Contact eczema induced by hybrid manicure. The role of acrylates as a causative factor

Introduction
Acrylates are widespread plastic materials, known for their sensitizing properties. So far, allergy to acrylate monomers has been known as occupational eczema, mainly concerning dentists and manicurists. However, a surge of allergic contact dermatitis (ACD) cases related to acrylates among users of hybrid varnishes have recently been reported.

Aim: This article reviews the pathogenesis, clinical manifestations, and dermoscopic features of contact eczema induced by hybrid manicure.

Material and methods
The study was performed on a group of 8 women. Clinical and dermoscopic features were evaluated and correlated with the period of exposure to acrylates. In addition, all patients underwent mycological examination to exclude fungal co-infection.

Results
Mycological examinations in all patients gave negative results, although 1 patient developed local secondary mixed supra-infection due to Pseudomonas aeruginosa and Candida spp. Distribution of clinical manifestations corresponded to the area of contact with the allergen and comprised both skin and nail changes. The severity of inflammation correlated positively with the exposure period. Subungual hyperkeratosis and onycholysis were the most common findings (8/8 patients), and eczematous finger pulp fissuring was a rarer sign (2/8 patients) but more specific clinically.

Conclusions
The surge of contact dermatitis related to acrylates seen in recent years requires dermatologists’ awareness. Nail changes induced by hybrid manicure can mimic onychomycosis or nail psoriasis. Therefore comprehensive patch testing should be performed in doubtful cases. Due to the lack of patch tests in our study, we can only suspect that we were dealing with allergic contact dermatitis. In case of confirmed allergy to acrylates, the patient should be aware of this and avoid them.