By Abby Van Voorhees, MD, May 01, 2012
In this month’s Acta Eruditorum column, Physician Editor Abby S. Van Voorhees, MD, talks with Denis Sasseville, MD, about his recent Dermatitis articles, “Acrylates” and “Acrylates in contact dermatitis.”
Dr. Van Voorhees: Can you tell us why acrylates are such a problem, warranting their label as contact allergen of the year? What applications do we have to be thinking of when we consider this allergen? Is this only a problem for those with artificial nails?
Dr. Sasseville: Acrylates have been around for a long time (since the 1930s) and their potential to induce cutaneous hyper-sensitization was recognized as early as the 1950s. The extremely varied applications of acrylates mean that individuals may be exposed in the occupational setting (painters, printers, dental personnel, orthopedic surgeons and nurses, beauticians, etc.) as well as the non-occupational setting from various devices such as artificial nails, dental prostheses, hearing aids, etc. More recent information about the chemical composition of numerous acrylates that were supposedly pure, as well as their quick degradation, led patch testing experts to modify their techniques. That is why the members of the North American Contact Dermatitis Group decided to select acrylates as allergen of the year.
Dr. Van Voorhees: Why do acrylates remain a problem when the FDA removed methyl methacrylate (MMA) from the market in the 1970s?
Dr. Sasseville: Because the industry has replaced MMA with other molecules (ethyl acrylate, 2-Hydroxyethyl methacrylate, etc.) that have been shown to be as allergenic as MMA. In addition, it is not rare for a beautician to falsely believe that the products that she uses do not contain acrylates because of the ban on MMA.
Dr. Van Voorhees: Where does contact dermatitis typically present when it is associated with acrylates?
Dr. Sasseville: The most dramatic presentation occurs in the occupational setting when, for example, a dentist develops scaling, desquamation, and deep painful fissures on the fingertips, associated with numbness and decreased dexterity, leading to variable lengths of time off work. Another presentation is in the recipient of artificial nails who develops acute and painful dermatitis around the fingernails, associated with shedding of the nails. Nail loss may be permanent, or if the nails grow back, they may be permanently distorted. In addition, such patients often develop painful dysesthesias of the fingertips that often keep them awake at night and interfere with daily activities. This may last for months.[pagebreak]
Dr. Van Voorhees: Is there any helpful protection for our patients who have this allergy?
Dr. Sasseville: Most gloves (latex, nitrile, vinyl) are rapidly penetrated by acrylates and thus offer minimal protection. Double gloving with nitrile gloves will allow workers to handle acrylates for short periods of time not exceeding 45-60 minutes. The best gloves are trilaminated polyethylene; they can withstand exposure for up to four hours. These gloves are expensive ($5.00/pair) and poorly fitting because they are not elastic.
Dr. Van Voorhees: Let’s talk about patch testing for a patient who we think may have become allergic to acrylates. You mention in your article that there are often impurities in many of the acrylate compounds. Is there a way to exclude that patients also have a sensitivity to an impurity when we do patch testing? Other pearls regarding patch testing these patients that you’d like to share with us?
Dr. Sasseville: Patients suspected of allergic contact dermatitis to acrylates can be patch tested to an extensive series of acrylates. Allergens are available from multiple sources (Chemotechnique, Almirall/Trolab, AllergEAZE) but are not FDA approved and are not sold in the USA. Experienced patch testers have access to these compounds, and patients should be referred to the appropriate resource person. Often, patients need to be tested to products from the workplace, appropriately diluted. All allergens should be fresh and kept at least in the refrigerator, if not in the freezer. Analyzing acrylates for impurities, and testing patients for sensitization to such impurities, remains research work and is not available in North America. Dr. Magnus Bruze from Malm, Sweden, has the laboratory facilities to perform such work, and has been instrumental in disseminating this information.
Dr. Sasseville is an associate professor in the division of dermatology at the McGill University Health Centre in Montral, Quebec. His articles were published in Dermatitis, Vol 23, No 1 (January/February 2012), pp. 3-5 and 6-16. doi:10.1097/DER.0b013e31823d5cd8 and doi: 10.1097/DER.0b013e31823d1b81.