Case Study: Delayed-Onset Perionychial Dermatitis Following Gel-X Nail Application

Case at a Glance

A 16-year-old female with no known allergies developed a localized, pruritic rash around her fingernails two days after a routine Gel-X manicure. The reaction resolved with topical cream application despite the artificial nails remaining in place, raising questions about a potential new-onset acrylate allergy.

Patient's Story

The patient is a 16-year-old female who has a history of using Gel-X nail applications as a successful method to manage a chronic nail-picking habit. She has consistently visited the same nail technician for this procedure multiple times in the past without any adverse reactions. Two days after her most recent manicure, while traveling overseas, she began experiencing novel symptoms around her nails.

Initial Assessment

The patient described the onset of swelling in her cuticles and the appearance of small, papular bumps on the skin surrounding the nail plates. The reaction was accompanied by mild pruritus on several, but not all, fingers and a tingling sensation. She denied any systemic symptoms. The patient has no personal history of allergies, but notes a paternal history of eczema. Physical examination via a provided image revealed mild erythema and edema of the proximal and lateral nail folds, consistent with perionychial inflammation.

The Diagnostic Journey

Due to her travel circumstances, the patient was unable to seek professional medical care or have the nails removed. Four days after the symptoms began, she applied a topical allergy cream (presumed to be a low-potency corticosteroid) obtained from a friend. The symptoms began to subside within a couple of days of application and resolved completely, even though the Gel-X nails were not removed. The primary differential diagnosis was allergic contact dermatitis (ACD) versus irritant contact dermatitis (ICD). The delayed onset of two days is highly characteristic of a Type IV hypersensitivity reaction, favoring a diagnosis of ACD, likely to an acrylate or methacrylate monomer in the gel product. It is possible the patient developed a new sensitization, or that a slight variation in the product or application technique led to increased skin exposure to an uncured monomer during this specific visit. The resolution of symptoms while the cured nails remained suggests the reaction was to transient contact with the uncured product, which was subsequently removed or degraded.

Final Diagnosis

Probable Allergic Contact Dermatitis (ACD) to an acrylate monomer in the Gel-X nail product.

Treatment Plan

The acute episode resolved with the application of a topical anti-inflammatory cream. The patient was advised to avoid all gel and acrylic nail products until a definitive diagnosis could be made. A referral to a dermatologist for patch testing to a standard acrylate series was recommended to identify the specific causative allergen(s). She was also counseled on the importance of strict avoidance, as repeated exposure can lead to more severe reactions.

Outcome and Follow-up

The patient's skin returned to baseline without scarring or long-term sequelae. She expressed concern over losing a tool that was effective for her nail-picking habit. The plan for dermatological follow-up and patch testing was emphasized to provide clarity on future cosmetic options and prevent recurrence. The patient was educated that developing new allergies to previously tolerated substances is a well-documented phenomenon.