Contact sensitization to cyanoacrylate adhesive as a cause of severe onychodystrophy

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Abstract
The technology used for artificial nails, the chemistry of cyanoacrylates and the reported reactions to these products are briefly reviewed. We studied three patients with prominent fingernail dystrophy, nail bed hyperkeratosis, fingertip eczema, and onycholysis, two of whom also had eczematous lesions at distant sites, ostensibly from hand transfer. Patch testing was performed with a standard screening tray, dried cyanoacrylate adhesives, and, in one case, with fingernail clippings. All three patients were prominently patch-test positive to the polymerized 2-ethylcyanoacrylate, used as an adhesive on artificial (plastic) fingernails. One patient was also mildly formaldehyde sensitive, one was mildly reactive to two acrylate allergens, and one was extremely allergic to toluenesulfonamide formaldehyde resin. One patient had a positive patch test to her fingernail clippings 2 months after use of the adhesive was discontinued and an attempt was made to remove it. Reactions to cyanoacrylate 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 slowly degrades in the presence of water probably releasing antigens. Patch testing with the dried adhesive on an adhesive plaster seems to be reliable.

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