Acrylic Nails Research Articles

Suicide by Ethyl Methacrylate Ingestion.

This case report characterizes a unique way in which suicide was accomplished through ingestion of chemicals typically used to create acrylic fingernails that resulted in death. Ethyl methacrylate and acrylic powder are commonly combined to form acrylic nails in nail salons. The process of applying acrylic nails utilizes each substance by mixing both before it typically solidifies within seconds of combining the two compounds. Ingestion of these compounds has not been previously described within the medical literature. The decedent was a nail technician at a local salon. He was found unresponsive in his yard which led to a 911 call. At the scene, a mostly empty 16-oz bottle of ethyl methacrylate, a chemical used at the salon where he worked, was found. At autopsy, the decedent's body had a strong chemical odor consistent with odors present at nail salons. Significant gastrointestinal tract damage was seen including discoloration within the esophagus, and the stomach contained a molded, hardened nail compound. The cause of death was ruled as complications of nail acrylic powder and liquid ethyl methacrylate ingestion. This case shows the unusual findings seen at autopsy from a decedent who committed suicide by ingestion of ethyl methacrylate with acrylic powder.

Effect of Different Post-Curing Methods on the Degree of Conversion of 3D-Printed Resin for Models in Dentistry.

The aim was to investigate the effects of different post-curing units on the chemical properties (degree of conversion) of 3D-printed resins for producing models in dentistry. The goal is to determine whether less-expensive post-curing units can be a viable alternative to the manufacturer's recommended units. Forty-five samples were fabricated with an LCD printer (Phrozen Sonic Mini, Phrozen 3D, Hsinchu City, Taiwan) using MSLA Dental Modeling Resin (Apply Lab Work, Torrance, CA, USA). These samples were divided randomly into four different groups for post-curing using four distinct curing units: Phrozen Cure V2 (Phrozen 3D, Hsinchu City, Taiwan), a commercial acrylic nail UV LED curing unit (SUNUV, Shenzhen, China), a homemade curing unit created from a readily available UV LED light produced (Shenzhen, China), and the Triad® 2000™ tungsten halogen light source (Dentsply Sirona, York, PA, USA). The degree of conversion was measured with FTIR spectroscopy using a Nicolet 6700 FTIR Spectrometer (Thermo Fisher Scientific, Waltham, MA, USA). Phrozen Cure V2 had the highest overall mean degree of conversion (69.6% with a 45 min curing time). The Triad® 2000 VLC Curing Unit had the lowest mean degree of conversion value at the 15 min interval (66.2%) and the lowest mean degree of conversion at the 45 min interval with the homemade curing unit (68.2%). The type of light-curing unit did not yield statistically significant differences in the degree of conversion values. There was a statistically significant difference in the degree of conversion values between the 15 min and 45 min curing intervals. When comparing individual light-curing units, there was a statistically significant difference in the degree of conversion for the post-curing units between the 15 min and 45 min curing time (p = 0.029).

Acrylates in artificial nails-Results of product analyses and glove penetration studies.

Artificial nail materials are mixtures that are prone to contain several sensitizing (meth)acrylates. It is not known whether the listing of (meth)acrylates is correct in these products' packages. Protective gloves suited for nail work are needed. To analyse (meth)acrylates in gel nail and acrylic nail products chemically and to compare the results with the information in the product labels, and to study penetration of artificial nail materials through selected disposable gloves. We analysed 31 gel nail products and 6 acrylic nail products for their (meth)acrylate content by gas chromatography-mass spectrometry (GC-MS). We tested the penetration of two nail products through three disposable gloves: nitrile rubber, neoprene rubber and polyvinyl chloride (PVC). Altogether 32/37 products contained (meth)acrylates. In all of them, there was discrepancy between the listed (meth)acrylates and those discovered in the analysis. The commonest (meth)acrylates were hydroxyethyl methacrylate (HEMA, 20/37 samples) and hydroxypropyl methacrylate (HPMA, 9/37 samples), but many of the product packages failed to declare them. Isobornyl acrylate (IBA) was discovered in nine gel nail products. The neoprene glove could withstand nail gel for 20 min and thin nitrile glove and PVC glove for 5 min. Acrylic nail liquid penetrated through disposable gloves quickly. Labelling of artificial nail products was notably incorrect on most products. Requirements for product labelling must be updated so that the risk of sensitization associated with artificial nail products is clearly indicated. Disposable gloves can probably be used short-term in gel nail work, whereas disposable gloves do not protect the user from acrylic nail liquids.

Contact allergy to acrylate-containing nail cosmetics: A retrospective 8-year study.

Over the last 10 years, allergic contact dermatitis (ACD) from acrylate-containing nail cosmetics (acrylic nails, gel nails, gel nail polish) has been reported repeatedly. To investigate the frequency and clinical features of ACD in nail cosmetics in a university hospital in Amsterdam, The Netherlands. A retrospective study in patients diagnosed with ACD from acrylate-containing nail cosmetics at the Amsterdam University Medical Centers between January 2015 and August 2023. Sixty-seven patients, all women, were diagnosed with ACD from nail cosmetics, representing 1.6% of all individuals and 2.3% of all women patch tested in this period. Sixty-five of sixty-seven (97%) subjects had a positive patch test to 2-hydroxyethyl methacrylate (HEMA). Forty-nine patients (73%) were consumers and 18 (27%) were professional nail stylists. The sites most frequently affected with dermatitis were the fingers (79%), hands (40%) and the head and/or neck. Avoidance of contact with acrylate-containing products resulted in complete clearing of dermatitis in 80% of patients. ACD from acrylate-containing nail cosmetics is frequent in women patch tested in Amsterdam. Nearly all were identified by a positive patch test to 2-hydroxyethyl methacrylate in the (meth)acrylate series or the European baseline series.

Presence of 2-hydroxyethyl methacrylate (HEMA) and other (meth)acrylates in nail cosmetics, and compliance with EU legislation: An online market survey.

During the last 15-20 years, allergic contact dermatitis from acrylates-containing nail cosmetics (acrylic nails, gel nails, gel nail polish) has been increasingly reported. 2-Hydroxyethyl methacrylate (HEMA) is considered to be the major allergenic culprit; few data on its presence in nail cosmetics are available. To investigate (1) the frequency in which HEMA and di-HEMA trimethylhexyl dicarbamate are present in nail cosmetics; (2) whether nail cosmetics comply with EU regulations; (3) which other (meth)acrylates are present in nail cosmetics and how often. One-line market survey. HEMA was present in nearly 60% of 394 cosmetic nail products and di-HEMA trimethylhexyl dicarbamate in 34%. Mandatory warnings on the packages of products containing HEMA were absent in 35% ('For professional use only') resp. 55% ('Can cause an allergic reaction'). Forty-five other (meth)acrylates were identified, of which the most frequent were hydroxypropyl methacrylate (25%), isobornyl methacrylate (16%) and trimethylolpropane triacrylate (12%). Some ingredient lists mentioned non-INCI names or non-specific names. HEMA was by far the most common ingredient of nail cosmetics, being present in nearly 60% of the products. Violations of EU legislation occurred in >30% (mandatory warnings missing) resp. 10% (mislabelling) of nail cosmetics.

A Survey of Skin Reactions Associated With Acrylic Nail Cosmetics, With a Focus on Home Kits: Is There a Need for Regulation?

Background: Sensitization to (meth)acrylates, the most common nail cosmetic allergens, is rising. In recent years, home acrylic nail kits have become easily available. Objective: To investigate the characteristics of individuals reporting skin reactions associated with acrylic nail cosmetics, particularly home kits. Methods: Cross-sectional survey of Facebook nail allergy support groups. Inclusion criteria were self-reported skin reactions associated with acrylic nails and age ≥18 years. Results: There were 199 respondents, nearly all female (99%), mostly white (83%), and 25-54 years old (83%). Seventy-eight percent reported using home acrylic kits, more than half for the first time during COVID-19. They predominantly learned about kits through social media (68%) and received training through websites/online videos (74%). Most home users (83%) first developed skin reactions after starting to use home kits. Compared with nonhome users, significantly more home users reported skin reaction onset within 1 year of use, as well as nail damage (P < 0.05). Conclusions: Among online nail allergy support group members, home acrylic nail kit use was common and associated with earlier development of skin reactions and more frequent nail damage than professional acrylic manicures. These findings raise important questions about the need to regulate home acrylic nail kits.

P23 Curing the nail

Abstract Introduction Ultraviolet light is a well known trigger for inducing cutaneous flares in people who are predisposed or have been diagnosed with cutaneous lupus, it may have far reaching implications, triggering organ threatening disease Ultraviolet light could be from various sources including the sun, light bulbs and drying lamps used in nail salons to “cure the nails”. Curing the nails is a term used in the manicure world where UVA type 2 light is used to facilitate complete and quick drying of the nail polish: these type of UV light have been implicated in the pathogenesis of lupus. Case description This is the case of a 41 year old lady of African descent diagnosed with discoid lupus at the age of 33. Symptoms include hair loss, hypopigmented lesions on her ear, urticarial rash, fatigue, joint stiffness. Prior history of pregnancy loss at 14 weeks noted, and her sister also suffers from lupus. On examination she was found to have scarring alopecia with hyperkeratotic erythematous lesions at the periungual area with acrylic nails. Blood work showed lymphopenia, positive ANA, positive dsDNA by ELISA, RO+, positive anti smith antibody, normal complements and no evidence of kidney involvement. She was treated with topical therapy and then escalated in turns to hydroxychloroquine, mycophenolate mofetil, azathioprine, rituximab and methotrexate. She had developed a rash on hydroxychloroquine leading to it's discontinuation. The periungual lesions were resistant to all of the above treatment including intralesional steroid. She had recurrent flares of the lesions which resulted in episodes of infection, pus drainage, and treatment with antibiotics. Nifedipine was introduced but did not ameliorate symptoms A causal link was eventually made between her exposure to UV light at the nail salon and the periungual lesion. She was advised to discontinue using the UV light and possibly resort to traditional nail polish and air drying. The periungual lesions significantly improved on cessation of using the UV lights. Discussion Gel/acrylic manicures are becoming increasingly popular as they are more aesthetically pleasing and long lasting compared to traditional nail polish which uses air drying method, however we should be aware of the risk of ultraviolet (UV) light exposure which is used to dry the nails. UV light stimulates keratinocytes to express more small nuclear ribonucleoproteins thereby secreting IL-1,1L-6, IL-3, GM-CSF which lead to tissue damage and increased autoantibody production, this can result in development of cutaneous lupus, worsening of cutaneous lupus or in some cases can precipitate organ threatening systemic lupus. As clinicians we should be aware of the risks and educate our patients on the implication to their disease, they should be encouraged not to use this method of manicure but rather resort to the traditional nail polish which uses air drying technique rather than UV light. Other options may include applying sun protection cream to the fingers before manicure or the use of UV protective gloves, these measures though may not provide adequate coverage to the periungual area. We should be aware and educate our patients on avoidance of other sources of UV light including avoidance of fluorescent light, tanning beds, surgical lamps and measures to reduce exposure. Key learning points Consider other sources of UV light exposure in patients with hard to treat skin disease. It is critical that we educate our patients on the possible side effects of UV exposure and counsel on strategies to minimise exposure

CD08 Double bubble trouble

Abstract A 29-year-old woman of Lithuanian heritage was referred to dermatology with a 3-year history of recurrent blistering to the hands and, occasionally, feet. The patient’s own photographs revealed small, tense blisters on the sides of her fingers and one on the foot. In the general dermatology clinic, she was noted to have acrylic nails, which she had been applying at home with her own gel nail kit for over 5 years. In recent years, the patient had noticed that use of the acrylic nail kit exacerbated her blistering. There was no prior history of skin disease or atopy. She was otherwise well, with no known allergies. She worked in the food-packing industry where she wore nonlatex gloves. In light of her frequent, prolonged use of acrylic nails and exacerbation of blistering on use of the home kit, she was suspected to have allergic contact dermatitis (ACD) to acrylates and was referred to the patch test clinic. Patch testing was performed to the British standard, facial, rubber and acrylate series. She had positive reactions to five different acrylates, confirming a clinical diagnosis of ACD relevant to her use of acrylic nails and gel polish. However, she was noted to have several unusual features. Clinically, she had small round scars on the dorsum of both hands. On questioning, she described scars occurring after each blister. Blisters occurred all year round but were significantly more frequent in the summer months. Exposure of her gel nails to ultraviolet (UV) light was felt to trigger the blistering. This prompted additional tests to investigate possible photosensitivity. Both urine and plasma porphyrin levels were significantly elevated, confirming cutaneous porphyria. This is an unusual case of a dual pathology causing blistering of the hands: ACD to acrylates and cutaneous porphyria. In most circumstances, it is ACD that is the overlooked diagnosis, but here, an important general medical diagnosis may have been missed. It is important to remember that blistering caused by gel nail kits may be multifactorial, with acrylates causing ACD and UV light possibly triggering cutaneous porphyria.

Exposure of formal and informal nail technicians to organic solvents found in nail products.

Nail technicians are exposed to volatile organic compounds (VOCs) emitted from nail products used in their daily work, which may cause adverse health effects. This study aimed to assess VOC exposure of nail technicians in the South African formal and informal sectors and to provide a task-based exposure assessment of different nail applications. Personal passive sampling was conducted on 10 formal and 10 informal nail technicians located in the northern suburbs of Johannesburg and the Braamfontein area, over 3 days. Real-time measurements were taken to determine task-based peak exposures. The number of clients serviced, working hours, type of nail application, type of ventilation, room volume, and carbon dioxide (CO2) concentrations, were also recorded. There were differences in the nail products used, the types of nail applications performed, the number of clients serviced, and breathing zones VOC concentrations of the formal and informal nail technicians. Some formal nail salons were equipped with mechanical ventilation while the informal nail salons relied on natural ventilation. CO2 concentrations were higher in the informal than the formal nail salons and increased during the course of the working day. Formal nail technicians were exposed to higher total volatile organic compounds (TVOC) concentrations than informal nail technicians, which may be due to the different nail application procedures as well as 'background' emissions from their co-workers-the bystander effect. Acetone was the predominantly detected VOC: the formal nail technicians were exposed to significantly higher TWA (8 h) concentrations [geometric mean (GM) 43.8 ppm, geometric standard deviation (GSD) 2.49] than were the informal nail technicians (GM 9.87 ppm, GSD 5.13). Methyl methacrylate among the informal nail technicians was measured at 89.7% detection frequency, far higher than that among the formal nail technicians (3.4%). This may be attributed to the observed popularity of acrylic nail applications in this sector. Nail applications involving soak-off gave rise to high TVOC peaks at the start of the nail application process. This is the first study to compare organic solvent exposures among formal and informal nail technicians and determine task-based peak exposures. It also brings attention to the often-overlooked informal sector of this industry.

Novel Osteo Refurbishment Method and Choice of Colouring Materials for Anatomy Specimens.

The introduction of competency-based medical education curriculum and a shifted focus towards self-directed learning (SDL) in medical schools across the world has necessitated a reduction of didactic teaching hours. Museum specimens are an indispensable tool in anatomy teaching and can play a pivotal role in fostering and reinforcing SDL. Coloring of specimens makes it attractive and facilitates understanding anatomy. The aims of this study were: (1) weigh up the two commonly used coloring materials in anatomy viz. acrylic paint and nail polish; and (2) to assess the perception of anatomy students towards a Novel Osteo Refurbishment Method (NORM) for restoration of partially damaged osteology specimens. Undergraduate and postgraduate students of anatomy were recruited in the study. Participants responded to a 5-point Likert scale questionnaire. Obtained data were analyzed using Microsoft Excel version 2019. For a comparison of the two coloring agents Mann-Whitney U test was applied to the responses toward the Likert scale-based questionnaire. P-value <0.05 was considered significant. Out of 318 study participants, 63.7% and 36.3% of the respondents were male and female, respectively. 90.5 % were new entrants to university and the remainder 9.5% had a prior university degree. Students found the acrylic paint to be a better coloring agent and they also opined that NORM generated refurbished osteology specimens could serve as a useful self-learning tool. Acrylic paint was found to be more suitable as compared to nail polish with significant p-value in most of the parameters tested. Acrylic colour holds a good place in coloring both specimens and models in anatomy. Nail polish can be an alternative but with some noted disadvantages. The initial experience with NORM yielded encouraging results with potential practical utility.

Dermatoscopy of subungual digital fibromyxoma (superficial acral fibromyxoma)

A 28-year-old female patient with a 5-year history of a nonpainful, slow-growing mass on the second right distal aspect of the phalanx noticed a nonpainful, firm, pink, dome-shaped growth elevating the nail plate 1 year ago. She had a history of accidental trauma with acrylic nails 1 year before the nail tumor. X-ray scan and soft-tissue ultrasonography (ACUSON X700; Siemens) showed hypoechogenic dermal tissue that measured 0.8 × 0.4 × 0.6 cm3 (Fig 1). Using pocket DL200 Hybrid (DermLite) (magnification: ×20), a nonpigmented tumor, with a pink, homogeneous color, and longitudinal, soft-pink and small, shiny, white streaks perpendicular to the nail plate were observed. Below the nail plate, a layer of white, hyperkeratotic projections, with sparse red, brown, and gray dots that were immediately adjacent, was observed. No vascular structures were seen in this patient, which is different from other publications that have reported this tumor (Fig 2).1Sialitti S. Abdelmouttalib A. Senouci K. Meziane M. Subungual acral fibromyxoma: new dermoscopic features.Our Dermatol Online. 2021; 12: 1-2Crossref Google Scholar The dermatopathology report described laminar compact hyperkeratosis, regular acanthosis, and elongated papillary processes. Superficial-medium dermis, a neoformation with spindle cell proliferations in the myxoid stroma, and no atypia or necrosis were also observed. CD34-positive cell staining was compatible with superficial acral fibromyxoma.Key messageSuperficial acral fibromyxoma is a benign, slow-growing, periungual or subungual tumor that was first described by Fetsch et al in 2001, with approximately 314 cases reported.2Griffiths C. Barker J. Bleiker T. Chalmers R. Creamer D. Acquired disorders of the nails and nail unit.in: Rook's Textbook of Dermatology: Specific Cutaneous Structure. 9th ed. Wiley-Blackwell, 2016: 2501Crossref Google Scholar, 3Kutzer H. Kamino H. Reddy V. Pui J. Fibrous and fibrohistiocytic proliferations of the skin and tendons.in: Bologna J. Dermatology. 4th ed. Elsevier, 2018: 2071Google Scholar, 4Bostanci S. Akay B.N. Akkaya Z. et al.Superficial acral fibromyxoma.J Am Podiatr Med Assoc. 2021; 111: 17https://doi.org/10.7547/20-119Crossref Scopus (0) Google Scholar, 5Crepaldi B. Soares R. Silveira F. et al.Superficial acral fibromyxoma: literature review.Rev Bras Ortop. 2019; 54: 491-496Crossref PubMed Scopus (0) Google Scholar, 6Fetsch JF Laskin WB Miettinen M Superficial acral fibromyxoma: a clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes.Hum Pathol. 2001; 32: 704-714Crossref Scopus (187) Google Scholar Dermatoscopic findings contribute to underdiagnosed analysis of this tumor that is identified based on several patterns reported and facilitate its challenging diagnosis compared with that of other acral tumors, including myxoid variations. Our dermatoscopy case report shows a digital fibromyxoma with no capillary patterns observed in the myxoid areas in a female patient with a history of acrylic nail trauma, and histopathology confirmed this diagnosis. No reports secondary to gel polish andsubungual acral fibromyxoma were found. Superficial acral fibromyxoma is a benign, slow-growing, periungual or subungual tumor that was first described by Fetsch et al in 2001, with approximately 314 cases reported.2Griffiths C. Barker J. Bleiker T. Chalmers R. Creamer D. Acquired disorders of the nails and nail unit.in: Rook's Textbook of Dermatology: Specific Cutaneous Structure. 9th ed. Wiley-Blackwell, 2016: 2501Crossref Google Scholar, 3Kutzer H. Kamino H. Reddy V. Pui J. Fibrous and fibrohistiocytic proliferations of the skin and tendons.in: Bologna J. Dermatology. 4th ed. Elsevier, 2018: 2071Google Scholar, 4Bostanci S. Akay B.N. Akkaya Z. et al.Superficial acral fibromyxoma.J Am Podiatr Med Assoc. 2021; 111: 17https://doi.org/10.7547/20-119Crossref Scopus (0) Google Scholar, 5Crepaldi B. Soares R. Silveira F. et al.Superficial acral fibromyxoma: literature review.Rev Bras Ortop. 2019; 54: 491-496Crossref PubMed Scopus (0) Google Scholar, 6Fetsch JF Laskin WB Miettinen M Superficial acral fibromyxoma: a clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes.Hum Pathol. 2001; 32: 704-714Crossref Scopus (187) Google Scholar Dermatoscopic findings contribute to underdiagnosed analysis of this tumor that is identified based on several patterns reported and facilitate its challenging diagnosis compared with that of other acral tumors, including myxoid variations. Our dermatoscopy case report shows a digital fibromyxoma with no capillary patterns observed in the myxoid areas in a female patient with a history of acrylic nail trauma, and histopathology confirmed this diagnosis. No reports secondary to gel polish andsubungual acral fibromyxoma were found. None disclosed.

963 Paediatric Full-Thickness Burns Caused by Cyanoacrylate Nail Adhesive - a Case Series

Abstract Cyanoacrylate glue, often found in acrylic nail kits, reacts in an aggressive exothermic reaction with cotton fabric. These potentially dangerous adhesives are freely available and there remains little understanding about the consequences on contact with cotton. We present two paediatric cases of thermal burns related to the use of cyanoacrylate glue, both seen after the application of acrylic false nails. The first patient is a 14-year-old girl, who presented with a 0.25% TBSA full thickness burn to the left heel, after she spilt some of nail glue onto her sock. The burn wound was initially dressed in Flamazine, but later required a formal debridement and split thickness skin graft (SSG). The second patient is a 11-year-old girl, who presented with a 0.1% TBSA full thickness burn to the dorsal right foot, after applying false nails and again spilling the glue onto her sock. Immediate first aid with cold water was used. This patient was first managed in a local hospital before being referred to the burn's unit due to worsening pain. The wound was dressed in Acticoat, due to a sloughy appearance, and then underwent formal debridement and SSG. Cyanoacrylate burns are caused by a thermal reaction rather than chemical as most may believe. In both cases described, cotton is likely to have acted as a catalyst, which is consistent with published literature. Warnings on packaging to increase awareness of potential reactions should be mandatory, as well as childproof packaging to help deter the unsupervised use of such adhesives.

Carbapenem-Resistant Actinetobacter Baumannii Transmission Containment in a Ventilator Skilled Nursing Facility

Background Actinetobacter baumannii are Gram-negative bacteria that can cause urinary, bloodstream, lung, wound, and other infections. In August 2020, the Louisiana Department of Health (LDH) was notified of three patients who were infected with carbapenem-resistant A. baumannii and were hospitalized at an acute care hospital within four weeks. They originated from the same ventilator skilled nursing facility (vSNF). LDH epidemiologists initiated a response consistent with CDC's national containment strategy to combat antibiotic resistant threats. Methods An in-person infection control assessment and response (ICAR) survey with rounding was conducted within five days of notification of the cluster. Interim infection control recommendations included implementing a policy for the removal of gel polish and acrylic nails, auditing of environmental cleaning practices, and reinforcing infection control competencies. Isolates were forwarded to the CDC Southeast Antibiotic Resistance Laboratory (ARLN) for pulse field gel electrophoresis and enhanced sensitivity testing. The facility agreed to colonization screening for the ventilator unit where all of the cases were previously housed. Swabs shipment was coordinated, and candidate screening patients were identified. Results Preliminary comparisons of antibiotic sensitivity results of cases showed similar resistance patterns for nine antibiotics, of which one was a carbapenem (meropenem). Two of the three index cases were confirmed for pan-resistant A. baumannii and positive for the OXA-23 gene on the CDC assay from respiratory and bronchiolar lavage specimens. Two rounds of colonization screenings were conducted greater than two weeks apart among four testing candidates each. No additional cases of A. baumannii, or any other multi drug-resistant pathogen, were identified. Conclusions Swift public health coordination is necessary for the containment of multi drug-resistant threats when introduced into congregate healthcare settings. While colonization screening results for this facility were encouraging, infection control recommendations and policy interventions were needed to prevent the spread of additional pathogens among vulnerable ventilated and non-ventilated patients. Actinetobacter baumannii are Gram-negative bacteria that can cause urinary, bloodstream, lung, wound, and other infections. In August 2020, the Louisiana Department of Health (LDH) was notified of three patients who were infected with carbapenem-resistant A. baumannii and were hospitalized at an acute care hospital within four weeks. They originated from the same ventilator skilled nursing facility (vSNF). LDH epidemiologists initiated a response consistent with CDC's national containment strategy to combat antibiotic resistant threats. An in-person infection control assessment and response (ICAR) survey with rounding was conducted within five days of notification of the cluster. Interim infection control recommendations included implementing a policy for the removal of gel polish and acrylic nails, auditing of environmental cleaning practices, and reinforcing infection control competencies. Isolates were forwarded to the CDC Southeast Antibiotic Resistance Laboratory (ARLN) for pulse field gel electrophoresis and enhanced sensitivity testing. The facility agreed to colonization screening for the ventilator unit where all of the cases were previously housed. Swabs shipment was coordinated, and candidate screening patients were identified. Preliminary comparisons of antibiotic sensitivity results of cases showed similar resistance patterns for nine antibiotics, of which one was a carbapenem (meropenem). Two of the three index cases were confirmed for pan-resistant A. baumannii and positive for the OXA-23 gene on the CDC assay from respiratory and bronchiolar lavage specimens. Two rounds of colonization screenings were conducted greater than two weeks apart among four testing candidates each. No additional cases of A. baumannii, or any other multi drug-resistant pathogen, were identified. Swift public health coordination is necessary for the containment of multi drug-resistant threats when introduced into congregate healthcare settings. While colonization screening results for this facility were encouraging, infection control recommendations and policy interventions were needed to prevent the spread of additional pathogens among vulnerable ventilated and non-ventilated patients.

The Protective Effects of Soft Contact Lenses for Contact Sports: A Novel Porcine Model for Corneal Abrasion Biomechanics.

The aim of this study was to determine whether soft contact lenses provide protection for the corneal surface. Fresh porcine eyes were inflated to intraocular pressures of 11 to 22 mm Hg and secured to a Styrofoam head. Newton meters affixed with artificial acrylic nails were placed at angles of 0°, 45°, and 90° from a porcine corneal surface. The force of impact was recorded at which corneal abrasions were induced. The experiment was repeated with Senofilcon A and Lotrafilcon A soft contact lenses placed upon porcine eyes. The mean forces required to induce a corneal abrasion with force at 0°, 45°, and 90° from corneal surface were 11±5.09, 9.18±2.76, and 7.72±2.61 Newtons, respectively. With soft contact lens barrier, the maximum measurable force of 50 Newtons could not produce a corneal abrasion. The force required to create corneal abrasions varies depending on the angle of the force vector. The use of contact lenses can withstand a minimum of five times the average force needed to create corneal abrasions.

Up in Flames: The Safety of Electrocautery Trephination of Subungual Hematomas with Acrylic Nails.

IntroductionSubungual hematomas are fingertip injuries, generally secondary to blunt trauma, that cause pain due to an accumulation of blood under the fingernail. It is generally considered standard of practice to relieve this accumulation by means of trephination with a hollow tip needle, a heated paper clip, or electrocautery. It has been assumed that due to the flammable properties of acrylic, trephination via electrocautery has the potential to ignite acrylic nails and cause burns and other potentially serious injury, making electrocautery contraindicated in patients with acrylic nails. Our thorough literature review failed to support or refute this assumption; so in the interest of ensuring that this practice is evidence-based, we sought to explore this topic.MethodsIn this study we used electrocautery trephination on acrylic nail products attached to simulated digits and recorded the presence and frequency of ignition events. We hypothesized that ignition would occur with sufficient frequency to support continuing the practice of avoiding electrocautery trephination in subungual hematomas with overlying acrylic nails.ResultsIn our study, we exposed 200 acrylic nails to trephination with electrocautery, and 83 nails ignited (41.5%).ConclusionWhile other variables exist, these findings do support the current practice pattern of avoiding trephination with electrocautery in those patients with acrylic nails overlying subungual hematomas.

Cosmetics and Personal Care Products-Related Ocular Exposures Reported to United States Poison Control Centers

ABSTRACT Purpose To study cosmetics and personal care products-related ocular exposures in the United States. Methods A retrospective analysis of cosmetics and personal care products-related ocular exposures from 2000 through 2018 was conducted using data from the National Poison Data System. Results From January 2000 through December 2018, United States Poison Control Centers received 266,743 calls concerning eye exposures to cosmetics and personal care products, corresponding to a mean of 14,039 calls per year. Young children (<6 years old) represented 51.6% of exposures, while older children and teenagers (6–19 years old) and adults (≥ 20 years old) represented 19.5% and 28.9% of exposures, respectively. Over the study period, the annual frequency of exposures decreased by 46.0%. The product subcategories associated with the highest proportion of exposures were perfumes, colognes, and aftershaves (19.0%), suntan and/or sunscreen products (11.2%), nail polishes (9.5%), soaps (6.3%), and creams, lotions, and make-up (5.8%). The product subcategories associated with the greatest proportion of moderate or major medical outcomes were acrylic nail adhesives (14.4%), miscellaneous nail products (12.9%), other hair care products excluding peroxides (10.9%), hair coloring agents excluding peroxides (8.9%), and peroxides (7.5%). Conclusions Although the annual frequency of exposures to cosmetics and personal care products declined during the study period, public health efforts are needed to prevent further ocular exposures to these products. Containers of potentially ocular-toxic products should be redesigned to reduce confusion with eye dropper bottles and to reduce attractiveness to young children, with immediate priority placed on acrylic nail adhesives.

18456 Modeling of usage and estimation of cost for efinaconazole 10% topical solution in the treatment of onychomycosis

Onychomycosis accounts for half of all nail diseases with toenails more commonly affected compared with fingernails. Efinaconazole 10% solution is often prescribed for toenail onychomycosis due to its higher mycologic and complete cure rates compared with other topicals. Cost is a limiting factor, with the average retail price for a 4-mL bottle being $575.49. Since the manufacturer has not reported the number of drops in a 4 or 8 mL bottle, it is unknown how much to prescribe for each patient and to estimate cost. We sought to calculate the volume of efinaconazole needed for a full treatment course and approximate cost by modeling patient usage. The length and width of all toenails were recorded from 26 volunteers and surface area was calculated. A 17 × 14 mm acrylic nail was affixed to a foot mannequin to reproduce the average female great toenail with 2-mm margins demarcated to replicate the nailfolds. One drop of efinaconazole 10% solution was applied to the surface of the great toenail and one drop was applied to the hyponychium. This process was repeated until the 4 mL bottle was depleted and then the experiment was replicated with a total of 5 bottles. Our study shows that there is large variability in the output volume of efinaconazole 10% solution. A 4 mL bottle lasts a mean of 24 days, and 2 drops is sufficient to treat 2 smaller toenails, which enables physicians to estimate volume and cost for a full onychomycosis treatment course.

Health and Safety in Nail Salons: A Cross-Sectional Survey.

In recent years, nail salons have become more abundant than ever. The majority are small businesses, often employing immigrant women. Nail technicians have many exposures at work including chemical, biological, physical, and ergonomic hazards but few data exist on their symptoms or occupational health and safety practices, particularly in the Canadian context. The aim of this study was to learn about nail technicians, their work, and their health and safety practices. Nail technicians were recruited from nail salons in Toronto, Ontario. Participants completed an anonymous survey with questions about demographics, work tasks, workplace health and safety practices, and symptoms (skin, respiratory, and musculoskeletal). A total of 155 nail technicians (95% female) participated in the survey. The majority of nail technicians performed manicures (99%) and pedicures (96%) and applied shellac polishes (86%). Only a third (34%) applied acrylic artificial nails. The reported use of personal protective equipment (PPE) was very high; 88% reported using a mask at work and 96% reporting using gloves. The most common symptoms reported by technicians were neck (44%) and back pain (38%). Skin and respiratory symptoms were less common with 6% of technicians reporting cough, 8% wheeze, and 5% a current rash. Technicians working over 30 h per week reported more neck pain (52 vs. 32%, P = 0.02). Technicians who reported using shellac polishes were more likely to report a runny nose (25 vs. 0%, P = 0.01). Nail technicians in Toronto, Canada are experiencing work-related symptoms. Musculoskeletal symptoms were the most common symptoms reported. Much of the focus on nail salons and health has been on chemical exposures, but ergonomic hazards should not be overlooked. Efforts to increase knowledge and improve occupational health in nail salons should include information on multiple possible workplace hazards and how to reduce impacts of exposure.

Nail Care for Healthcare Workers during COVID-19 Pandemic.

Nail Care for Healthcare Workers during COVID-19 Pandemic.

Patch testing hydroxyethyl (meth)acrylate

Contact allergy occurs when the skin comes into contact with allergens (chemicals that cause allergy), causing sensitisation. This means that if the skin comes into contact with the same allergen again, it can develop an eczema-like reaction known as allergic contact dermatitis (ACD), which affects 20% of people. Patch testing is used by dermatologists to find out what the substance causing the reaction might be. This is done by applying a range of known allergens to patches of the skin to see which trigger a reaction. The baseline (standard) series of patch test allergens is recommended in everyone undergoing patch testing and aims to include the most common allergens which cause ACD. (Meth)acrylate chemicals are the key ingredients in acrylic nails, gel nails and gel polish nails. There are different types of meth(acrylates). The authors of this study from 15 centres in the U.K. decided to add 2-hydroxyethyl methacrylate (2-HEMA) 2% in petrolatum (pet.) to the baseline patch test series in 2016-7, aiming to detect ACD in patients using acrylic nails. Patients with a history of (meth)acrylate exposure, or who tested positive to 2-HEMA, were then selectively tested with a further short series of eight (meth)acrylate allergens. Of 5,920 patients, 1.7% (102) were allergic to 2-HEMA and 2.4% (140) to at least one (meth)acrylate. (Meth)acrylate allergy would have been missed in 0.6% of patients (36) without testing 2-HEMA in everyone. 94% of allergic patients were women. 37 of the 140 were sensitised by working in the nail industry and 97 were sensitised by wearing acrylic nails. Only six people developed the allergy due to exposure to other sources (surgical glue, adhesive medical appliances and printing ink). The authors recommend that 2-HEMA 2% pet. should be added to the British baseline patch test series and suggest a standardised short series of 15 (meth)acrylate chemicals, which is likely to detect most cases of (meth)acrylate allergy.