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The Dangers That Lurk in Nail Salons
The nail and hair salon industry is rapidly growing, with over 50,000 salons nationwide offering services valued at $6.4 billion annually. Many consumers patronize nail salons unaware of the risks to which they are exposing themselves. Recent findings in medical studies are calling attention to these risks and may make nail salon patrons think twice before their next pedicure, nail wrap or hair clipping.

In a recent investigation by the Center for Disease Control and Prevention, Atlanta, Georgia, 110 individuals in Northern California were identified, all of whom developed furuncles, or boils, on their legs after receiving pedicures and whirlpool footbaths at the same nail salon. These cases, initially brought to public attention by local dermatologists, involved boils unresponsive to traditional antibiotic therapy, resulting in ulcers and scars in some cases. All cases resulted from exposure to the throne footbath during pedicure.

How could this have happened? Donít salons clean their throne footbaths between customers? The answer is yes and no.

Most salons sanitize by rinsing the baths with benzyl alconium chloride or other cleansers that are ineffectual in eradicating organisms such as mycobacterium, certain fungi, yeast, and bacterial contaminants. Laboratory cultures at 10 throne footbaths in Northern California revealed contamination with a rapidly growing organism related to tuberculosis called Mycobacterium fortuitum.

Many people have their cuticles or calluses cut without giving it a second thought. It is not rare for an aesthetician to draw blood during one of these procedures. This practice is dangerous and tantamount to performing skin surgery without sterile equipment. A recent study shows that yeast and several disease-causing bacteria are commonly present on nail salon instruments. Studies further suggest that solutions used to sanitize multi-use razors and nail clippers at nail salons and barbershops are ineffective at killing hepatitis C virus.

Whether all these organisms can and do cause disease is the important question. Several reports of digital infections requiring antibiotic therapy after a manicure or pedicure suggest the risk is real. Furthermore, cases of bone infection (osteomyelitis) linked with manicures/pedicures that have resulted in amputation of a digit support our suspicion of medical hazards.

Another area of risk in nail salons was brought out in a recent study of the relationship between spontaneous abortions and working in a salon during pregnancy. In a large study of over 8000 female cosmetologists, age 22-36 years, an association was found between spontaneous abortion and the number of hours worked per day in cosmetology, the number of chemical services performed per week, the use of formaldehyde-based disinfectants, and work in salons where nail sculpturing was performed by other employees. The good news was that no important associations were found among cosmetologists who worked less than 35 hours per week, suggesting that the risk to salon patrons, while undefined, is probably relatively low.

Nail salon employees run the risk of exposure to organic solvent vapors (i.e. toluene, acetone, formaldehyde) and methacrylate dusts, both known to have neurotoxic properties. Throat, nose and skin irritation have been reported. One study found mild problems in cognition, memory and learning associated with occupational exposure, as compared to controls. Methacrylate allergies are also relatively common, resulting in itchy rashes that can affect more than just hands, sometimes of such severity and progression as to require a vocational change.

If these dangers are so real, why donít we hear more about them? We can only guess that a combination of circumstances contributes to the lack of information on the topic. A lack of awareness by the medical establishment and difficulty tracking and quantifying problems likely play a role in our state of ignorance. Obviously, it would not be in the salon industryís best interest to advertise these risks.

These issues need to be addressed on a national level, educating those in the field on how to decrease risks. Legislation is needed to ensure that all salon practitioners are licensed and meet some uniform minimum disinfection criteria.

As a salon patron, what can you do to protect yourself from these dangers? While requirements for licensing vary from state to state, with some states not even requiring a license at all, you should check that your salon is licensed. Before returning to your salon, acquire your own nail instruments and hair razors.

Whirlpool baths in hospitals are required to run a 10-minute disinfection cycle between patients and have their filters changed weekly, if not daily. In many salons, the baths are merely wiped down with a cleaner between patrons and the filters are never changed. Until these issues are addressed, it is advisable that one avoids using throne footbaths. A warm water basin that can be properly cleaned is preferable for foot soaks. However, if you absolutely must have your throne, an important measure is to avoid shaving legs for 3 days before throne footbath immersion, as this has been identified as a major risk factor.

Patrons should also question salon technicians about hygiene and disinfection procedures. Ideally, salons should acquire autoclaves, and sterilize equipment as is done in hospitals and physicianís offices. However, this is rarely the case. Instruments should be disinfected by complete immersion for at least 10 minutes in a Food and Drug Administration-approved high-level disinfectant like 2% gluteraldehyde and an Environmental Protection Agency-registered tuberculocidal disinfectant. The equipment should be rinsed, dried, and stored in a clean dry container. If instruments are left soaking in a tub that is constantly filled with newly used equipment, this should signal a red flag that hygiene practices in this salon are inadequate. Patrons should realize that hepatitis C is not necessarily killed by any of these practices.

The nail cuticle functions to protect the finger from infection and should not be cut. Similarly, cutting calluses is skin surgery and the beauty parlor is not the place for this practice. Manicurists working with open wounds on their hands, or a policy where they are willing to work on customers with open wounds is a red flag that hygiene is inadequate.

Finally, good air ventilation is another important health consideration in salons, especially in light of spontaneous abortions and neurotoxin side effects. Salons where cosmeticians are wearing masks should be avoided as they likely are using cheaper and more neurotoxic nail wraps.

Bearing these considerations in mind, nail salon regulars should proceed with a cautious awareness that they may be living dangerously.

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"The Dangers That Lurk in Nail Salons"
   authored by:
Eve Lowenstein, MD, PhD, is Assistant Professor in the Department of Dermatology for SUNY Health Science Center at Brooklyn, where she supervises residents in training. Dr. Lowenstein is also an associate of South Nassau Dermatology PC in Oceanside a...

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