TY - JOUR
AU - Cubitt, Jonathan, J
AB - Abstract Nail glues are routinely used for the application of false nails and are readily available for unrestricted purchase from highstreet and online retailers. We present the case of a young lady who accidentally spilled her nail glue on to her cotton pajama trouser leg setting off a violent exothermic reaction that resulted in a full-thickness burn injury to her foot. She ultimately went on to require surgical debridement and skin grafting. We intend to remind both healthcare workers and members of the public that while nail glue alone in contact with the skin is relatively harmless, contact together with natural fibers such as cotton clothing produces a dangerous chemical reaction, which is too often underestimated and can lead to serious burn injuries. Our patient and the surgical team agree that more must be done to raise awareness of the risks these products pose, and retailers must ensure consumers are responsibly informed. Fast-acting adhesives for false nail applications commonly contain cyanoacrylate monomers that polymerize in the presence of hydroxide ions, eg, water. Cotton is mainly cellulose, a plant polysaccharide, that has many hydroxyl (-OH) groups. When the two come in to contact, there is a rapid polymerizing exothermic reaction where the glue cures faster and hotter. In a case series by Kelemen et al,1 the exothermic reaction between nail glue and cotton leggings was examined, and an average temperature of 68°c was recorded over a duration of 12.2 seconds. CASE REPORT We present this case of a full-thickness burn to the left foot of a 23-year-old female seen 3 days after she accidentally spilled her nail glue on to her cotton pajama trouser leg while applying false nails (Figure 1). The cotton material quickly became adherent to the skin potentiating a thermal burn injury, secondary to an exothermic chemical interaction. Figure 1. Open in new tabDownload slide Nail adhesive product. Cyanoacrylate (sold by Primark®, manufactured in China). Figure 1. Open in new tabDownload slide Nail adhesive product. Cyanoacrylate (sold by Primark®, manufactured in China). Our patient carried out appropriate first aid, cooling the area with water and trying to remove any adherent clothing. She tried using acetone nail polish remover to lift away the glue. She suffered a deep burn to the anterior aspect of her left ankle and dorsum of her left foot (Figure 2) that did not heal readily with dressings, and 2 weeks following the injury, she required skin grafting. Postoperatively she recovered well and was completely healed 10 days later, 30 days since the burn (Figure 3). Figure 2. Open in new tabDownload slide Full-thickness burn to left ankle and dorsum of foot, day of injury. Figure 2. Open in new tabDownload slide Full-thickness burn to left ankle and dorsum of foot, day of injury. Figure 3. Open in new tabDownload slide Healed split-thickness skin graft, 3 months postoperation. Figure 3. Open in new tabDownload slide Healed split-thickness skin graft, 3 months postoperation. DISCUSSION This mechanism of burn has been described before, indeed in a case series published by Coles et al,2 they described 3 cases of nail glue spilling on to clothing causing burn injuries. Interestingly they also presented a case involving direct contact of nail glue to bare skin only, which did not result in a burn. While solvents are effective for removing cyanoacrylate, they can cause chemical irritation to burnt skin, and we would recommend avoiding it in this scenario. Application of mineral oil, such as baby oil or vegetable oil, has been proven to help lubricate the cyanoacrylate resin off the skin surface.3,4 We include our patient’s perspective as follows with her intention to raise awareness: The reaction of the glue was instantaneous. There was absolutely no time to get the clothes away from my skin. There are warnings on the back of the packaging, but I don’t think they reflect the severity of the damage this product can cause. The glue hardened so quickly I couldn’t safely remove the clothes, and soapy water did not help at all. The manufacturer suggests this product is suitable for those aged from 12 years old, which I think is also a serious concern. This presentation raises the question of whether retailers are adequately warning consumers of the risks specific to nail glues coming in contact with skin and cotton clothing. Packaging labels are now mentioning the risk of skin burns, but it may not be conveying the severity as seen in this case. Is it responsible to market and sell these products to children under the age of 16 years? CONCLUSION It is widely recognized that cyanoacrylate glues can cause localized irritation on direct skin contact. Toileting and safely removing the glue is often advised on the product’s warning label. The specific combination of glue and natural fiber clothing adhering to skin and causing burn injuries is poorly publicized. As demonstrated in this report, significant full-thickness burns can be sustained as a result. Should manufacturers or retailers of these cosmetic adhesives do more to raise awareness? Consumers must be cautioned and carry out proper first aid as they would for any other thermal injury. Healthcare providers must be aware of this injury mechanism, recognize the immediate and delayed presentations, manage and refer to their local burns service as appropriate. REFERENCES 1. Kelemen N , Karagergou E, Jones SL, Morritt AN. Full thickness burns caused by cyanoacrylate nail glue: A case series . Burns 2016 ; 42 : e51 – 4 . Google Scholar Crossref Search ADS PubMed WorldCat 2. Coles C , Javed MU, Hemington Gorse S, Nguyen D. Paediatric burns secondary to nail adhesives: a case series . Burns Trauma 2016 ; 4 : 17 . Google Scholar Crossref Search ADS PubMed WorldCat 3. Bélanger RE , Marcotte ME, Bégin F. Burns and beauty nails . Paediatr Child Health 2013 ; 18 : 125 – 6 . Google Scholar Crossref Search ADS PubMed WorldCat 4. Toxbase . Superglue (Cyanoacrylate glues (excluding tissue adhesives)) [Toxbase web site]; available from www.toxbase.org; accessed 30 April 2020 . © The Author(s) 2020. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Cyanoacrylate Nail Glue and the Pajama Catalyst
JF - Journal of Burn Care & Research
DO - 10.1093/jbcr/iraa131
DA - 2020-11-30
UR - https://www.deepdyve.com/lp/oxford-university-press/cyanoacrylate-nail-glue-and-the-pajama-catalyst-0GQNy5HV7F
SP - 1306
EP - 1308
VL - 41
IS - 6
DP - DeepDyve
ER -