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Allergic contact dermatitis - Nail and Distal Digit
See also in: Overview,Cellulitis DDx,External and Internal Eye,Anogenital,Hair and Scalp,Oral Mucosal Lesion
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Allergic contact dermatitis - Nail and Distal Digit

See also in: Overview,Cellulitis DDx,External and Internal Eye,Anogenital,Hair and Scalp,Oral Mucosal Lesion
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Contributors: Shari Lipner MD, PhD, Susan Burgin MD, Bertrand Richert MD, Robert Baran MD
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Synopsis

This summary discusses adult patients. Allergic contact dermatitis in children is addressed separately.

Contact dermatitis of the nail unit may be either irritant or allergic, and allergic contact dermatitis comprises 20% of contact dermatitis cases of the nail. Allergic contact dermatitis of the nail apparatus commonly involves the proximal nail fold (PNF) and the hyponychium and may cause both skin changes and nail plate abnormalities. Onycholysis is the most common nail change. Other nail findings include pitting, Beau lines, and onychodystrophies. These changes are caused by involvement of the adjacent proximal nail matrix. Hyponychium involvement results in severe subungual hyperkeratosis and nail bed splinter hemorrhages.

There are multiple causes of allergic contact dermatitis of the nails. A careful history can elicit allergens that commonly come into contact with the fingers. Workers in certain occupations, such as hair dressers, manicurists, dental workers, fiberglass workers, printers, and glue workers, are at high risk for developing irritant as well as allergic contact dermatitis. Common allergen-containing products include sunscreens (oxybenzone [benzophenone-3]), cosmetics, soaps, and dyes.

A history may elicit exposure to long-lasting nail polishes containing methacrylates. Methacrylates can also be found in dental products and hard plastics. Formaldehyde, which is found in nail hardeners, is another cause of contact dermatitis. Foods can rarely cause allergic contact dermatitis. Efinaconazole can also cause contact dermatitis.

Per February 2019, isobornyl acrylate was named the "contact allergen of the year" by the American Contact Dermatitis Society. It is an acrylic monomer often used as an adhesive. Acrylic nails are a potential source. Clinician awareness is important, because testing using routine panels does not identify isobornyl acrylate.

Related topic: Hand dermatitis

Codes

ICD10CM:
L23.9 – Allergic contact dermatitis, unspecified cause

SNOMEDCT:
40275004 – Contact dermatitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 09/08/2017
Last Updated: 03/19/2019
Copyright © 2019 VisualDx®. All rights reserved.
Allergic contact dermatitis - Nail and Distal Digit
See also in: Overview,Cellulitis DDx,External and Internal Eye,Anogenital,Hair and Scalp,Oral Mucosal Lesion
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Allergic contact dermatitis : Erythema, Scaly plaque, Vesicle, Pruritus
Clinical image of Allergic contact dermatitis
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