First case of pustular eyelid allergic contact dermatitis to methacrylates in artificial nails

We present the first case of pustular eyelid eczema due to contact allergy to methacrylates in artificial nails. A 36-year-old African woman with a past history of ACD (allergic contact dermatitis) to fragrances and thiuram mix, was referred for acute pustular lesions, erythema and mild oedema of the eyelids and periorbital skin. The lesions had started the week before on the eyelids and were slowly extending to the temples and cheeks (Figure 1). She also had erythema and squamous lesions of the hands with a few pustules (Figure 2). She had received a prescription for oral Pristinamycin and local Fucidin with no improvement. The patient had not recently been using gloves. She avoided the use of fragrances in her personal products since she had received her first diagnosis of ACD to fragrances. The patient reported she had recently been to see a beautician for an artificial nail application, but 3 days later, she decided to pull the false nails out herself. Patch tests had been performed with EBS (European baseline series) and acrylates series using test preparations from D'Estaing (Grasse France) or SmartPractice Europe (Greven, Germany), using IQ ultra chambers® from Chemotechnique MB Diagnostics AB (Vellinge, Sweden) and Mepilex® border tape with an occlusion time of 48 h according to the ESCD guidelines. Positive results were found for 2-hydroxypropyl methacrylate 2% pet (+) and ethylene glycol dimethacrylate 2% pet (+) at D3 and D10; as well as 2-hydroxyethyl methacrylate 2% pet (+), thiuram mix 1% pet (++), fragrance mix I 8% pet (++) and fragrance mix II 14% pet (++), linalool 0.5% pet (++), limonene 0.2% pet (+). She healed a few days later with a topical dermocorticoid treatment and the avoidance of artificial nails and nail products. The eyelids are one of the most sensitive areas of skin: frequently exposed to potential allergens, histologically the thinnest skin area of the body, and with an occluded eyelid skin while the eye is open. Contamination of the fingers with small amounts of allergen can result in the transfer of sufficient material to the eyelids to produce dermatitis via hand-to-face contact.1, 2 Contact allergy from acrylic compounds is well known and often described related to artificial nails in the occupational setting, but also concerns the non-occupational setting.3-6 The pustular form of ACD to acrylates is unusual with no other case reported to our knowledge. Pustular ACD is rare and has been reported with fragrances, colophonium, rubber additives, textile dyes, triethanolamine and benzoic acid.7-11 Pustular lesions can mimic an infectious skin disease, and hamper the diagnosis of ACD. In conclusion, this is the first case of pustular eyelid ACD associated with methacrylates in artificial nails. This report highlights the importance of considering unusual location and presentations in acrylate ACD. Marion Menanteau: Writing – original draft; investigation. Lynda Bensefa-Colas: Supervision; investigation. Marie-Noëlle Crepy: Writing – review and editing; investigation.