synthetic fingernails result in full thickness burn and terminalisation

Annals of Burns and Fire Disasters - vol. XXIX - n. 2 - June 2016
BEWARE FLAMMABLE FINGERNAILS. CASE REPORT:
SYNTHETIC FINGERNAILS RESULT IN FULL THICKNESS
BURN AND TERMINALISATION
ATTENTION AUX ONGLES FACTICES EN ACRYLIQUE. CAS CLINIQUE:
BRÛLURE PROFONDE DU POUCE AYANT NÉCESSITÉ UNE AMPUTATION
Arnaout A.,* Cubitt J., Nguyen D.
The Welsh Burns and Plastics Centre, Morriston Hospital, Swansea, Wales
SUMMARY. Having long artificial (acrylic) nails is a current fashion trend, and they are becoming an increasingly popular cosmetic enhancement. We believe that they can be a potential burn hazard to their unknowing users. We present the first reported case in medical literature of a woman whose acrylic nail ignited from a cigarette butt a short distance from the nail while she was taking the final puffs. She
sustained a full thickness burn to her dominant left thumb, resulting in terminalisation. Acrylic nails are very flammable and, once ignited,
they burn to completion, with the source of flame removed. The temperature at the end of a cigarette can reach 900oC when the smoker
takes a puff, which would explain how the artificial nail in our case study ignited. The flammability hazard of artificial fingernails is apparently well known in the beautician community. There are multiple beauty websites and blogs raising awareness of the danger of synthetic
nails catching fire. We feel this potential risk should be further highlighted to the public.
Keywords: acrylic, synthetic nails, methyl-cyanoacrylates, flammable, nail glue, nail adhesive
RÉSUMÉ. Le port d’ongles factices en acrylique est un artifice cosmétique à la mode actuellement. Nous pensons que ses utilisateurs
ignorent leur danger potentiel. Nous présentons le premier cas de brûlure à cause de ces dispositifs. Il s’agit d’une patiente dont le faux
ongle en acrylique a pris feu alors qu’elle tirait les dernières bouffées de sa cigarette, dont l’extrémité enflammée était donc très proche
de ses ongles. Il en est résulté une brûlure profonde du pouce gauche (main dominante) ayant nécessité une amputation. Les ongles acryliques sont hautement inflammables, la combustion étant complète même quand a source de chaleur a été retirée. La température de 900°C
atteinte à l’extrémité d’une cigarette quand le sujet tire une bouffée peut expliquer la mise à feu de l’acrylique. L’inflammabilité des ongles
acrylique semble bien connue dans le monde de la cosmétique, puisque l’on trouve de nombreux avertissements à ce sujet sur les sites et
blogs dédiés. Ce risque devrait être mieux transmis au grand public.
Mots-clés: acrylique, ongles factices, colle métyl-cyanoacrylate, inflammation
Introduction
Long artificial (acrylic) nails are a current fashion trend, and
are becoming an increasingly popular cosmetic enhancement.
We believe that they can be a potential burn hazard to their
unknowing users. We present a case report of a significant
flame burn from an acrylic (ethyl and methyl-cyanoacrylates)
nail, and discuss our review of the available literature regarding
the flammability of artificial nails and the adhesive glue used
to apply them.
Case study
A 64-year-old woman had acrylic nails applied at a beauty
salon, five weeks prior to presenting to the Welsh Burns Centre
with full thickness burn to the dorsal side of her thumb. The
burn extended from the dorsal tip to the distal intrapharyngeal
joint (Fig. 1).
*
Fig. 1 - View of full thickness burn dorsal, left thumb - pre-operative (left).
Overall view of the left hand with visible burn on left dorsal thumb preoperative (right).
Corresponding author: Ali Arnaout, The Welsh Burns and Plastics Centre, Morriston Hospital, Swansea SA6 6NL, Wales. Email: [email protected]
Manuscript: submitted 25/02/2016, accepted 15/04/2016.
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Annals of Burns and Fire Disasters - vol. XXIX - n. 2 - June 2016
She had been smoking a cigarette with her left dominant
hand. Whilst taking the final puffs, the acrylic nail on her
thumb suddenly caught fire. The patient extinguished the flame
with a damp cloth. With no further first aid, she then presented
to A&E the following day, and was referred to our Burns Centre with a full thickness burn on her left dominant thumb.
The burn was managed conservatively to allow it to demarcate. The patient was discharged home with a follow up
appointment two weeks after the accident, allowing us to determine the level of terminalisation to provide her with the best
functional outcome. During surgery, the necrotic distal phalanx
debrided back to healthy bone. The distal intrapharyngeal joint
was preserved and the tip was reconstructed with a volar-based
flap (Fig. 2).
Discussion
As synthetic fingernails become increasingly popular,
burns units might see a rising number of patients presenting
with similar burns to our patient’s. To the best of our knowledge, there have not been any reported cases in medical literature of the acrylic or gel element in a synthetic nail resulting
in a flame burn.
An experimental study conducted by Vanover et al.1 at
Lamar University tested the flammability of various synthetic
fingernails using the flame of a common birthday candle and
a Bunsen burner.
The temperature of a candle flame ranges from 800-1400oC
depending on the flame colour,2 while the temperature of a cigarette can reach 900oC during a puff and fall to about 400oC between puffs.3,4 Vanover et al1 report that the average ignition
time was 1.1s, with 58% igniting in 1 second or less when using
a candle flame, while with an average of 0.8s, 87% ignited in 1
second or less when using higher temperature flames from a
Bunsen burner. Once ignited, with the source of flame removed,
the nails burned to completion. The study also suggested that
once ignited, the nails are not easily extinguished.
The temperature of a cigarette when puffed is comparable
to the lower end temperature spectrum of a candle flame, which
would explain how the artificial nail in our case study ignited;
when the patient was taking the final puffs on the cigarette, the
butt was at a short distance from her acrylic nail, allowing
enough time for it to ignite and result in the burn.
We do not believe that the public understands how flam-
BIBLIOGRAPHY
1. Vanover WG, Woods JL, Allin SB: Synthetic Fingernails as a Fire
Hazard in the Chemistry Laboratory, J Chem Educ, 76 (11): 1521,
1999.
2. Fisher, J: Temperature of a Candle Flame. In: Elert G (ed): “The Physics
Factbook”, 1999. Available from http://hypertextbook.com/facts/1999/
JaneFishler.shtml.
3. Guerin MR, Brunnemann KD, Dodet B, Hoffmann D: Formation and
physiochemical nature of sidestream smoke. Environmental Carcinogens: Methods of Analysis and Exposure Measurement. IARC Scientific Publications, 9 (81): 11-23, 1987.
4. United States Public Health Service. Office of the Surgeon General.
How tobacco smoke causes disease: the biology and behavioral basis
for smoking-attributable disease: a report of the Surgeon General.
Washington, DC. xv, 704 p, 2010.
Fig. 2 - View of the post-operative left thumb reconstructed with a volarbased flap (left).
Overall view of the post-operative hand post reconstruction (right).
mable synthetic fingernails are, even from lower flame temperatures such as candles: an accident could result in a burn
with devastating outcome, leading to terminalisation of the affected digit - in our case a vital dominant thumb - which may
impair overall hand function.
There are several case studies5-7 that report significant burns
resulting from spillage of nail glue adhesive (cyanoacrylatebased) onto cotton clothes; four presented with full thickness
burns on their thighs,6,7 and one with superficial dermal burn on
the abdomen.5 There is a known reaction between cyanoacrylate
[CH2=C(CN)CO2R] monomer found in nail glue adhesive and
the hydroxyl [-OH] found in cotton or wool that could cause a
thermal burn when in direct contact with the skin.6
The flammability hazard of artificial fingernails is apparently well known in the beautician community. There are multiple beauty websites and blogs raising awareness of the
potential risk of synthetic nails catching fire.8,9 A South Carolina USA news website, wistv.com, reported a news piece
where a woman’s acrylic nail caught fire whilst lighting a candle in church in 2002.10
We feel this hazard should be further publicized, especially
to clients in beauty salons, through official medium in the form
of a warning label or a supplementary leaflet, with the potential
risk highlighted to the public.
5. Belanger RE, Marcotte ME, Begin F: Burns and beauty nails. Paediatr
Child Health, 18 (3): 125-6, 2013.
6. Kelemen N, Karagerou E, Jones S, Morritt A: Is artificial nail application safe for adolescent children? Annals of Burns and Fire Disasters,
XXVIII, 2015.
7. Tang CL et al.: Vanity burns: an unusual case of chemical burn caused
by nail glue. Burns, 32 (6): 776-7, 2006.
8. DeMiers C: What You Should Know About The Dangers Of Wearing
Acrylic Nails. Available from: http://www.naturalalternativeremedy.
com/dangers-wearing-acrylic-nails/. Accessed 13/08/2015.
9. Warning Gel Nails Highly Flammable!!! [16/04/2008] Available from:
http://fab5idaho.blogspot.co.uk/2008/04/warning-gel-nails-highlyflamable.html. Accessed 13/08/15.
10. Edwards D: Buyer Beware: flammable fingernails. [26/11/2002] Available from: http://www.wistv.com/story/1028703/buyer-beware-flammable-fingernails. Accessed 13/08/15.
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