Nail allergy and eczema

Acrylate monomers are a well recognised cause of ACD. However, people with atopic eczema are at higher risk of ACD since their skin barrier is damaged, which increases the penetration of allergens and irritants (substances that causes irritation). In some cases, it can be difficult to distinguish between ACD and atopic eczema. 

Nail technicians are also at high risk due to occupational exposure to acrylates. The more you are exposed to an allergen, the more likely you are to become sensitised. Nail bars are ubiquitous on every high street and nail technicians are often young people working in poor – sometimes slave-like – conditions, as highlighted in media reports. Nail technicians are often inadequately trained on the correct use of personal protective equipment and the potential health risks associated with acrylates. 

To tackle the problem, there have been calls for increased regulation, better training and personal protective equipment for nail technicians, along with better labelling and a national registration process to monitor growing popularity of artificial nail fashions and surveillance on the incidence of sensitisation – particularly among consumers using kits at home. 

In an attempt to protect workers, the Hair And Beauty Industry Authority (HABIA) has produced a code of practice for the nail industry. This includes wearing nitrile protective gloves. The Health and Safety Executive, too, outlines health and safety in nail bars. Premises in the UK providing manicures and nail extensions are required to be registered under ‘massage and special treatment premises licensing’ – but this is overseen on a regional basis by local authorities, and criteria vary. Any increase in future incidence of sensitisation should be kept under surveillance. 

The step-by-step nail application and removal process highlights the many points at which someone can become sensitised to acrylates: 

1. First, the consumer chooses their colour from an expansive array. 

2. The nails are filed and shaped. The cuticle, which is a protective seal, is pushed back and removed and therefore damaged. 

3. A primary layer of gel polish containing acrylate monomers (the active allergen) is applied to the nails and each hand is then placed underneath the UV lamp for 30 seconds, allowing time for the active acrylate monomers to polymerise into their inactive form. 

4. This cycle is repeated until two coats of colour and a finishing coat are completed. 

5. The removal process involves filing the nails, soaking them in acetone for 15 minutes – which is highly irritant – and then scraping off the gel polish. 

6. Acrylic nails are then frequently re-applied. 

There are many points at which an individual can become sensitised to acrylates during the application and removal of acrylic nail fashion. 

• Nail trauma - Because the nail is traumatised in the application and removal process, any uncured monomers can easily penetrate the broken cuticle, nail fold or damaged skin barrier. 

• Skin contact - If any skin is touched by a nail coated with uncured acrylate monomers, these monomers can be transferred to the skin and cause sensitisation. 

• Uncured nails - Many gel polishes require a specific UV or LED lamp to ensure the acrylate monomers are polymerised. If there is a mismatch between the gel polish and the lamp, or the hands are placed under the lamp for the incorrect amount of time, not all the monomers will be polymerised into their inactive form, or ‘cured’. A nail with uncured monomers carries a risk of sensitising wherever it touches. 

It’s important that this is accurately diagnosed so that the person understands to avoid acrylate allergen, since allergy to these chemicals can have lifelong consequences – such as avoiding future dental treatments and surgeries containing acrylates. 

Unfortunately, all nail enamels – including removers and artificial nails – contain allergens to which people can become sensitised. The most common is tosylamide formaldehyde resin. Hypoallergenic nail enamels that use polyester resin or cellulose acetate butyrate may be an alternative, but sensitivity is still possible, and they are less durable and scratch resistant.