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Patients with repeated dermatitis of the skin surrounding the nail plate might benefit from a refresher course on the chemical agents commonly used to formulate various nail products and possible skin reactions associated with those agents, according to a physician.
"I am a believer in nail cosmetics. However, they should be used properly and according to directions, and thus add to attractiveness and protection," says Richard K. Scher, M.D., F.A.C.P., adjunct professor of dermatology, University of North Carolina School of Medicine, Chapel Hill, N.C.
If patients were better educated about irritants that are commonly contained in nail products, they may rethink what they choose to apply to the nail plate and use around the nail unit, and at what frequency the products are used, Dr. Scher says.
Yet, according to Dr. Scher, an effective primary treatment of chronic dermatitis - whether surrounding the nail or somewhere else on the body - is the discontinuation of the agent suspected of causing the reaction.
"There is much less reaction to tosylamide than to formaldehyde," Dr. Scher says.
Plasticizers help make nail enamels pliable to minimize chipping. Dibutyl phthalate (DBP) is a commonly used plasticizer, but because of its possible irritant nature, some product packaging now states, "does not contain DBP."
Film-forming agents produce a shiny yet tough nontoxic film that adheres to the nail plate. The film is gas-permeable, so the health of the nail plate is not compromised by a lack of oxygen exchange. A commonly used film-forming agent, nitrocellulose, is usually well-tolerated.
Small metal beads placed inside the nail enamel bottle to mix the agents may contain nickel, which can lead to allergic dermatitis. However, plastic beads are frequently used today, and Dr. Scher says nickel sensitivity from nail products is therefore much less likely.
Finally, the solvents that suspend these agents might include n-butyl acetate or ethyl acetate, with toluene and isopropyl alcohol added as diluents. These may be drying for the periungual skin.
Regarding polish removers, acetate formulations are milder to the nail and skin, but harsher acetone-based products are quite drying and cause irritation, especially when used too frequently.
"If you change your polish every day, the remover is more trouble than the polish," Dr. Scher says.
While some patients may find it difficult (and perhaps less than attractive) to cooperate with a treatment recommendation to stop polishing their nails, Dr. Scher says it is a primary way to treat dermatitis surrounding the nail plate.
"There are essentially only two ways to treat a dermatitis: Stop using the offending agent, and apply corticosteroids," he says. "In most cases, the dermatitis is mild enough so a topical corticosteroid would work."
Dr. Scher notes that the strength of steroid treatment would depend on the severity of the dermatitis, and systemic corticosteroids are rarely required.
Mild cases may even clear without intervention. Moderately severe to severe cases that are left untreated have a higher probability of resulting in permanent damage to the nail bed and/or the nail matrix.
"By and large, it is true that people are smart enough to stop using what is irritating their skin," he says. "Most men and women can use nail products very safely."
Disclosures: Dr. Scher reports no relevant financial interests.