Severe bullous hand eczema from nail (meth)acrylates in an 8‐year‐old child

Allergic contact dermatitis (ACD) from nail (meth)acrylates is a well-known complication of occupational exposure, especially among nail aestheticians. We report the case of a severe allergy to methacrylates in an 8-year-old child who became aware of 'aesthetic' use. An 8-year-old girl with family history of atopy was referred to dermato-allergology due to two episodes of acute hand eczema in April 2023 and in June 2023. In the first episode, she developed a highly itchy vesicular eczematous eruption starting in the periungual area, progressing to the dorsal side of the hands and then to the palmar side, that resolved with topical corticosteroids. The second episode (June 203) was severe, with bullous lesions (Figure 1) and severe oedema of the dorsal side of the hands. She was hospitalized for 4 days with administration of antibiotic on an initial suspicion of dactylitis. Finally, eczema was diagnosed, and the evolution was favourable with high-class topical corticosteroids with 'Wet wrapping'. The autoimmune test was negative, especially for bullous dermatitis with anti-BP-230/180 by ELISA. The child's mother had started training as a nail technician remotely 2 years ago. From time to time, the mother applied gel varnish to her girl's nails, and then finally, the child would apply it herself. Mother used gel polish on nail and cure under a LED or UV lamper purchased on Amazon. But, after the first reaction, the nail products were confiscated and the child certifies that she never used them. Patch testing was performed with European baseline series, cosmetic series and acrylates series. Allergens were applied in IQ Ultra chambers (Chemotechnique Diagnostics, Vellinge Sweden) on the back for 48 h and readings were performed on day (D) 2 and D3. Strong (++) reactions to 2-hydroxyethyl-methacrylate(HEMA) from European baseline series, ethyleneglycol dimethacrylate EGDMA (++), methyl metacrylate (++), triethyleneglycol demethacrylate TEGDMA (+) were observed on D2 and D3 (Figure 2A, B). She also had2 acute bullous reactions (+++) to personal nail products which contained (meth)acrylates (Figure 2C). Reactions to Méthyldibromo glutaronitrile (+), t-Butyl hydroquinone (++), Myroxylon pereirae (++) and fragrance mix-1 (+) were also present. Positivity to t-butyl hydroquinone was applicable because it's a spontaneous polymerization inhibitor. About peru balsam et fragrance mix 1, she already had reactions to perfumed products. Hand eczema due to nail (meth)acrylate allergy diagnosis was confirmed. She finally confessed to secretly using the semi-permanent lacquer 48 h before the second reaction. We explained to the parents that this child can't be able to use semi-permanent lacquer, but above all that it would be necessary to be attentive to her career plans. Indeed, this child will not be able to work in nail art, dentistry or printing for example. She wanted to become a make-up artist. Nails-art are becoming increasingly popular among the younger population. (Meth)acrylate allergy is common in occupational settings, especially in nail aesthetics. Consumers are also affected, but in the paediatric age it's exceptional. In the literature, only three cases have been published about ACD from nail methacrylate.1-3 We report the youngest case. 2-HEMA is recognized as one of the most frequently encountered allergens in this group, alongside 2-hydroxypropylmethacrylate, ethyleneglycol dimethacrylate and triethyleneglycol dimethacrylate.4 It's essential to remember that when handling this nail product, even outside an occupational situation, it is possible to induce sensitization with violent reactions and, above all, serious consequences for one's professional prospects. Caution is required in the use of cosmetics on children, with the risk of irreversible damage in the future. However, it was mentioned 'Keep away from children' on the back of nail product. The uncurred and undiluted nail products were applied in the patch test. However, this procedure is not recommended as high levels of strong sensitizers may be present, which may sensitize the patient, if not allergic or give very strong reaction in those with a pre-existing allergy.5 Instead such products should be appropriately diluted, if included in the patch test. Magalie Coco-Viloin: Writing – original draft; investigation; writing – review and editing. Françoise Giordano: Supervision; validation; writing – review and editing. The authors declare no conflicts of interest.