Nail Salon Health Hazards.

Reviewed by Charlotte E. Grayson Mathis, MD
From the WebMD Archives

May 4, 2001 - Before heading to the local salon for a manicure or pedicure, be forewarned! You could wind up with more than a new shade of polish. As 110 unlucky folks in Santa Cruz, Calif., recently learned, you might also take home a nasty infection.

That particularly severe bacterial outbreak wasn't typical, but it's a reminder that even simple cosmetic procedures carry health risks.

In late September 2000, a dermatologist in Santa Cruz contacted the county board of health after several patients began showing up at her office with similar, treatment-resistant skin abscesses or boils on their lower legs. She told officials that all five people had recently had a pedicure in one of the whirlpool foot bath chairs at a single salon. These recliner-type chairs have an integral footbath with recirculating water that reaches to just below the patron's knees.

The county called in Kevin L. Winthrop, MD, a CDC medical epidemiologist with the State of California Department of Health Services, to investigate. "We visited the salon, reviewed and watched the procedure, and took cultures of the [sick] women's legs and the foot bath filter screens," he tells WebMD. The screens had never been removed for cleaning, and tremendous amounts of hair, skin, and organic debris had built up.

Laboratory tests revealed massive amounts of the same unusual microbe Mycobacterium fortuitum in both the filter screens and patients' sores. It is a common bug normally found in quantities too small to be problematic.

"That sealed it and told us the source of the infection," says Winthrop. The salon owners closed the shop voluntarily in early October.

Winthrop's team eventually identified 110 people who'd been infected. "No one died and no one was hospitalized, but there are still some people being treated now," he says. "We anticipate that many will require plastic surgery, because these boils can be very disfiguring."

Winthrop calls the situation "very unusual." The vast amount of organic debris in the poorly maintained spa chairs provided "a breeding ground for microorganisms." Even occasional cleaning would have prevented the outbreak. But with no specific laws and only vague manufacturer's guidelines for maintaining the chairs, the salon owners had never anticipated a problem.

James Goldstene, chief of the California Bureau of Barbering and Cosmetology, which worked directly with federal and state officials on the investigation, tells WebMD that newly written sanitation guidelines for the chairs should become law within weeks, significantly reducing that particular hazard.

And those portable, self-contained, footbaths normally used for pedicures? Because they are easily emptied and cleaned between clients, they are unlikely to harbor dangerous levels of bacteria, says Winthrop.

So, chances are you will not contract a horrific infection like the one that hit in Santa Cruz. But don't get too comfortable. There are other dangers lurking.

"The biggest problem is what's known as nail fungus. It's a communicable disease," says Ollie Pendley, first vice president of the National-Interstate Council of State Boards of Cosmetology. "Another is ringworm. Also, both the drills that are sometimes used, and cuticle pushing can damage the matrix of the nail, causing permanent loss or deformity," she tells WebMD.

Pendley, a licensed master cosmetologist, is a retired cosmetology instructor for the Georgia State Public School System, and an educational consultant in cosmetology. She lives in Lithia Springs, Ga.

Licensed nail technicians are trained to identify skin conditions and diseases, and to know which are communicable and thus unsafe to work on. "If and when we recognize a disorder that needs to be seen by medical experts, our responsibility is to suggest that the client sees a doctor or for treatment. There's not a law, per se, but it's the ethics taught in their training."

Before you let technicians touch you, says Pendley, "ask to see their license. Is the name on the license [that of] the person sitting in the chair?" It's not yet law, but her organization is working with legislators to make photographs on all cosmetology licenses a requirement.

As soon as you enter a salon, let your senses tip you off to potential problems, the experts tell WebMD. While you wait, watch to see what each technician does between customers.

"Eyeball around and look at the cleanliness. If there's a lot of dust and nail debris, they haven't cleaned," says Pendley. "They are supposed to completely clear everything off of the table and sanitize their hands between clients. Make sure all implements are completely submerged in a hospital-grade disinfectant, and are lifted out with a pair of tongs."

According to Goldstene, "disposable items such as nonmetal supplies like toe spreaders and emery boards cannot be disinfected, so new ones should be used for each customer." That's not a suggestion, he says, "that's existing law."

We can all benefit from following these suggestions, says Goldstene, but for some of us, it's really crucial. "Diabetics in particular have special health concerns that they should disclose [to the technician]. Because of circulatory problems [that many diabetics have], any infections would be potentially more serious."

If you're uncomfortable for any reason, "don't be afraid to walk out," says Goldstene, "even if you had an appointment." And don't hesitate to report your experience to the authorities. "We absolutely want consumers to call us if they ever have a question or complaint," he says.

Pendley concurs. "Consumers should take responsibility, and if something doesn't look right, speak up. If you're too shy, you can write directly to the state board of cosmetology. You can find them on the Internet, or call your state capital for the number."