D2.98 - Allergic Contact Dermatitis from 2-Hydroxyethyl Methacrylate in a Nail Technician

 2‑Hydroxyethyl methacrylate (HEMA), a methacrylate monomer widely used in nail cosmetics, is a significant contact allergen. Its inclusion in the European baseline patch test series in 2019 reflects the increasing number of allergic contact dermatitis (ACD) cases among consumers and nail technicians. Positive reactions to HEMA in European centres range from 0.9% to 4.4%, with nearly two-thirds of sensitizations linked to nail cosmetic products, especially in women. Early recognition and precise identification of the allergen are crucial for prevention and management of ACD.

 A 38-year-old woman who had worked as a nail technician for approximately 10 years presented with a history of recurrent hand eczema characterized by vesicles, erythema, and pruritus. She had discontinued her professional activity due to periodic exacerbations of eczema affecting her hands. The patient reported that the dermatitis had been present for approximately two years, with recurrent flare-ups. At the time of examination, vesicles were observed on the fingers, accompanied by severe pruritus. Patch testing demonstrated sensitization to acrylates, with a positive reaction to 2-hydroxyethyl methacrylate observed at the 72-hour reading.Nickel allergy and irritant contact dermatitis were considered in the differential diagnosis but were excluded based on clinical findings and patch test results.

 Allergic contact dermatitis from nail acrylates, particularly HEMA, is increasingly common among young female nail technicians, with occupational exposure accounting for up to 90% of cases in Europe. Studies report positive reactions to HEMA in 1.5–3.7% of patch-tested patients, and up to 72% among professional nail technicians, highlighting its strong sensitizing potential. Patch testing with HEMA identifies the majority of sensitized patients, although cross-reactivity with other acrylates may occur. Even with protective gloves and masks, prolonged exposure can lead to recurrent hand eczema, emphasizing the need for early recognition and preventive measures.

 Our case illustrates that prolonged occupational exposure to HEMA can cause recurrent dermatitis even with partial protective measures. Early identification, allergen avoidance, and proper safety precautions are crucial to prevent disease progression and maintain work capacity.