Clinical and Experimental Dermatology (1976) i , 191.

Clinical meeting of St John's HospitalDermatological Society: 6 November 1975

Onycholysis due to acrylic nail applications

PETER GOODWINDepartment of Dermatology, The Middlesex Hospital, Mortimer Street, London W I N 8AA

Accepted for publication 2g January 1976

History

Prior to her attendance at the Dermatology clinic the patient (Mrs O.S.B.,* age 59 years)attended a commercial establishment (Just Nails) specializing in the artificial enlargement andbeautifying of the finger nails. The procedure is as follows: after roughening with a burr thenail plate is painted with liquid acrylic which, when hardened, produces a prosthetic nail whichis enlarged and elongated by repeated applications. The prosthesis can be filed and manicuredto shape and as the nail plate grows out further applications of acrylic are made to maintainan even contour. After several applications the patient noticed the development of paronychialsoreness and marked finger nail changes.

Examination

There was onycholysis affecting the distal portions of all finger nails (Fig. i). Paronychialinflammation had subsided by the time of her first attendance but the nail bed was dry andthickened. Mycological examination and culture was negative for fungus.

Discussion

In the absence of any other possible causes such as psoriasis or previous history of onycholysis,it seemed probable that these nail changes resulted from a reaction to acrylic. Similar effectsfrom these nail applications have been seen but not previously reported. The mechanism isuncertain but it appears that acrylic monomer damages the nail bed, possibly by penetratingthe nail plate. Contact sensitivity to acrylic monomer is considered unhkely.

* St John's Hospital Bureau Number P62090.

191

192 P.Goodwin

Figure i. Appearance of flnger nails showing oncholysis and sub-ungual hyperkeratosis.

Comments

Dr P.D. Samman

This is the fourth case of this type that I have seen. The first was a lady employed by thefirm and, for instructioa purposes, employees have their own nails treated. Some weeksafter the first application the patient developed an acute infection in one finger and suffereddamage to a few nails similar to the changes seen in today's patient. The second suffereddamage to only one nail whilst the third, seen recently, had severe damage to several nails.The damage consisted not only of sepsis and onycholysis but also of hyperkeratosis belowsome of the affected nails. The change was so severe in my third patient that she described itas a third nail below her normal and false nails. We are arranging patch tests on this patient.Patch tests on the first were negative and the material in her case appeared to be acting asan irritant. ,

Dr E. Cronin drew attention to an article published almost 20 years ago recording naildamage due to the same materials.

Reference

FISHER, A.A., FRANKS, A. & GLICK, H . (1957) Allergic sensitisation of the skin and nails to acrylicplastic nails. Journal of Allergy 28, 84.