While there have been few reported cases of deaths due to a nail salon visit gone wrong, one California woman blames her daughter’s death on an infection associated with bacteria she may have picked up during a pedicure in 2004. Little data has been collected in regards to salon-related deaths and illnesses across the country. U.S. News spoke to podiatrists, dermatologists and other health professionals to find out which health risks you should be aware of and how to protect yourself during your next manicure or pedicure.

While a day at the salon might be relaxing, you could be putting your fingers, toes and more at risk.

Close-up of a woman’s hand receiving a manicure in a nail salon.
Manicures can be a pleasurable experience for you, but your skin may feel differently because of the chance for micro-injuries or infections.

By Hannah Webster July 28, 2014 | 2:09 p.m. EDT + More
Molly Dannenmaier, of Galveston, Texas, visits a local salon every three weeks. She regularly gets a pedicure and occasionally treats herself to a manicure – but the pedicure is a staple. It wasn’t until both she and a friend developed toe infections that she considered the health risks. “[My friend] got a terrible infection, and in fact had to have surgery to have her toe nail removed,” Dannenmaier recalls. “It’s never going to grow back.”

While Dannenmaier’s infection was not as bad, she says she now thinks differently about going to the salon. But because it’s part of her longtime routine, she keeps going back.

“I never even imagined it was the nail salon,” Dannenmaier says. “You know, it’s been a month or two, and I keep going. I guess I’m in denial.”

While there have been few reported cases of deaths due to a nail salon visit gone wrong, one California woman blames her daughter’s death on an infection associated with bacteria she may have picked up during a pedicure in 2004. Little data has been collected in regards to salon-related deaths and illnesses across the country. U.S. News spoke to podiatrists, dermatologists and other health professionals to find out which health risks you should be aware of and how to protect yourself during your next manicure or pedicure.

Injury and Infection

Ouch! The nail technician clipped your cuticles a little too quickly and nicked the skin. She apologizes and rinses it off. It stopped bleeding, so you figure it’s fine to continue your pedicure. But is that really a good idea?

Robert Spalding, a Tennessee podiatrist and author of “Death by Pedicure,” says the most alarming health risk at a nail salon is injury that leads to infection.

About 75 percent of salons in the U.S. don’t follow state protocol for disinfection, Spalding says. While it’s impossible to be completely sterile, salons should sterilize their tools using an autoclave – a machine used in medical environments that produces ​steam and pressure for disinfecting equipment.

Many nail salons use liquid disinfectants to clean tools, but this method is only effective if nail technicians soak the instruments for around 20 minutes. When shops get busy, tools are often removed early and used on the next client.

Also worrisome: Manicures and pedicures may cause microtraumas​​ to the skin by nail filing or cuticle cutting​, resulting in infection. “Those little micro-injuries that can be unseen are the ones that can lead to big problems,” Spalding says. Hepatitis B, MRSA, and other bacterial infections are potentially life-threatening and can be picked up in salons​. “There’s a huge difference between a bacterial infection and a fungal infection,” Spalding adds. “A huge number of people walk in with nail fungus, and most state laws prohibit them to be served, but they are served anyway. That then causes a bigger problem on the bacterial level.”

Dennis Shavelson,​ a podiatrist in New York City​, says infections can stem from dull nail files, but sharp instruments are especially concerning​. “If [technicians are] cheating with sharp instruments or cutting corns or calluses instead of kind of grinding or shaving them, you can get infections, injuries, irritation,” he says.

What you can do: People with poor circulation or diabetics are at a much higher risk of contracting an infection, and most diabetics should avoid going to a typical nail salon, Shavelson says. Check with your local podiatrist to see if the office offers a medical pedicure instead.

However, all salon-goers can protect themselves by bringing their own instruments or asking technicians about the salon’s disinfecting procedures – and requesting the technician use plastic gloves. Consider only going to salons that use autoclaves to disinfect instruments and tools. Never allow anyone to use a credo blade, which is a callus razor that resembles a vegetable peeler, or any other type of sharp instrument to remove skin. ​​ In fact, it’s illegal for salons to use credo blades in most states. ​ If you’re injured in a salon or experience any pain or redness following a visit, see a physician as soon as possible.

Nail Fungus

Many of us love soaking our feet in the warm, bubbling water attached to a massage chair. But have you ever thought about the people who were soaking their feet before you?

Shavelson says a common misconception is that people can develop athlete’s foot or similar fungal infections at nail salons. But typically, foot fungus develops in dark, moist enclosures – not a nail salon foot bath.

Nail fungus, however, is another story. Shavelson says it can spread in a salon if foot baths and instruments aren’t cleaned properly.

What you can do: If you think you may have a fungus, never go to a nail salon to have the problem treated. Nail fungus is often treatable at home, but you should see a podiatrist if it continues to grow after the initial removal, Shavelson advises. “If they just see an area that’s turning white, I would take a nail clipper and remove that part of the nail, and if it keeps getting white or grows back white then they should get some help,” he says.

Unlike over-the-counter athlete’s foot medication, over-the-counter nail fungus medication is rarely effective​, he adds. If the fungus needs medication, it’s important to use a prescribed treatment.

Most nail salons see a steady parade of business. Nails get cut and filed, feet soak in tubs, cuticles get pushed back and trimmed, calluses get buffed. And while the majority of nail salon visits won’t send you on your way with anything other than an excellent manicure and pedicure, customers — and salon workers — are at risk of spreading disease.

How can a desire for well-groomed nails lead you straight to the doctor’s office? All that buffing, clipping and trimming means that it’s not uncommon for hands and feet to get nicked and cut. And wherever you have open wounds and a lot of skin-to-skin and skin-to-surface contact, you have a very good chance of picking up some gross bacteria or (viruses.http://health.usnews.com/health-news/health-wellness/articles/2014/07/28/health-risks-lurking-at-the-nail-salon)

So what are the risks of a pampering footbath? We’ve got five nasty bugs to look out for.

Despite its name, athlete’s foot affects people regardless of their athletic prowess. It’s the common name for tinea pedis, a fungal infection that requires a moist, confined environment to take root and spread.

Unfortunately, the pedicure baths of a salon provide a breeding ground. Let’s face it: Lots of feet get put into that tub, and not all of those feet are clean. If a spa doesn’t regularly clean its foot tubs between each client, the odds of leaving the spa with a fungal infection you didn’t walk in with increase. Also, fungus isn’t so easily removed from the surfaces it grows on, so a light cleaning may not rid a tub of its presence. Frequent use of an anti-fungal cleaning agent is the best way to prevent spa clients from getting athlete’s foot from a foot tub. On the other hand, if your feet are itching like crazy and you haven’t changed your socks in weeks, you should steer clear of spas or any activity that could potentially spread the fungus to others.

A spa treatment is supposed to make you feel like a princess, so you don’t want to go home looking more like the frog the princess kissed instead.

One thing available at nail salons that’s not posted on any service menu is a contagious skin disease. With all the hands and feet passing through a salon each day, the odds are solid that some of those appendages have warts on them.

Warts are caused by a contagious virus called human papillomavirus (HPV). There are many different strains of the virus (such as the type that can cause cervical cancer), but only a few different kinds spur the overproduction of skin cells that results in warts.

Warts spread through person-to-person contact when HPV makes contact with a break in the skin. Hands play host to both common warts and palmer warts. The tops of feet may also have common warts, while the bottoms can have plantar warts, which grow inward due to constant pressure between the foot and the ground. All of these are contagious.

Warts can be spread if a salon worker uses the same pumice stone for different clients. Most salons offer new pumice stones, and you can always bring your own to lower the risk of getting warts. You should also frequent salons where employees wear plastic gloves that they change between appointments.

HPV isn’t the only virus you can pick up at the spa. The H1N1 virus (more commonly — and misleadingly — known as theswine flu) makes an appearance as well.

H1N1 is a highly contagious strain of the flu virus. One big reason for this is that most people have no immunity to it, because it’s new. It spreads just like the “regular” flu virus — someone infected with it coughs, sneezes or touches their mouth and then makes contact with another person or a surface someone else will touch.

The virus can survive outside the body for up to eight hours, meaning that an infected customer at a salon can unknowingly booby-trap the establishment with the virus. With all the hand-to-hand contact that occurs in a salon, it’s not difficult to understand why swine flu could easily spread between employees and customers.

So how can you avoid it? Ideally, salon workers wear protective disposable gloves for each client and change and gloves (with a hand washing for good measure) between appointments. All instruments should be treated with chemical germicides.

And if a salon employee is exhibiting flu symptoms, reschedule your appointment. Likewise, if you’re infected with H1N1 (or show any flulike symptoms at all, even without diagnosis), cancel that appointment, no matter how much attention your nails need.

Another good reason to make sure your nail technician changes his or her gloves between customers: a superbug called MRSA.

If you’ve paid attention to the news in recent years, you’ve likely noticed an uptick in stories about a type of staph infection called methicillin-resistant Staphylococcus aureus. MRSA infections can lead to severe scarring, amputation and even death — and it’s resistant to antibiotics.

Though not common, MRSA is known to be spread at nail salons, leading to infections on hands and beneath fingernails. Symptoms usually appear within 24 hours — you’ll likely experience pain in your hands and be unable to bend or use your fingers with any degree of comfort. The swollen, red skin around the infected area will crack open and ooze pus. It’s hard to miss.

MRSA can be spread through the sharing of unsanitized nail files or other nail implements. These implements should be soaked in a disinfecting solution for a minimum of 10 minutes, then treated with a sterilizing agent. Foot baths should be vigorously cleaned and sanitized between clients.

This nasty bug might give you a good reason not to shave your legs. You can get Mycobacterium fortuitum from foot baths — and the risk is greatly increased when a soak is preceded by leg shaving.

What does an M. fortuitum infection consist of? Large boils on the toe, foot or leg. These boils may be surrounded by smaller bumps. Sometimes they heal on their own, but they can linger and even turn into open sores. M. fortuitum boils can be lanced by a medical professional and treated with extremely potent antibiotics, but unfortunately, these boils and sores can cause heavy scarring.

To avoid getting the bug, pay attention to any regional reports of M. fortuitum outbreaks. Take your own nail tools to the salon for them to use during your appointment. And don’t be afraid to ask the salon owner about the establishment’s cleaning procedures. After all, you want to treat yourself, but not to a bug like M. fortuitum. (http://health.howstuffworks.com/skin-care/nail-care/health/5-nail-salon-infections.htm#page=1)

 

List of Common Fingernail Diseases