A Nice, Healthy Manicure

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What could be more fun than getting your nails done? Manicures and pedicures are big business these days, appealing to those who seek a little luxury and some personal pampering. In 1997 alone, U.S. consumers spent over $6 billion on nail services. However, this pleasurable activity is not without risk. No matter how much nail polish you put on, you can't cover up the fact that it can bring along with it some unwanted and unhealthy consequences. Nothing to get paranoid about but something to keep in mind.

One common health effect is an allergic reaction. People commonly react to either the methacrylate (MMA) compounds found in acrylic nails, formaldehyde found in nail hardeners, or toluene sulfonamide formaldehyde resin found in nail laquers. Allergic reactions can result in the loss of cuticles and also brittle nails, which may be painful and annoying, but it does not pose a serious threat to your health.

However, the possibility of infection from the tools and equipment provided by the salon, if not properly sanitized, is a serious health threat. Recently, an outbreak of mycobacterial infections is northern California was reported in the New England Journal of Medicine (May 2002). The common factor amongst the 110 infected individuals: they all had received footbaths and pedicures at one particular nail salon. Bacterial infections are no laughing matter. If the skin around your nail becomes red or inflamed, if your nail lifts away from the nail bed, or if the nail becomes black or green, you could have an infection. One of the most serious types is mycobacterium smegmatis, which quickly replicates, does not respond well to antibiotics, and can leave ugly scars.

But bacterial and fungal infections may not be the only types of infections transmitted by unsanitary nail salon conditions. Viral infections such as herpes can be passed along. In May, a Colorado woman was awarded over $3.1 million because she contracted herpes through the use of non-sterile manicuring tools. (The size of the award was due in part to her less plausible claim that the herpes infection ran down her immune system and made her increasingly prone to illness. It was her first professional manicure ever, and probably her last.)

However, the good news for the millions of people who seek out nail services is that only a small number actually experience serious health problems. Cases such as the Colorado woman's are few and far between. The slight possibility of infection from manicures and pedicures does not mean that you should never get your nails done again. We must remember that a lot of things in life are risky: eating out, driving automobiles, riding bicycles, even crossing a street.

While there is no sure-fire way to eliminate the risk associated with manicures and pedicures, there are a number of actions you can take to reduce your risk for infection.

First, be aware of your surroundings. Are you getting a manicure in a licensed establishment by a licensed manicurist? How clean is the establishment? Manicurists' tables should be cleaned between clients. Manicurists should wash their hands before and after each manicure.

Second, if possible, note how clean the tools are and how they are disinfected. Alcohol is not an effective sterilizer, and to kill infection tools should be submerged for ten minutes in Barbicide or a similar product before being used. If the Barbicide is at all cloudy, then it is not effectively sterilizing the equipment and should be replaced. If a tool is dropped on the floor, it should subsequently be cleaned. Manicurists should never share equipment and should make sure to disinfect their tools between clients. Also, nail buffers, emery boards, and toe separators should never be used twice a nail buffer used to rid a fungus from one individual can easily spread to the nails of others if used again.

The greatest precautionary measure one could use to decrease his or her chance of infection is to bring along a personal manicure/pedicure set to the salon. And never allow the manicurist to trim your cuticles they serve the purpose of keeping bacteria out of the nail bed, so you are actually increasing your risk for infection if they are at all cut or clipped.

Be wary, be vocal, but also try to have some fun. While there are some risks involved, don't let it ruin what can easily be a very enjoyable and safe experience.

Karen Schneider is a research intern at the American Council on Science and Health.

Responses:

August 21, 2002

I would like to comment on the article by Karen Schneider. Although alcohol is not an effective sterilizer, neither is Barbicide. Both are disinfectants. Studies have shown that 70% isopropyl alcohol is a very effective intermediate level disinfectant (it is tuberculocidial), whereas Barbicide is only a low level disinfectant and should not be used on semi-critical instruments. All instruments require thorough washing before immersion in any disinfectant.

I have thoroughly researched and consulted the top specialists in the area of disinfectants for Toronto Public Health's Personal Services Settings Protocol, and I have written the portion on disinfectants for the Ministry of Health and Long-Term Care Protocol.

Sincerely,

Cecilia Alterman
Cecilia N. Alterman, BES, BASc., CPHI(C)
Communicable Disease Investigator
Toronto Public Health, North Region


September 4, 2002

Per Karen's Schneider's article on salon manicures: I have wondered for years about the long-term health impacts (on both clients and staff) of manicures performed in salons in which artificial nail applications comprise a significant part of the business.

The fumes from these chemical processes are intense and have always given me a severe headache. Has there been any research done on potentially serious consequences of spending time in poorly ventilated salons, e.g., respiratory, liver, or central nervous system damage?

A. Burgess
Seattle


November 11, 2002

Karen Schneider didn't mention hepatitis. I thought cold sterilization was completely inadequate to kill these viruses. Is there no concern about this? Or is the incubation period too long to easily make the causal connections?

Also, what about haircuts and the associated tools? Seems they could transmit hepatitis and other infections. Just wondering...

csulli02


Schneider replies:

With the existence of such blood-borne diseases as HIV and hepatitis, which can live outside the body, the beauty industry should be diligently disinfecting and sterilizing their equipment. Highly concentrated HIV (at least 100,000 times greater than typically found in the blood of patients with HIV) has been found to be detectable outside the body after drying for one to three days. However, studies performed by the Centers for Disease Control (CDC) have found that HIV rapidly reduces in concentration when drying within several hours. And hepatitis B and C can live outside the body for a few days to a week.

HIV and hepatitis B and C can be transmitted by blood to blood contact, and it is possible that if there is blood on a hair or nail instrument (dried or wet) that it could subsequently infect another who is cut or injured with the same tool. In theory, these viruses could be transmitted by contaminated items, such as razors, clippers, or scissors; however, the CDC has never reported any actual cases of infection transmitted this way. While there is risk in receiving nail or hair services, you must remember it is minimal and rare, and you should not be discouraged from getting a haircut or other occasional pampering.

Here are some precautionary measures that manicurists should take to decrease risk of transmission between clients: Before placing the hair and nail equipment in disinfectant, the instruments should be washed with soap and hot water to rinse away any blood or particles. Also, the State of California Department of Consumer Affairs recommends that all items at manicure and nail salons be disinfected by complete immersion in an "EPA-registered disinfectant with bactericidal, fungicidal, and viricidal activity."

To find more information about these EPA-registered disinfectants, you can visit the EPA website and find specific brands and sterilants that are effective against tubercule bacteria, human HIV-1 virus, and hepatitis B virus: http://www.epa.gov/oppad001/chemregindex.htm. This data is current as of March 2, 2002. Barbicide falls amongst the disinfectants listed as an "EPA-registered antimicrobial product effective against human HIV-1 virus."

Also, if you require additional information, you can call the EPA Antimicrobials Division hotline at 703-308-0127, send a fax to 703-308-6467, or e-mail info_antimicrobial@epa.gov.

Finally, you can call your state's cosmetology board and ask what their regulations are for disinfecting/keeping sanitary conditions at salons. For a listing of the state boards, check out: http://www.beautytech.com/st_boards.htm. If you find that your salon is not following these regulations you can file a complaint with the Board.


September 3, 2003

I read your piece on the Web and the response by Cecilia Alterman. Is she for real? According to the California State Board Technical Advisory site I found, in effect, any EPA-registered disinfectant with demonstrated bactericidal, fungicidal, and virucidal activity can be used.

According to what the label says on Barbicide, it fills that bill, and certainly Barbicide Plus does, which also is effective with HIV. So who is correct? The California State Board or Ms. Alterman?

Thank you for your time.

Rafael