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Nail Product Allergies - Questions and Answers from Dr Dana

Is it possible to be allergic to manicures?
Allergic reactions to beauty and personal care products occur when the skin is repeatedly exposed to small amounts of the allergen over months to years. The reaction to the allergen usually appears several days after the cosmetic has contacted the skin and can appear as redness, swelling, and blistering of the skin or surrounding the nail. Sometimes the nail will burn and then separate or lift off of the nail bed. Interestingly, when the stimulus is a nail ingredient, the rash does not always appear on the fingertips and sometimes presents as a rash on the eyelids, the lips arms, chest or neck. Allergic reactions to nail products are much less common than irritant reactions. Anyone can develop an irritant reaction to a nail product if enough of the chemical comes in contact with the skin and because irritant reactions can look like allergic reactions, distinguishing the two can be challenging but is important because allergies tend to be life-long whereas irritant reactions are not. Also, if you have a true ingredient allergy then you will likely be allergic to any product that has that ingredient or even ingredients with a similar chemical structure. Therefore, it becomes important to be able to distinguish allergic from irritant reactions and patch testing is the best method to accurately differentiate between the two. Dermatologists patch test by applying a concentrated amount of the suspected chemical to the skin on the patient’s back and the skin is usually evaluated two and then four days later.

What exactly is the reason for the reaction? What are people actually allergic to?
There are hundreds of ingredients in personal care products and nail cosmetics that can cause allergic reactions. In the nail salon, allergies can occur to soaps, hand sanitizers, fragrance or preservatives in hand and foot creams, reactions to ingredients such as uncured methacrylate or acrylate oligomers and monomers in gels, tosylamide/formaldehyde resins or toluene which are in some nail polishes and hardeners, and even airborne induced allergies can occur from dust from acrylics and fumes from glues. In the salon, enhancements in particular are often the culprit because of improper curing. Once the product is cured completely, it cannot cause an allergy. However, any repetitive skin contact with uncured gels, resins, monomers or adhesives can cause allergic reaction to develop.

What are some signs that someone might be allergic?
Often allergies from nail cosmetics can appear on the face. Think, itchy, swollen eyes, or lip swelling. When the reaction is localized to the nails possible reactions include: redness, swelling, and blistering of the skin or surrounding the nail. Sometimes the nail will burn and then separate or lift off of the nail bed. A new reaction that has recently been observed from allergies to the gel manicures (UV soak off gels) is a psoriasis reaction of the nail bed. The nails appear to develop psoriasis suddenly after documented exposure to gel manicure.

Are people more likely to be allergic to gel manicures than regular ones?
Anything that requires curing is theoretically a larger allergen risk. Nail techs are a lot more at risk than nail clients for allergy development because they have repetitive exposures. For techs: The biggest thing that techs can do is to know the products that they are working with inside and out. Proper curing of products is essential as repeated exposure to improperly cured product is one of the biggest reasons for salon tech product sensitivity. Improper curing can occur from using the wrong nail lamps as every product requires a specific UV wavelength for proper curing. There is no such thing as a universal lamp that works for all products and brands. Other causes of improper curing include applying product too thick, mixing brands, rushing through a service and not allowing proper cure time, using incorrect liquid to powder rations and not maintaining and cleaning UV bulbs. Nail techs should always follow the manufacturers instructions and not rely on fellow technicians or on-line videos. If a client calls hours later to report the reaction then it is more likely to be an irritant induced reaction. Salon technicians should have relationships with local dermatologists that they can refer their clients to in an event like this. If the client’s reaction is on or surrounding the nails and you the gel or enhancement product has just been applied, it is important to not soak them off until they are seen and treated by a dermatologist.

Any advice on how to avoid these reactions (other than simply giving up nail polish for good)?
The best advice is to avoid the allergy from the get go. Look for polishes that are Free of the common culprits (9-Free). Nail techs can also consider wearing gloves. Nitrile gloves are preferred as many clients may be latex sensitive. As previously stated, avoiding skin contact is the key to minimizing risk. General operational protocols such as keeping tools, containers and working surfaces clean and dust free.
If the reaction is confirmed to be a true allergy then avoidance of the allergic trigger is imperative and avoiding other products with the ingredient will also be key.

Would you recommend women experiencing these reactions visit an allergist to know for sure?
They should visit a board certified dermatologist who has extensive experience with patch testing.