What are the public health and safety implications of using home acrylic nail kits?
Clinical Applications
Dr. Schwarzenberger is the former physician editor of DermWorld. She interviews the author of a recent study each month.
By Kathryn Schwarzenberger, MD, FAAD, November 1, 2024
In this month’s Clinical Applications column, DermWorld Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Brandon Adler, MD, FAAD, about his Dermatitis paper ‘A survey of skin reactions associated with acrylic nail cosmetics, with a focus on home kits.’
DermWorld: You and your co-authors sought to investigate the characteristics of individuals reporting skin reactions associated with acrylic nail cosmetics, particularly home kits. What prompted you to study this topic?
DermWorld: How did you go about collecting these data? What were the specific criteria used to determine a “skin reaction” in the survey, and how were these reactions categorized or validated?
Dr. Adler: We posted the survey link on two Facebook nail allergy support groups over a period of several months. Our only inclusion criteria were age ≥18 years and a self-reported history of skin reactions associated with acrylic nail cosmetics. While the latter is broad, we did ask specific questions about the nature of the reactions (including timing, affected body sites, and associated symptoms). However, a limitation of this study was the inability to confirm the diagnosis of allergic contact dermatitis.
DermWorld: You found that acrylic nail kit home users were more likely to experience skin reactions and nail damage compared to professional acrylic manicures. Can you elaborate on why you think that is?
Dr. Adler: There are several theories. Compared to receiving a manicure from a professional at a salon, who precisely applies the uncured (highly allergenic) polish onto the nail plate, home users are thought to be at higher risk of spilling it onto the more reactive periungual skin prior to curing under the UV lamp. In addition, home users will have to make use of the less steady non-dominant hand to complete their manicures, and they have the option to repeat manicures more frequently than at the salon (i.e., greater number of exposures). Compounding these technical contributors is an educational one: We found that home users most commonly received their training from websites/YouTube videos (74%) or social media (44%) — sources which may not emphasize the risk of contact sensitization to uncured acrylates.
DermWorld: Were there any significant differences in the types or severity of skin reactions reported by users who learned about home kits through social media versus those who received training through websites or online videos?
Dr. Adler: We did not conduct this sub-analysis, although it would be useful to explore in future studies. It would also be intriguing to perform a content analysis of social media posts on home acrylic nail kits — particularly how often they discuss potential risks, including sensitization.
DermWorld: What are the potential implications for public health and consumer safety regarding the use of home acrylic nail kits based on the study’s findings?
Dr. Adler: There is an argument to be made that perhaps home acrylic nail kits shouldn’t be made readily available to consumers. As I explain to my patients who have become sensitized — I wish this conversation was rare, but it isn’t — the most important problem isn’t that they can no longer use the entire range of modern, long-lasting, chip-resistant nail cosmetics. It’s that following sensitization to acrylates, they may later experience reactions to other common consumer, occupational, and/or medical products that contain these ubiquitous allergens — ranging from adhesives to dental and bone cements and even in-ear headphones. Some of these exposures can lead to adverse outcomes following medical procedures or impose limitations on treatment options. In the United States, protecting the public from potent contact allergens does not seem to be a high regulatory priority. We lag behind the European Union, which has enacted legislation regarding several prominent allergens; these regulations were subsequently associated with fewer positive patch test reactions over time.
Brandon Adler, MD, FAAD, is clinical associate professor in the dermatology department at the Keck School of Medicine at the University of Southern California. Dr. Adler does not have any relevant financial or commercial conflicts of interest. His paper appeared in Dermatitis.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
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