to a material or chemical (the allergen) that is in contact with the skin.
Examples of allergens causing contact dermatitis:
- Nickel in jewellery / belts / watches
- Paraphenylenediamine (PPD) in hair dye
- Parabens in medicated creams and moisturisers
- Balsam of Peru in perfumes and cosmetics
Sufferers may have been in contact with the allergen for years without it causing Allergic Contact Dermatitis, and only tiny quantities of an allergen are needed to cause Allergic Contact Dermatitis.
The skin acts as a natural barrier keeping millions of allergens out of the body and away for your immune system, so if the skin barrier is impaired (e.g. leg ulcers / long term eczema etc) those people are more prone to Allergic Contact Dermatitis.
Now, back to nails…
Nail cosmetics include:
- nail enamels (varnish/polish)
- nail enamel removers
- cuticle removers and
- artificial nails
The chemical most responsible for allergic reactions to nail varnish/polish is the preservative tosylamide formaldehyde resin which can be in high quantities in base coats to improve glueing to the nail surface.
In a study by the North American Contact Dermatitis Group (NACDG)1, tosylamide formaldehyde resin was found to be the eight most common ingredient causing allergic contact dermatitis in patients with a cosmetic allergy. Although a small amount of free formaldehyde may be found in tosylamide formaldehyde resin it appears that most who react to this resin do not also have a formaldehyde allergy.
Allergic reaction is most commonly due to wet nail enamel but some patients may also react to the dried enamel. Other reported cases of dermatitis to nail enamels include allergy to the solvent butyl acetate and discolouration of the nail surface (especially around the cuticle area) caused by colourants.
Individuals with sensitivity to certain chemicals found in nail cosmetics may get allergic and/or irritant contact dermatitis reactions. Fingers may be affected, but more often than not dermatitis develops around the eyelids, in and behind the ears, around the mouth and chin, sides of the neck, basically anywhere that your hand frequently touches.
Allergic reactions to nail cosmetics around the fingers usually appear as redness and swelling of the fingertips. Other affected areas show a typical allergic contact dermatitis reaction – intense swelling and redness of the area within a few hours, or a rash may appear after a day or two following contact. The affected skin may be red, swollen and blistered or dry and bumpy.
What is the treatment for nail cosmetics allergy?
Nail varnish Allergic Contact Dermatitis should clear quickly once the allergen = polish is removed. Steroid creams with or without an antibiotic may speed up recovery.
Management of Allergic Contact Dermatitis from nail cosmetics on other parts of the body should be treated in the normal way that you would for eczema e.g. topical corticosteroids and emollients/moisturisers.
How can I avoid nail cosmetics allergy?
The best way is by avoiding all products that contain the allergen you are sensitive to.
Hypoallergenic nail enamels that use polyester resin or cellulose acetate butyrate may be an alternative, but sensitivity is still possible. These alternatives are also less durable and scratch-resistant than varnishes made with tosylamide formaldehyde resin.
*Beware when using nail varnish as a barrier against nickel allergy to your watch/belt/jewellery!
ROC Clinic London and ROC Clinic Aberdeen are able to run patch tests against 35 of the commonest ACD-causing allergens (using the recommended European Baseline Series), over the course of 1 week, inclusive of 3 appointments with our Private GPs.
1Fransway et al, North American Contact Dermatitis Group patch test results for 2007-2008. Dermatitis. 2013 Jan-Feb;24(1):10-21.