Zgryźliwość kojarzy mi się z radością, która źle skończyła.
Clinics in Dermatology (2013)
, 573
–
577
31
Cosmetic treatment of nails
Zoe Diana Draelos, MD
⁎
Department of Dermatology, Duke University School of Medicine, Durham, NC 27708
Abstract Nail cosmetics are an important part of personal expression. Although their use can result in a
variety of dermatologic issues, the popularity of nail cosmetics is huge. Dermatologists must recognize
problems associated with nail cosmetics and understand the process for using these cosmetics. Many
problems can be avoided through careful use or a change in the application procedure.
© 2013 Elsevier Inc. All rights reserved.
Introduction
Nail polish
The most commonly used nail cosmetic is nail polish.
2
Nail polish is available in clear and all the colors of the
rainbow with special surface effects including glitter, shine,
pearl, and crackle finish. While nail polish is generally
considered safe, some consumer groups have blogged on the
Internet regarding the safety of phthalates, which are found
in almost all nail polishes. Phthalates have been linked to
estrogenic effects on the body, but it is unlikely that nail
polish applied to the nonliving nail plate has much effect, and
the safety of phthalates has not been considered an industry
issue until recently.
Nail polish is an outgrowth of the automobile painting
industry and the adaptation of this technology for cosmetic
purposes gave rise to one of the largest cosmetic companies
still in existence today, Revlon.
3
Nail polish, also known as
nail enamel, is a pigmented coating applied to the nail plate.
4
It was introduced in the 1920s when lacquer technology was
developed in the automobile industry to replace slow-drying
oil-based paints. The basis of nail polish is nitrocellulose,
which is created by reacting cellulose fiber from cotton
linters or wood pulp with nitric acid. The boiled nitrocellu-
lose is dissolved in organic solvents, which evaporate,
leaving a hard, glossy film known as a lacquer.
5
In 1930,
Charles Revson developed the idea of adding pigments to the
Nails are a frequently adorned, yet rather challenging
structure for dermatologic treatment. The results of success-
ful treatment of nail conditions cannot be observed for 3 to 6
months, which is often longer than the patient is willing to
wait. Once the cells of the nail matrix are damaged, repair is
not possible, creating further challenges; yet, attractive nails
are important to many individuals, as they can indicate
gender, occupation, attention to fashion, and hygiene
standards. No other nonliving structure of the body can
say so much about who we are and how we want to be
perceived by others.
While the nail functions primarily to protect the tender
fingertip tissue, the nails have become the focus of body art
through the introduction of both simple and elaborate
cosmetic procedures. This contribution examines the cur-
rently popular nail cosmetics and their effect on the health
of the nail plate and surrounding tissues.
1
The goal is to
survey the dermatologic issues that arise from the use of
these nail cosmetics.
⁎
Corresponding author. Tel.: (336) 841-2040; fax: (336) 841-2044.
E-mail address:
(Z. D. Draelos).
0738-081X/$
–
see front matter © 2013 Elsevier Inc. All rights reserved.
574
Z.D. Draelos
may be added to act as diluents to keep the lacquer thin and
to lower its cost. To this vehicle, a variety of coloring agents
and specialty fillers can be added to determine the final
cosmetic appearance of the nail polish. Coloring agents, such
as organic colors, may be selected from a list of certified
colors approved by the U.S. Food and Drug Administration
(FDA). Inorganic colors and pigments may also be used but
must conform to low heavy-metal content standards.
8
These
colors can be suspended within the lacquer with suspending
agents, such as stearalkonium hectorite, to produce colors
ranging from white to pink to purple to brown to orange to
blue to green.
Decorator nail effects can be created with specialty fillers,
such as guanine fish scale, bismuth oxychloride, or titanium
dioxide-coated mica, to give a frosted appearance, due to
enhanced light reflection. Chopped aluminum, silver, and
gold can be added for a metallic shine. A newer trend is to
artistically decorate the nails on top of the nail polish. Nail
decals composed of plastic with clear glue on one side can be
pressed over the nail polish to create textures and images.
Airbrushing with different nail polish colors can be used to
create flowers, holiday motifs, or any other artistic image
desired to the nail. In addition, rhinestone jewels or metallic
tapes can be affixed for a different fashion statement. Nail
polish is basically a colored canvas for the addition of other
nail decorative arts; the application technique is summarized
in
Table 2
.
Proper nail polish application requires three layers: a base
coat, a pigmented nail enamel, and a top coat (
Table 2
). The
base coat ensures good adhesion to the nail plate and
prevents polish from chipping. It contains no pigment, less
primary film former, more secondary film-former resin, and
a lower viscosity, because a thinner film is desirable. The
second layer is the actual pigmented nail enamel. The top
coat, or third layer, provides gloss and resistance to
chipping. It contains increased amounts of primary film
former, more plasticizer, and less secondary film-forming
resins. Some top coats may contain sunscreen to protect the
nail lacquer but do not contain pigment. Finally, a nail-
polish drier, consisting of vegetable oils, alcohols, and
silicone derivatives, may be brushed or sprayed over the
Table 1 Nail polish ingredients
Type of
Ingredient
Examples of Ingredients
Primary film
former
Nitrocellulose, methacrylate polymers,
vinyl polymers
Secondary film-
forming resin
Formaldehyde, p-toluene sulfonamide,
polyamide, acrylate, alkyd and vinyl resins
Plasticizers
Dibutyl phthalate, dioctyl phthalate, tricresyl
phosphate, camphor
Solvents and
diluents
Acetates, ketones, toluene, xylene, alcohols
Colorants Organic D&C pigments, inorganic pigments
Specialty fillers Guanine fish scale or titanium dioxide-coated
mica flakes or bismuth oxychloride for
iridescence
clear lacquer to form an opaque, colored nail polish; he
founded the cosmetic company Revlon in 1932.
Amazingly, basic nail polish has changed very little since
its first introduction, except for the use of polymers that
increase the flexibility of the film over the nail to resist
peeling and chipping. Nail polish consists of pigments
suspended in a volatile solvent to which film formers have
been added (
Table 1
).
6
Nitrocellulose is the most commonly
employed primary film-forming agent in nail lacquer
because it produces a shiny, tough film that adheres well to
the nail plate. The film is oxygen permeable, which is felt to
be important to nail plate health. This is the advantage of
using nail polish to camouflage nail discoloration, instead of
artificial nail prostheses, which are oxygen impermeable. As
a result, nail polish places an inert protective coating on the
nail plate that does not produce damage.
A secondary film-forming resin must be added, however,
to make the nail polish flexible; otherwise, it would crack
with movement of the nail plate. The main resin used to
enhance the nitrocellulose film is toluene sulfonamide
formaldehyde; however, this resin is allergenic and found
on the standard dermatology patch test tray. Nail polishes
labeled
should not use this resin. The resin
has been eliminated in some hypoallergenic nail enamels and
replaced with a polyester resin or cellulose acetate butyrate,
but sensitivity is still possible, and the enamel is less resistant
to wear, meaning it is readily removed from the nail plate
with friction.
7
Nail lacquers also contain other ingredients, including
plasticizers such as dibutyl phthalate and dioctyl phthalate,
which function to keep the product soft and pliable in the
bottle. These controversial ingredients were mentioned
previously. Even though they are felt to be safe, some states,
such as California, are considering disallowing products with
these ingredients for sale.
All of the ingredients discussed are then dissolved in a
solvent, such as N-butyl acetate or ethyl acetate, leaving a
colored film on the nail plate. Toluene or isopropyl alcohol
“
hypoallergenic
”
Table 2 Nail polish application technique
Step Product
Aims
1
Base Coat Clear polish designed to seal nail plate with
a thin coat of film former
2
Nail
Enamel
Pigmented polish producing an opaque
film to camouflage underlying discolored
nail plate
3
Top Coat
Thin clear polish containing sunscreen to
prevent polish color fading, add high shine,
and prevent removal of nail enamel
4
Nail Polish
Drier
Liquid that speeds drying of the nail polish
by encouraging evaporation of the solvent
Cosmetic treatment of nails
575
completed nails to induce rapid hardening of the enamel by
drawing off the nail-polish solvent.
For those who are unable to hold a brush or do not have
a steady hand, press-on nail polish is available. This
product is much like nail decals, where sheets of stickers
with colors and textures are sold with adhesive on the
backside. The sticker is peeled from the sheet and pressed
over the native nail plate. Excess decal is trimmed away to
shape the plastic to the size and shape of the nail plate.
These stickers do not require drying and can be used by
those with hand disabilities, who otherwise would not be
able to paint their nails.
Nail polish is a relatively safe cosmetic and is used by
persons of all ages and pregnant females. Two nail-polish
problems are worth discussing: allergic contact dermatitis
and nail plate staining. Patients with proximal nail fold
erythema and edema, fingertip tenderness and swelling, and/
or eyelid dermatitis should be evaluated for allergic contact
dermatitis to nail products.
9
The most common cause of
allergic contact dermatitis of this type is nail-polish allergy.
The North American Contact Dermatitis Group determined
that 4% of positive patch tests were due to toluene-
sulfonamide-formaldehyde resin used in nail polish, as
discussed previously. Patients who are allergic to the
toluene-sulfonamide-formaldehyde resin should consider
using hypoallergenic nail polish containing the alternative
polyester resins, which are less allergenic.
10
Even though the
allergic reaction is most commonly due to wet nail enamel,
one study found 11 out of 59 patients who were patch-test
positive to wet polish also reacted to the dried enamel.
11
Patch testing to verify allergy to toluene-sulfonamide-
formaldehyde resin can be performed using the standard
patch test tray or the patient's bottle of nail polish.
12
Nail
polish can be tested as is but should be allowed to dry
thoroughly as the volatile solvent can cause an irritant
reaction if not allowed to evaporate rapidly. The toluene-
sulfonamide-formaldehyde resin can also be tested alone in
10% petrolatum.
13
Patients who are allergic to this resin
should select hypoallergenic nail polishes.
14
In addition, certain colors of nail polish can stain the nail
plate. The nail staining occurs when the polish pigment is
dissolved rather than suspended. It is most common with
deep red nail polishes containing D&C Reds No. 6, 7, 34, or
5 Lake.
15
The nail plate will be stained yellow after 7 days of
continuous wear, but the stain will fade without treatment in
approximately 14 days, once the enamel has been removed.
Scraping of the nail plate with a scalpel blade can be used to
confirm that only the nail surface has been stained, an
important distinction in nail pigmentation abnormalities.
16
pigmented polymer of any color desired. It is applied in three
layers with exposure to UV light to cause polymerization to
occur. This same technology is used in dental prostheses and
also in furniture manufacture. Rarely, allergy can occur to the
unpolymerized materials, but the polymer is nonallergenic
once cured. The biggest challenge with shellacs is the
removal process, which can damage the natural nail plate. In
addition, it is possible that patients on photosensitizing oral
medications, such as tetracycline or doxycycline, may
experience photoonycholysis when exposed to the UV
radiation required to cure the polymer.
17
Fortunately,
shellacs are designed to be worn for 3-4 weeks before
removal is required, which minimizes nail plate injury.
Nail shellacs are gaining in popularity, because the hard
nail film resists chipping, denting, and scratching. It cures
immediately, shortening the drying time originally required
for nitrocellulose-based nail polishes. The shellac also
produces a flawless surface with high shine, also a desirable
trait. Perhaps the biggest challenge is that they are presently
only performed in professional salons, but it is probable that
consumer administered nail shellac may be developed.
Nail extensions
In addition to adorning the nails with transparent or
colored films, nail elongation is also a commonly practiced
cosmetic procedure. A variety of devices for nail elongation
are available for consumer purchase and professional
application. Both are discussed.
Preformed nail prostheses
The original artificial nail was a preformed piece of plastic
that was glued over the natural nail plate with a methacrylate-
based adhesive.
18
This procedure was performed both at
home by the consumer and in professional nail salons. These
nails are still popular today and available in a variety of
styles: precolored, uncolored, precut, and uncut. Preformed
nails come in press-on, preglued forms and in forms
requiring glue application, but the nails usually pop off
before onycholysis can occur with trauma. The nails also
come in a variety of sizes and shapes to match the patient's
natural nail plate.
19
Even with the variety available, most
patients do not find a suitable preformed nail, accounting for
the increasing popularity of custom-made nail prostheses
discussed next.
Custom nail prostheses
Custom-made nail prostheses are known as sculptured
nails, an increasingly popular method of obtaining long, hard
nails. The word
is used since the custom-made
artificial nail is sculpted on a template attached to the natural
nail plate. The sculpted nail fits perfectly and, if well done,
can be hard to differentiate from a natural nail. These
sculptured nails are the most common cosmetic cause of
onycholysis in women who present to a dermatologist.
“
sculptured
”
Nail shellacs
The newest technique for temporarily coloring the nails is
nail shellac, which is based on the same technology used for
gel nail extensions. The shellac can be a transparent or
576
Z.D. Draelos
or damage. If necessary, the sculptured nails can be
removed by soaking in acetone.
Damage to the natural nail plate still occurs with nail
sculpture use, even if the individual is conscientious. After 2
to 4 months of wear, the natural nail plate becomes yellowed,
dry, and thin. Most nail salon operators prefer to allow the
patient's natural nail to grow and act as a support for the
sculpture; however, the nails become thin, bendable, and
weak. For this reason, it is not advisable to wear sculptured
nails for more than 3 months consecutively, with a month of
rest between applications.
Table 3
Sculptured nail prostheses technique
Step # Procedure
1
All nail polish and oils are removed from the nail.
2
The nail is roughened with a coarse emery board,
pumice stone, or grinding drill to create an optimal
surface for sculpted nail adhesion
3
An antifungal, antibacterial liquid, such as decolorized
iodine, is applied to the entire nail plate to minimize
onychomycosis and paronychia.
4
The loose edges of the cuticle are trimmed, removed, or
pushed back depending on the operator.
5
A flexible template is fit beneath the natural nail plate
upon which the elongated sculpted nail will be built.
Nail sculptures with preformed tips
A less time-consuming and less expensive method to make
custom nail prostheses is to combine custom-made nail
sculptures with preformed artificial tips. This involves applying
the liquid acrylic to the natural nail and embedding a preformed
nail tip at the distal end. This method is at present the most
popular technique for nail elongation. It is much quicker and
less expensive. It also allows the nail technician to make either
short or very long nails to fit the wishes of the consumer.
6
The acrylic is mixed and applied with a paintbrush to
cover the entire natural nail plate and extended onto the
template to the desired nail length. A clear acrylic is
used over the natural nail plate attached to the nail bed
so that the natural pink color shows through. A white
acrylic is used from the nail plate's free edge distally.
7
The nail prosthesis is sanded to a high shine.
8
Nail polish, jewels, decals, decorative metal strips, and
airbrushed designs may be added, depending on the
fashion tastes of the patient.
Problems with nail prostheses
The most common problems with nail prostheses are
allergic contact dermatitis and onycholysis. Allergic contact
dermatitis may occur due to the methacrylates used to create
custom nail prostheses and the methacrylate-based glues used
to attach preformed nail prostheses.
22,23
Even though methyl
methacrylate is no longer used, isobutyl, ethyl, and tetra-
hydrofurfuryl methacrylate are still strong sensitizers.
24,25
It is
important to remember the polymerized, cured acrylic is not
sensitizing, only the liquid methacrylate monomer.
26
Acareful
nail operator, who avoids skin contact with the uncured acrylic,
can avoid sensitizing the patient. Patch testing should be
performed in suspected sensitized individuals with methyl
methacrylate monomer, 10% in olive oil, and methacrylate
acid esters, 1% and 5% in olive oil and petrolatum.
27
Onycholysis may also occur due to the use of nail
prostheses. Onycholysis occurs because the bond between
the artificial nail and the natural nail plate is stronger than the
adhesion between the natural nail and the nail bed. Minor
trauma rips the nail from the nail bed, an injury that cannot be
repaired until new nail growth occurs. Onycholysis can also
occur due to sensitivity to the methacrylate polymer.
28,29
The application technique is summarized in
Table 3
. The
entire process takes 2 hours to create a set of ten fingernails.
Originally, methyl methacrylate was the monomer used to
fashion the nail, but its use has been discontinued due to its
sensitizing potential. Currently, liquid ethyl or isobutyl
methacrylate are utilized as the monomer and mixed with
powdered polymethyl methacrylate polymer. The product is
allowed to polymerize in the presence of a benzoyl peroxide
accelerator, making a formable acrylic, which hardens in 7 to
9 minutes.
20
Usually, hydroquinone, monomethyl ether of
hydroquinone, or pyrogallol are added to slow down
polymerization.
21
The acrylic is then shaped to the length
and fingernail style desired by the patient. The bond formed
between the acrylic and the natural nail plate is extremely
strong, because the nail plate is chemically, and sometimes
physically, etched with a drill to increase the surface area
over which polymerization can occur. It is for this reason that
trauma usually separates the natural nail plate from the nail
bed, causing onycholysis.
Many individuals are not aware that the finished nail
sculptures require more care than natural fingernails. With
continued wear of the sculpture, the acrylic loosens from the
natural nail, especially around the edges. These loose edges
must be clipped and new acrylic applied approximately
every 3 weeks, to prevent development of an environment
for infection. The sculpture grows out with the natural nail
plate and more polymer must be added proximally,
depending on the nail growth rate. This procedure is
known as
References
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problems. Dermatol Ther. 2007;20:54-59.
2. Rich P. Nail Cosmetics. Dermatol Clin. 2006;24:393-399.
3. Draelos ZD. Nail Cosmetic Issues. Dermatol Clin. 2000;18:675-683.
4. Baran R, Schoon D. Nail beauty. J Cosmet Dermatol. 2004;3:167-170.
5. Wimmer EP, Scholssman ML. The History of Nail Polish. Cosmet
Toilet. 1992;107:115-120.
6. Wing HJ. Nail preparations. In: deNavarre MG, ed. The Chemistry and
Manufacture of Cosmetics. Wheaton, Il: Allured Publishing Corpora-
tion; 1988;983-1005.
“
”
Failure to undergo filling every 2 to 3
weeks will result in the creation of a lever arm that
predisposes the natural nail plate to traumatic onycholysis
filling.
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7. Schlossman ML. Nail-enamel resins. Cosmetic Technol. 1979;1:53.
8. Schlossman ML. Nail polish colorants. Cosmet Toil. 1980;95:31.
9. Scher RK. Cosmetics and ancillary preparations for the care of the nails.
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10. Militello G. Contact and primary irritant dermatitis of the nail unit
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11. Tosti A, Guerra L, Vincenzi C, et al. Contact sensitization caused by
toluene sulfonamide-formaldehyde resin in women who use nail
cosmetics. Am J Contact Dermatitis. 1993;4:150-153.
12. Lazzarini R, Duarte I, de Farias DC, et al. Frequency and main sites of
allergic contact dermatitis caused by nail varnish. Dermatitis. 2008;19:
319-322.
13. deGroot AC, Weyland JW, Nater JP. Unwanted effects of cosmetics
and drugs used in dermatology. 3rd ed. New York: Elsevier; 1994;526.
14. Shaw S. A case of contact dermatitis from
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1970;6:521-524.
20. Barnett JM, Scher RK, Taylor SC. Nail cosmetics. Dermatol Clin.
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21. Viola LJ. Fingernail elongators and accessory nail preparations. In:
Balsam MS, Sagarin E, eds. Cosmetics, Science and Technology. 2nd
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22. Mowad CM, Ferringer T. Allergic contact dermatitis from acrylates in
artificial nails. Dermatitis. 2004;15:51-53.
23. Kanerva L, Estlander T. Allergic onycholysis and paronychia caused by
cyanoacrylate nail glue, but not by photobonded methacrylate nails.
Eur J Dermatol. 2000;10:223-225.
24. Marks JG, Bishop ME, Willis WF. Allergic contact dermatitis to
sculptured nails. Arch Dermatol. 1979;115:100.
25. Fisher AA. Cross reactions between methyl methacrylate monomer and
acrylic monomers presently used in acrylic nail preparations. Contact
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26. Fisher AA, Franks A, Glick H. Allergic sensitization of the skin and
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27. Baran R, Dawber RPR. The nail and cosmetics. In: Samman PD, Fenton
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29. Baran R. Nail cosmetics: Allergies and irritation. Am J Clin Dermatol.
2002;3:547-555.
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”
nail
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15. Samman PD. Nail disorders caused by external
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Cosmet Chem. 1977;28:351-356.
16. Daniel CR, Osment LS. Nail pigmentation abnormalities:
their
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17. Fisher AA. Adverse nail reactions and paresthesia from
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’
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zanotowane.pl doc.pisz.pl pdf.pisz.pl hannaeva.xlx.pl
, 573
–
577
31
Cosmetic treatment of nails
Zoe Diana Draelos, MD
⁎
Department of Dermatology, Duke University School of Medicine, Durham, NC 27708
Abstract Nail cosmetics are an important part of personal expression. Although their use can result in a
variety of dermatologic issues, the popularity of nail cosmetics is huge. Dermatologists must recognize
problems associated with nail cosmetics and understand the process for using these cosmetics. Many
problems can be avoided through careful use or a change in the application procedure.
© 2013 Elsevier Inc. All rights reserved.
Introduction
Nail polish
The most commonly used nail cosmetic is nail polish.
2
Nail polish is available in clear and all the colors of the
rainbow with special surface effects including glitter, shine,
pearl, and crackle finish. While nail polish is generally
considered safe, some consumer groups have blogged on the
Internet regarding the safety of phthalates, which are found
in almost all nail polishes. Phthalates have been linked to
estrogenic effects on the body, but it is unlikely that nail
polish applied to the nonliving nail plate has much effect, and
the safety of phthalates has not been considered an industry
issue until recently.
Nail polish is an outgrowth of the automobile painting
industry and the adaptation of this technology for cosmetic
purposes gave rise to one of the largest cosmetic companies
still in existence today, Revlon.
3
Nail polish, also known as
nail enamel, is a pigmented coating applied to the nail plate.
4
It was introduced in the 1920s when lacquer technology was
developed in the automobile industry to replace slow-drying
oil-based paints. The basis of nail polish is nitrocellulose,
which is created by reacting cellulose fiber from cotton
linters or wood pulp with nitric acid. The boiled nitrocellu-
lose is dissolved in organic solvents, which evaporate,
leaving a hard, glossy film known as a lacquer.
5
In 1930,
Charles Revson developed the idea of adding pigments to the
Nails are a frequently adorned, yet rather challenging
structure for dermatologic treatment. The results of success-
ful treatment of nail conditions cannot be observed for 3 to 6
months, which is often longer than the patient is willing to
wait. Once the cells of the nail matrix are damaged, repair is
not possible, creating further challenges; yet, attractive nails
are important to many individuals, as they can indicate
gender, occupation, attention to fashion, and hygiene
standards. No other nonliving structure of the body can
say so much about who we are and how we want to be
perceived by others.
While the nail functions primarily to protect the tender
fingertip tissue, the nails have become the focus of body art
through the introduction of both simple and elaborate
cosmetic procedures. This contribution examines the cur-
rently popular nail cosmetics and their effect on the health
of the nail plate and surrounding tissues.
1
The goal is to
survey the dermatologic issues that arise from the use of
these nail cosmetics.
⁎
Corresponding author. Tel.: (336) 841-2040; fax: (336) 841-2044.
E-mail address:
(Z. D. Draelos).
0738-081X/$
–
see front matter © 2013 Elsevier Inc. All rights reserved.
574
Z.D. Draelos
may be added to act as diluents to keep the lacquer thin and
to lower its cost. To this vehicle, a variety of coloring agents
and specialty fillers can be added to determine the final
cosmetic appearance of the nail polish. Coloring agents, such
as organic colors, may be selected from a list of certified
colors approved by the U.S. Food and Drug Administration
(FDA). Inorganic colors and pigments may also be used but
must conform to low heavy-metal content standards.
8
These
colors can be suspended within the lacquer with suspending
agents, such as stearalkonium hectorite, to produce colors
ranging from white to pink to purple to brown to orange to
blue to green.
Decorator nail effects can be created with specialty fillers,
such as guanine fish scale, bismuth oxychloride, or titanium
dioxide-coated mica, to give a frosted appearance, due to
enhanced light reflection. Chopped aluminum, silver, and
gold can be added for a metallic shine. A newer trend is to
artistically decorate the nails on top of the nail polish. Nail
decals composed of plastic with clear glue on one side can be
pressed over the nail polish to create textures and images.
Airbrushing with different nail polish colors can be used to
create flowers, holiday motifs, or any other artistic image
desired to the nail. In addition, rhinestone jewels or metallic
tapes can be affixed for a different fashion statement. Nail
polish is basically a colored canvas for the addition of other
nail decorative arts; the application technique is summarized
in
Table 2
.
Proper nail polish application requires three layers: a base
coat, a pigmented nail enamel, and a top coat (
Table 2
). The
base coat ensures good adhesion to the nail plate and
prevents polish from chipping. It contains no pigment, less
primary film former, more secondary film-former resin, and
a lower viscosity, because a thinner film is desirable. The
second layer is the actual pigmented nail enamel. The top
coat, or third layer, provides gloss and resistance to
chipping. It contains increased amounts of primary film
former, more plasticizer, and less secondary film-forming
resins. Some top coats may contain sunscreen to protect the
nail lacquer but do not contain pigment. Finally, a nail-
polish drier, consisting of vegetable oils, alcohols, and
silicone derivatives, may be brushed or sprayed over the
Table 1 Nail polish ingredients
Type of
Ingredient
Examples of Ingredients
Primary film
former
Nitrocellulose, methacrylate polymers,
vinyl polymers
Secondary film-
forming resin
Formaldehyde, p-toluene sulfonamide,
polyamide, acrylate, alkyd and vinyl resins
Plasticizers
Dibutyl phthalate, dioctyl phthalate, tricresyl
phosphate, camphor
Solvents and
diluents
Acetates, ketones, toluene, xylene, alcohols
Colorants Organic D&C pigments, inorganic pigments
Specialty fillers Guanine fish scale or titanium dioxide-coated
mica flakes or bismuth oxychloride for
iridescence
clear lacquer to form an opaque, colored nail polish; he
founded the cosmetic company Revlon in 1932.
Amazingly, basic nail polish has changed very little since
its first introduction, except for the use of polymers that
increase the flexibility of the film over the nail to resist
peeling and chipping. Nail polish consists of pigments
suspended in a volatile solvent to which film formers have
been added (
Table 1
).
6
Nitrocellulose is the most commonly
employed primary film-forming agent in nail lacquer
because it produces a shiny, tough film that adheres well to
the nail plate. The film is oxygen permeable, which is felt to
be important to nail plate health. This is the advantage of
using nail polish to camouflage nail discoloration, instead of
artificial nail prostheses, which are oxygen impermeable. As
a result, nail polish places an inert protective coating on the
nail plate that does not produce damage.
A secondary film-forming resin must be added, however,
to make the nail polish flexible; otherwise, it would crack
with movement of the nail plate. The main resin used to
enhance the nitrocellulose film is toluene sulfonamide
formaldehyde; however, this resin is allergenic and found
on the standard dermatology patch test tray. Nail polishes
labeled
should not use this resin. The resin
has been eliminated in some hypoallergenic nail enamels and
replaced with a polyester resin or cellulose acetate butyrate,
but sensitivity is still possible, and the enamel is less resistant
to wear, meaning it is readily removed from the nail plate
with friction.
7
Nail lacquers also contain other ingredients, including
plasticizers such as dibutyl phthalate and dioctyl phthalate,
which function to keep the product soft and pliable in the
bottle. These controversial ingredients were mentioned
previously. Even though they are felt to be safe, some states,
such as California, are considering disallowing products with
these ingredients for sale.
All of the ingredients discussed are then dissolved in a
solvent, such as N-butyl acetate or ethyl acetate, leaving a
colored film on the nail plate. Toluene or isopropyl alcohol
“
hypoallergenic
”
Table 2 Nail polish application technique
Step Product
Aims
1
Base Coat Clear polish designed to seal nail plate with
a thin coat of film former
2
Nail
Enamel
Pigmented polish producing an opaque
film to camouflage underlying discolored
nail plate
3
Top Coat
Thin clear polish containing sunscreen to
prevent polish color fading, add high shine,
and prevent removal of nail enamel
4
Nail Polish
Drier
Liquid that speeds drying of the nail polish
by encouraging evaporation of the solvent
Cosmetic treatment of nails
575
completed nails to induce rapid hardening of the enamel by
drawing off the nail-polish solvent.
For those who are unable to hold a brush or do not have
a steady hand, press-on nail polish is available. This
product is much like nail decals, where sheets of stickers
with colors and textures are sold with adhesive on the
backside. The sticker is peeled from the sheet and pressed
over the native nail plate. Excess decal is trimmed away to
shape the plastic to the size and shape of the nail plate.
These stickers do not require drying and can be used by
those with hand disabilities, who otherwise would not be
able to paint their nails.
Nail polish is a relatively safe cosmetic and is used by
persons of all ages and pregnant females. Two nail-polish
problems are worth discussing: allergic contact dermatitis
and nail plate staining. Patients with proximal nail fold
erythema and edema, fingertip tenderness and swelling, and/
or eyelid dermatitis should be evaluated for allergic contact
dermatitis to nail products.
9
The most common cause of
allergic contact dermatitis of this type is nail-polish allergy.
The North American Contact Dermatitis Group determined
that 4% of positive patch tests were due to toluene-
sulfonamide-formaldehyde resin used in nail polish, as
discussed previously. Patients who are allergic to the
toluene-sulfonamide-formaldehyde resin should consider
using hypoallergenic nail polish containing the alternative
polyester resins, which are less allergenic.
10
Even though the
allergic reaction is most commonly due to wet nail enamel,
one study found 11 out of 59 patients who were patch-test
positive to wet polish also reacted to the dried enamel.
11
Patch testing to verify allergy to toluene-sulfonamide-
formaldehyde resin can be performed using the standard
patch test tray or the patient's bottle of nail polish.
12
Nail
polish can be tested as is but should be allowed to dry
thoroughly as the volatile solvent can cause an irritant
reaction if not allowed to evaporate rapidly. The toluene-
sulfonamide-formaldehyde resin can also be tested alone in
10% petrolatum.
13
Patients who are allergic to this resin
should select hypoallergenic nail polishes.
14
In addition, certain colors of nail polish can stain the nail
plate. The nail staining occurs when the polish pigment is
dissolved rather than suspended. It is most common with
deep red nail polishes containing D&C Reds No. 6, 7, 34, or
5 Lake.
15
The nail plate will be stained yellow after 7 days of
continuous wear, but the stain will fade without treatment in
approximately 14 days, once the enamel has been removed.
Scraping of the nail plate with a scalpel blade can be used to
confirm that only the nail surface has been stained, an
important distinction in nail pigmentation abnormalities.
16
pigmented polymer of any color desired. It is applied in three
layers with exposure to UV light to cause polymerization to
occur. This same technology is used in dental prostheses and
also in furniture manufacture. Rarely, allergy can occur to the
unpolymerized materials, but the polymer is nonallergenic
once cured. The biggest challenge with shellacs is the
removal process, which can damage the natural nail plate. In
addition, it is possible that patients on photosensitizing oral
medications, such as tetracycline or doxycycline, may
experience photoonycholysis when exposed to the UV
radiation required to cure the polymer.
17
Fortunately,
shellacs are designed to be worn for 3-4 weeks before
removal is required, which minimizes nail plate injury.
Nail shellacs are gaining in popularity, because the hard
nail film resists chipping, denting, and scratching. It cures
immediately, shortening the drying time originally required
for nitrocellulose-based nail polishes. The shellac also
produces a flawless surface with high shine, also a desirable
trait. Perhaps the biggest challenge is that they are presently
only performed in professional salons, but it is probable that
consumer administered nail shellac may be developed.
Nail extensions
In addition to adorning the nails with transparent or
colored films, nail elongation is also a commonly practiced
cosmetic procedure. A variety of devices for nail elongation
are available for consumer purchase and professional
application. Both are discussed.
Preformed nail prostheses
The original artificial nail was a preformed piece of plastic
that was glued over the natural nail plate with a methacrylate-
based adhesive.
18
This procedure was performed both at
home by the consumer and in professional nail salons. These
nails are still popular today and available in a variety of
styles: precolored, uncolored, precut, and uncut. Preformed
nails come in press-on, preglued forms and in forms
requiring glue application, but the nails usually pop off
before onycholysis can occur with trauma. The nails also
come in a variety of sizes and shapes to match the patient's
natural nail plate.
19
Even with the variety available, most
patients do not find a suitable preformed nail, accounting for
the increasing popularity of custom-made nail prostheses
discussed next.
Custom nail prostheses
Custom-made nail prostheses are known as sculptured
nails, an increasingly popular method of obtaining long, hard
nails. The word
is used since the custom-made
artificial nail is sculpted on a template attached to the natural
nail plate. The sculpted nail fits perfectly and, if well done,
can be hard to differentiate from a natural nail. These
sculptured nails are the most common cosmetic cause of
onycholysis in women who present to a dermatologist.
“
sculptured
”
Nail shellacs
The newest technique for temporarily coloring the nails is
nail shellac, which is based on the same technology used for
gel nail extensions. The shellac can be a transparent or
576
Z.D. Draelos
or damage. If necessary, the sculptured nails can be
removed by soaking in acetone.
Damage to the natural nail plate still occurs with nail
sculpture use, even if the individual is conscientious. After 2
to 4 months of wear, the natural nail plate becomes yellowed,
dry, and thin. Most nail salon operators prefer to allow the
patient's natural nail to grow and act as a support for the
sculpture; however, the nails become thin, bendable, and
weak. For this reason, it is not advisable to wear sculptured
nails for more than 3 months consecutively, with a month of
rest between applications.
Table 3
Sculptured nail prostheses technique
Step # Procedure
1
All nail polish and oils are removed from the nail.
2
The nail is roughened with a coarse emery board,
pumice stone, or grinding drill to create an optimal
surface for sculpted nail adhesion
3
An antifungal, antibacterial liquid, such as decolorized
iodine, is applied to the entire nail plate to minimize
onychomycosis and paronychia.
4
The loose edges of the cuticle are trimmed, removed, or
pushed back depending on the operator.
5
A flexible template is fit beneath the natural nail plate
upon which the elongated sculpted nail will be built.
Nail sculptures with preformed tips
A less time-consuming and less expensive method to make
custom nail prostheses is to combine custom-made nail
sculptures with preformed artificial tips. This involves applying
the liquid acrylic to the natural nail and embedding a preformed
nail tip at the distal end. This method is at present the most
popular technique for nail elongation. It is much quicker and
less expensive. It also allows the nail technician to make either
short or very long nails to fit the wishes of the consumer.
6
The acrylic is mixed and applied with a paintbrush to
cover the entire natural nail plate and extended onto the
template to the desired nail length. A clear acrylic is
used over the natural nail plate attached to the nail bed
so that the natural pink color shows through. A white
acrylic is used from the nail plate's free edge distally.
7
The nail prosthesis is sanded to a high shine.
8
Nail polish, jewels, decals, decorative metal strips, and
airbrushed designs may be added, depending on the
fashion tastes of the patient.
Problems with nail prostheses
The most common problems with nail prostheses are
allergic contact dermatitis and onycholysis. Allergic contact
dermatitis may occur due to the methacrylates used to create
custom nail prostheses and the methacrylate-based glues used
to attach preformed nail prostheses.
22,23
Even though methyl
methacrylate is no longer used, isobutyl, ethyl, and tetra-
hydrofurfuryl methacrylate are still strong sensitizers.
24,25
It is
important to remember the polymerized, cured acrylic is not
sensitizing, only the liquid methacrylate monomer.
26
Acareful
nail operator, who avoids skin contact with the uncured acrylic,
can avoid sensitizing the patient. Patch testing should be
performed in suspected sensitized individuals with methyl
methacrylate monomer, 10% in olive oil, and methacrylate
acid esters, 1% and 5% in olive oil and petrolatum.
27
Onycholysis may also occur due to the use of nail
prostheses. Onycholysis occurs because the bond between
the artificial nail and the natural nail plate is stronger than the
adhesion between the natural nail and the nail bed. Minor
trauma rips the nail from the nail bed, an injury that cannot be
repaired until new nail growth occurs. Onycholysis can also
occur due to sensitivity to the methacrylate polymer.
28,29
The application technique is summarized in
Table 3
. The
entire process takes 2 hours to create a set of ten fingernails.
Originally, methyl methacrylate was the monomer used to
fashion the nail, but its use has been discontinued due to its
sensitizing potential. Currently, liquid ethyl or isobutyl
methacrylate are utilized as the monomer and mixed with
powdered polymethyl methacrylate polymer. The product is
allowed to polymerize in the presence of a benzoyl peroxide
accelerator, making a formable acrylic, which hardens in 7 to
9 minutes.
20
Usually, hydroquinone, monomethyl ether of
hydroquinone, or pyrogallol are added to slow down
polymerization.
21
The acrylic is then shaped to the length
and fingernail style desired by the patient. The bond formed
between the acrylic and the natural nail plate is extremely
strong, because the nail plate is chemically, and sometimes
physically, etched with a drill to increase the surface area
over which polymerization can occur. It is for this reason that
trauma usually separates the natural nail plate from the nail
bed, causing onycholysis.
Many individuals are not aware that the finished nail
sculptures require more care than natural fingernails. With
continued wear of the sculpture, the acrylic loosens from the
natural nail, especially around the edges. These loose edges
must be clipped and new acrylic applied approximately
every 3 weeks, to prevent development of an environment
for infection. The sculpture grows out with the natural nail
plate and more polymer must be added proximally,
depending on the nail growth rate. This procedure is
known as
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