Following reported cases of infections linked to nail salon whirlpool footbaths, officials are reaching out to consumers and salon owners.

SACRAMENTO -- Following reported cases of bacterial infections linked to Northern California-area nail salons, the state is issuing a safety alert for consumers receiving pedicures.

"Consumer safety guidelines are especially important during the holiday season, when consumers use salons more often to get ready for holiday gatherings, and salon gift certificates are being bought for gifts," said Terri Ciau, Executive Officer, California State Board of Barbering and Cosmetology.

Local and state officials have been working together to investigate the outbreak of infections that cause lesions on the legs of customers who received pedicure services at various salons in the

San Jose area. Although only three salons have been cited, customers of additional salons have also reported lesions.

The lesions are linked to contaminated whirlpool footbaths, used as part of pedicure procedures. When the footbaths are not properly cleaned and disinfected, hair and skin debris build up in the tub basin, allowing bacteria to grow to unusually high levels.

Officials with the State Board of Barbering and Cosmetology and the Department of Health Services, along with local officials in the Santa Clara County Public Health Department, are investigating the reported cases. The cases came to light after consumers complained to the Board of Barbering and Cosmetology about lesions appearing following pedicure procedures.

"The cooperation between the county and state, as well as our local physician community, has been outstanding," said Dr. Marty Fenstersheib, Health Officer, Santa Clara County. "We will continue to work in partnership to monitor and address the situation in order to protect the public's health."

In response to these recent bacteria infections, the Board of Barbering and Cosmetology, along with the state and county health departments, is conducting an education campaign for both consumers and salon owners.

"With helpful guidelines, we want to educate the consumers of California on how they can help protect themselves from whirlpool bath infection," Ciau said. "In addition, we are reaching out to our salon licensees to emphasize the importance of cleaning and disinfecting that follow state health and safety regulations."

The Board is mailing out 37,000 letters to its salon licensees throughout the state outlining the proper cleaning procedure for the whirlpool footbaths. The cleaning and disinfection procedures are part of regulations enacted three years ago in response to a bacterial outbreak linked to whirlpool footbaths in a Santa Cruz County nail salon. The letters to licensees will be printed in three languages – English, Spanish and Vietnamese.

The footspa regulations include cleaning and disinfecting between each pedicure customer, and a more thorough cleaning at the end of the business day that includes a 10-minute system circulation. Every other week, the footspa system must be cleaned with a bleach solution, when the basin must be soaked in the solution for at least six hours.

To help protect themselves, consumers can use the following guidelines before they get a pedicure treatment that includes a whirlpool footbath:

1. Don’t shave your legs before the appointment. Shaving makes you more susceptible to nicks and cuts, which are gateways for bacteria.

2. If you have broken skin or lesions on your lower legs, do not get a pedicure.

3. Check out the salon. Make sure its Board of Barbering & Cosmetology license is posted in plain view in the reception area and is current;

1. Make sure the operator’s license is posted at his or her work station;

2. Make sure the Board’s Health and Safety poster is displayed in the reception area;

3. See whether the salon is clean, free of trash, and set up with clean instruments;

4. Don’t be afraid to ask the operator how the footspas are cleaned and disinfected. If they hesitate or won’t answer you, that could be a sign you may want to take your business elsewhere.

5. If you have any doubts about the cleanliness standards at a salon, leave.

6. If the footspa’s basin looks dirty, consider having a pedicure without the use of a whirlpool spa.

The first step consumers should do - if they suspect that they are infected through a pedicure procedure - is to visit their doctor, according to the State Department of Health Services.

"If you have one or more persistent skin boils after having a pedicure with a whirlpool footbath, you should contact your doctor for an evaluation. Let your doctor know that you have had a whirlpool footbath before your skin infection started," said State Public Health Officer Dr. Richard Joseph Jackson.

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Disease a risk at beauty salons as people rush to get summer treatments

May. 18, 2003 - Canadian Press

Can Salons Spread Infection?

by Charles Downey - Third Age Health Encyclopedia

When you sit down to have your fingernails manicured, you're probably more worried about which shade of polish to choose than catching a potentially deadly disease.

Back in 1965, a medical researcher managed to trace several hepatitis B patients back to a barber who unintentionally transmitted the disease by shaving all the patients with the same razor. The barber had used a disinfectant, but it wasn't strong enough to kill all the germs.

In those days, many of the serious blood-borne diseases that plague us today—such as HIV/AIDS, hepatitis B and C—were less prevalent. Medical researchers say as many as four million Americans now have hepatitis B. But 10% of those cases have no known cause. Researchers investigating hepatitis C cases say 30% of patients have not shared needles with another illicit drug user—the chief means of transmission.

Medical researchers are now asking: could poorly trained cosmetologists and barbers using dirty instruments be unwittingly spreading diseases?

A Closer Look at Salons

Texas dermatologist Shelly A. Sekula, M.D., has looked closely at the sanitary practices of the cosmetology and barber industry and found conditions sadly lacking.

"Nail and hair salons may be a source of blood-borne as well as other infectious diseases," says Dr. Sekula who practices in Houston, Texas, and chairs the Legislation Committee for the Texas Dermatological Society. "There is good evidence that razors, nail files, barber's scissors, tattoo needles, and body piercing instruments are risk factors for transmitting hepatitis B and C."

Dr. Sekula's interest in this area began when she saw one patient with a contagious fungal infection on her toes and feet. When questioned, the patient remarked that she had noticed just "one little cut" after the pedicure. "And the red warning flags went up," Dr. Sekula says.

"If I was going into a nail salon, I would look for a photo license of the operator. I would also ask about sterilization procedures and would not permit an electric drill to be used on my nails. Nail drills whir so fast, they can easily penetrate the nail and cut you." And they may have cut the person before you, too. So if you do wear acrylic nails and opt for the nail drill, you can buy and bring your own drill bits, designed solely to reduce the risk of nail infections from using community, multiple-use instruments.

Adds Phoebe Rich, M.D., president of the Council for Nail Disorders in Schaumburg, Illinois: "There is a potential for the spread of infection if the salon instruments are not properly cared for."

Proper Precautions

* Sterilization
* The best sterilization methods are steam, ethylene oxide gas, dry heat and chemical germicides. Anything that can draw blood—nail clippers, cuticle scissors, callus paring blades, reusable and straight razors—should be soaked in a chemical germicide.
* "However, most states only require cosmetologists and barbers to use a low-level hospital grade disinfectant—which may or may not kill all the microorganisms," Dr. Sekula says. "To really be safe, I suggest bringing your own instruments." And don't be fooled by operators who wear face masks. They're not protecting you—they're protecting themselves from breathing in fumes and nail dust.
* Gloves
* Though cosmetologists rarely wear them, latex gloves are another important safety precaution. Why don't they wear them? Perception. If you sat down in a salon for a manicure or a pedicure, and the technician put on a pair of rubber gloves, you might think she had some contagious condition.
* Actually, she would be protecting you from any ailments suffered by the previous client. Many professionals—health and dental workers, emergency teams, firefighters, police and correctional officers—wear latex gloves because they are using a technique known as "universal precautions." That means limiting the spread of blood diseases by assuming that everybody's blood, bodily fluids, and tissues are infectious.
* "The federal Occupational Safety and Health Administration (OSHA) requires any worker at risk of contracting an infection to wear gloves," Dr. Sekula says. "But, curiously, OSHA regulations leave it to employers and the various states to decide if workers in the cosmetology and barber industries should wear gloves."

Selecting a Safe Nail Salon

To help you decide if a salon provides sanitary nail services, the United States Food and Drug Administration (FDA) experts suggest you consider the following:

* Is the salon licensed?
* Licenses should be prominently posted, both for the salon and the operators. If you don't see them, ask.
* How are nail implements sanitized?
* Autoclaving (heat sterilization) is best, says Ralph Daniel, M.D., a dermatologist in Jackson, Mississippi. But most states allow chemical sterilizing as long as the implements are immersed in the solution for at least 10 minutes between customers.
* Ask the technician what the salon's practices are.
* If they're using a chemical solution, check the product's label for words like "germicidal" to indicate that it is strong enough to kill bacteria. If in doubt, bring your own implements, Daniel suggests.
* Is there a pre-service scrub?
* Both the nail technician and the client should wash their hands with an antimicrobial soap before nail work begins.
* Is each customer given a fresh bowl of soapy water to soak their nails in and is a new nail file used for each customer?
* Both practices should be followed.
* Is the facility neat and clean?
* Paul Kechijian, M.D., a clinical associate professor of dermatology and chief of the nail section at New York University, compares selecting a salon to selecting a restaurant. "Ask yourself when you walk in: would you want to eat there?" he says.
* Is there a strong smell of fumes in the salon?
* If there is, it's a sign that the facility is poorly ventilated, says John Bailey, Ph.D., acting director of FDA's Office of Cosmetics and Colors. Inhaling the fumes from nail products can make you sick.

The Spread of Disease

A client in a salon may have an injury to the cuticles, a cut in the nail folds, or could have bled when calluses were removed too deeply. A hair cutter could have accidentally nicked his client. Customers might have open areas or cracks in their scalps. Crusts, scales and lice can attach to combs and brushes and easily transmit infection or infestation to the next unwitting patron.

In 1989, a warning was sounded that barber scissors and razors contaminated with blood can pass along the human immunodeficiency virus (HIV). A medical researcher found that hepatitis C could be transmitted via the straight razors commonly used in barber shops to trim sideburns and necks. The researcher dunked razors from five different barber shops into five commonly-used sterilizing solutions. Results? None of the five solutions destroyed hepatitis C, even though some were soaked for six hours, 24 hours, and seven days.

"Other research shows that hepatitis B can survive outside the body for seven days or more on chairs, headrests, workbenches, instruments and tools," Dr. Sekula says. "Hepatitis B is one hundred times more contagious than the HIV virus."

According to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, hepatitis B is now the leading cause of liver transplantation and the second leading cause of cirrhosis (after alcohol) in the United States. About 10,000 Americans will contract hepatitis B this year with that number expected to triple over the next two decades. Currently, the CDC says hepatitis B costs the US $700 million yearly in lost work and health care costs.

Cuts, nicks and scrapes at the beauty salon or barber shop can also lead to other, less deadly, conditions for both clients and shop operators, including warts, bacterial and fungus infections, and reactions to various products and fumes.

Reducing the Risk

"The risks would be virtually eliminated if operators used disposable instruments, wore rubber gloves, employed proper hand washing and used appropriate sterilization techniques," says Dr. Sekula. She would also like to see physicians appointed to the governing boards in every state so the beauty industry can have the latest health information.

Resources:

Finger nails: looking good while playing it safe. US Food and Drug Administration.

Gitlin, N, Nohe, FS, and Weiss, M. Hepatitis C: Risk of a haircut. Annals of Internal Medicine. 1997;126(5).

Hair and nail salons linked to infectious diseases. American Academy of Dermatology.

Wagner, R.F. Risks of infection to dermatologists, cosmetic workers, and the public. International Journal of Dermatology. 1990;29:253-257.

Elizabeth Smoots, MD
November 2003

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Keep Your Tools To Yourself

Studio City, CA- February 20, 2003

In response to the recent epidemic of bacterial and fungal infections received by the those who frequent nail salons, Laurie Shiers and Valerie Moizel have created CUTIEKIT. A complete professional manicure and pedicure kit that you take with you to the nail salon, CUTIEKIT helps prevent infection by limiting the number of tool users to one: You.

Celebrities such as Julia Roberts, Salma Hayek, Catherine Zeta Jones, Faith Hill, Maggie Gyllenhaal and Queen Latifah all recognize the benefit of the CUTIEKIT and the importance of Keeping Your Tools to Yourself. Peri Gilpin gave them out as Christmas gifts. Kate Hudson’s movie “How to Lose a Guy in 10 Days” talks about the dangers of sharing nail care tools, and Kate herself has a kit.

Stores like Pure Beauty, Fred Segal, Umberto Beverly Hills and the Mandalay Bay Resort Group all carry this fresh, unique item, which has been called the ideal gift. The kit is a must for travelers and also effective for at-home use. Lucky Magazine “absolutely loves” the CUTIEKIT according to the March 2003 issue, as do the recipients of the Critics Choice Award and Grammy gift bags. EXTRA TV has done a segment featuring the creators and their new product- the first in a line of lifestyle kits and beauty accessories. While there are many manicure kits currently on the market, only CUTIEKIT contains the complete set of tools routinely used at nail salons. CUTIEKIT can also be purchased at www.cutiekit.com.

The dangers of catching an infection at a salon are real. Each year, millions of people who frequent nail salons are exposed to a host of dangerous viral, bacterial and fungal infections, ranging from HIV, Hepatitis B and C, staphylococcus, streptococcus, athlete's foot and nail fungus. Although nail salons are required by law to follow strict sanitary codes and regularly sterilize their equipment, the harsh reality for the customer is that many, if not most, do not. A recent 20/20 investigation found that of all the professional nail salons they randomly selected around the country, almost all tested positive for potentially harmful bacteria.

The CUTIEKIT motto is “Keep Your Tools To Yourself”, which is exactly what Valerie Moizel was doing the day she sat down next to Laurie Shiers at their favorite nail salon. Strangers only for a few seconds, Laurie began quizzing Valerie about the several expensive nail tools she’d bought, totaling over $90. After getting a fungus on her toe, Valerie swore off pedicures, but later reconsidered when she learned that the possibility of infection is greatly reduced when you bring your own tools. Laurie had had a similar experience. An hour later, the two freshly manicured entrepreneurs had a plan: Every girl, no matter what her budget, deserves her own set of supplies and should always keep her tools to herself.


Laurie Shiers, Valerie Moizel-Hatton

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Keeping on your toes Nail care can be infectious, so be vigilant. 
April 18, 2001 
By MAYRAV SAAR
The Orange County Register 

TOM SPRY enjoys a nail treatment at Happy Nails and Spa in Mission Viejo, whose owner says workers can be fired for not following cleanliness and disinfection rules.

The warm water is bubbling, the comfy massage chair is vibrating, but Shannon Minardi won't rush to take off her shoes. Before she hands her feet over to a pedicurist, she scans the beauty shop for warning signs. 

How clean is it? Are manicurists sharing equipment? Dropping tools on the floor and not disinfecting them? If so, Minardi turns on her unpampered heel and leaves. 

"My sister got a nail fungus from a pedicure before," Minardi, of Rancho Santa Margarita, said as she relaxed into a pedicure at Happy Nails and Spa in Mission Viejo. "So I watch what they do before I get one." 

Minardi's caution is rare. People generally associate pedicures with relaxation, fun, even good health. 

But local dermatologists say they've seen luxury turn ugly, with patients hobbling into their offices on bacteria- and virus-infected feet. 

"Nail salons are not my favorite places," said Orange dermatologist Dr. Melissa Watcher. 

"I always tell people, 'If you're going to go, bring your own tools.' " 

Though people rarely think about the potential dangers that lurk in nail salons, it only takes one bad experience to change a person's outlook. 

After soaking her feet in a spa and getting her legs massaged and toes perfectly tended, Cherri Brown has this to say about personal pampering: "I will never go get a pedicure again." 

The sales rep always prided herself on her twice-a-month manicures and pedicures, performed at a Monterey-area salon. 

She's considerably less proud of the scars that now cover her legs, the result of an infection caused by Mycobacterium smegmatis. 

"My legs look like they've been shot by a shotgun," says Brown, who first noticed the problem in what she thought was a mosquito bite. It was small at first, but then swollen and purple. It grew in size. 

WHAT THEY DON'T want to see is above: the remnants of a nail fungus on the big toe that the patron said she caught at a different nail shop.

And then it spread. 

Two, four, 11 "bites." Infections that wouldn't go away. 

At last count, there were 33 lesions on one leg. On the other, 23. 

"It's not a very pretty thing," she says. 

Mycobacterium smegmatis is a rapidly replicating bacterium that responds poorly to medication. 

Health authorities in Brown's area believe she was the victim of poorly cleansed equipment at the salon she visited. More than 100 women who visited the same salon have sickened. 

Brown will need to take antibiotics for at least six months and may need skin grafts, she says. 

It's an outcome of beauty care that she never anticipated. Most consumers don't. 

"I think a lot of people are unaware there is a risk," says Dr. Phoebe Rich, president of the Council for Nail Disorders and a clinical associate professor of dermatology at Oregon Health Sciences University. 

CLIPPERS and other nail-care tools should be cleaned after every use, health officials say, and stored only with other cleaned instruments.

Watcher, the Orange dermatologist, says she sees at least one patient a week with a minor spa-related viral or bacterial infection. Severe infections from a manicure or pedicure are rare. 

Consumers spent more than $6 billion on nail treatments in 1998, and pedicures were the most rapidly growing service. Yet for all the people who go to nail salons and undergo procedures, there are relatively few cases of serious problems. 

"It's not a huge public health risk - but that varies by salon," Rich says. "What's much more common is for people who are having manicures in salons that aren't scrupulous about sterilizing instruments to be transmitted athlete's foot, toenail fungus and even warts." 

The California Department of Consumer Affairs also recognizes other potential pedicure dangers, including allergic reactions, loss of a nail, and the spread of staph infections or viruses and, in extreme cases, HIV and hepatitis. There are no known instances of the latter being transmitted through pedicures, yet the potential certainly exists, many health officials believe. 

"You can't scare people too much, in my opinion," says Dr. Shelley Sekula Rodriguez, a Texas dermatologist who has scrutinized the sanitation practices of the cosmetology industry. 

In one small study, Sekula Rodriguez analyzed seven nail instruments used by salons and found five were growing viral, bacterial and fungal colonies. 

Industry insiders insist that such practices are the exception rather than the norm. But David Tran, general manager of Happy Nails and Spa, said one salon's bad practices affect the entire industry. 

"Salons that were not clean gave everyone a bad image," said Tran, who says manicurists at Happy Nails' 23 stores can be fired for eschewing disinfectant. "The most important thing for a customer to look for is if (manicurists) are using clean equipment." 

Indeed, the Fancy Nails establishment in Watsonville that Brown frequented was shut down in October after patrons began complaining of unusual sores around their feet, ankles and legs. 

The Monterey County Health Department learned that all those patrons had frequented the salon, where soiled instruments were stored next to clean ones, and emery boards, cuticle clippers and buffers were not properly disinfected between customers. Foot spas were contaminated. And credo blades - razor-like instruments illegal in California salons - were also utilized. 

"You have to watch out for yourself," says Tracey Weatherby, a spokeswoman for the state Department of Consumer Affairs. 

"When you receive health and beauty services in salons - whether it's a pedicure or some kind of hair treatment - you need to make sure they're properly trained and properly licensed. You don't want somebody affecting your body unless they are taking the proper health and safety precautions." 

Knight-Ridder Newspapers contributed to this report. 

Before you get a pedicure...
Tips for getting the safest manicure or pedicure 

Be a snoop. Check to see if the establishment has a license, which should be prominently displayed in the reception area. Make sure your cosmetologist has a license posted at his or her workstation. 

Be a snob. If the salon appears even the slightest bit dirty, leave. If the towels aren't clean or the instruments do not appear to be sanitized, leave. Another bad sign: If the salon smells of strong odors. 

Be inquisitive. How does the salon disinfect its instruments? Are items that cannot be sanitized - such as nail buffers, emery boards, toe separators and orange sticks - disposed of immediately after use? Do workers wash their hands between treatments? 

Be a diva. Bring your own manicure and pedicure equipment with you to ensure the instruments will not be used on anyone else. This will reduce your risk for getting athlete's foot, toenail fungus, bacteria or warts, but it isn't foolproof. If dirty towels or foot tubs are used, there is still a potential for problems. 

Defend your cuticles. Don't allow them to be clipped or cut. Cuticles keep bacteria from getting under the nail bed. 

Look out for illegal equipment. Razor blades that are sometimes been used to cut calluses off the feet are considered unsafe and are definite no-nos in salons in California. 

For more tips, www.dca.ca.gov/barber.

The Orange County Register
ocregister@link.freedom.com 

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Nail Salon Health Hazards

By Liza Jane Maltin
WebMD Feature
Reviewed By Michael  Smith, MD

May 1, 2002 - 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., learned, you might also take home a nasty infection.

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 bacteria Mycobacterium fortuitum in both the filter screens and patients' sores. It is a common bug normally found in quantities too small to be a problem.

"That sealed it and told us the source of the infection," says Winthrop. The salon owners closed the shop voluntarily in early October 2001.

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 told WebMD in 2001. "We anticipate that many will require plastic surgery, because these boils can be very disfiguring."

He originally presented the findings at a medical conference in Atlanta. The research has now been published in the May 2 issue of The New England Journal of Medicine.

Winthrop called 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.

Last year, James Goldstene, chief of the California Bureau of Barbering and Cosmetology, which worked directly with federal and state officials on the investigation, told WebMD that emergency sanitation guidelines for the chairs had been put in place and should significantly reduce that particular hazard. Those changes have now become law, and other states are currently looking into similar regulations.

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 get 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."

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

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 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 Pendley's 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 agrees. "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."

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May 29 — A Westminster, Colo., woman has won a jury award of $3.1 million against a nail salon that she claims gave her herpes through the use of non-sterile instruments. Kristina Preston, 29, said she contracted the virus when she went to the Top Nails salon in Aurora, Colo., on May 2, 1998, for her very first professional manicure. When she left the salon, Preston said, "My cuticles on my thumbs were burning and wouldn't stop." And the discomfort only got worse.

Pointing a Finger at Discount Nail Salons

LA TIMES - Friday, January 28, 2000

By BOOTH MOORE, Times Staff Writer
 

A chemical many of them use--flouting a widely ignored state rule--is blamed for multiple ills. But proponents dispute the claims, accusing foes of racism and economic self-interest.

Last year U.S. women spent more than $4 billion on artificial fingernails, and business appears to be booming right into the new century. But underneath that glossy veneer is a chaotic scene of unanswered health questions, brutal competition and even claims of racism.

At issue is a chemical called methyl methacrylate, or MMA. Millions of women who paid for acrylic nail services in recent years may have been exposed unknowingly to the chemical, which has been blamed for fungal infections, nail deformities and other problems.

The U.S. Food and Drug Administration, calling MMA a "poisonous and deleterious substance" when used in nail products, obtained a preliminary injunction against one maker of MMA 26 years ago. Manufacturers quickly, and voluntarily, switched their salon clients over to ethyl methacrylate (EMA), a more expensive--and reputedly safer--bonding liquid.

The FDA did not pursue regulatory action, which left a door open for the issue to return in the future. Now a surge in openings of discount salons, most run by Vietnamese immigrants, has brought it back with a vengeance.

The discount salons may offer a full set of nails for $25 compared to $60 or more at their more established competitors. Some of the difference can be explained by the low overhead of the discount salons, which often operate in cheap storefronts and rely on low-wage immigrant technicians. But another reason is the admitted use of MMA, which can cost as little as $15 a gallon compared to as much as $215 for a gallon of EMA.

"I haven't heard from anyone that our product [MMA] hurt them," said Jennifer Hajali, vice president of CA Chemists, an Anaheim manufacturer that produces both EMA and MMA for use in salons. It is economics, not health, that is driving the controversy, she says. "This [MMA] has become a hot topic in the last two years because competition from discount salons is so fierce."

Others disagree. "We need more consumer awareness about MMA," said Nancy King, a Maryland nail technician who successfully shepherded a bill through that state's Legislature in 1999 to ban the substance in beauty salons there. So far, 30 states have imposed regulations on the use of MMA.

In 1993 the Barbering and Cosmetology Program of the California Department of Consumer Affairs prohibited the use of MMA in nail salons, but the rule is almost totally ineffectual. There are only 15 inspectors for California's 9,348 nail and hair salons. Chemicals would have to be analyzed to prompt a formal investigation, but inspectors aren't authorized to confiscate materials. Even if a salon were found to be using MMA, the fine would be a mere $25. So MMA use here is reported to be growing dramatically.

"I don't want to put anyone out of business for any reason, but salons using MMA are making a 700% profit margin," said Pat Stephenson, a nail technician who led the fight in Kentucky to regulate MMA. "If they are going to work in America, let's do it the American way."

And the American way she refers to seems to exclude discount salons, which in California are mostly owned by Vietnamese immigrants.

Chemical First Used by Nail Salons in '70s MMA, which is primarily used in making Plexiglas and Lucite, in dentistry and to bind a prosthesis to the bone in joint replacement surgery, was first used in the nail industry in the 1970s when acrylic nails were introduced.

Such nails are created from a combination of powdered acrylic and a bonding chemical that is made into a paste and spread over the natural nail. Once the paste hardens, the resulting surface can be shaped and painted. A procedure called a "fill" involves literally filling in the gap between the acrylic and the cuticle as the nail grows.

This new form of artificial nails was costly but the strength and durability--especially for women whose natural nails were brittle or prone to breaking--made them desirable.

Soon after acrylic nails were introduced, the FDA began receiving complaints about nail irritations, discolorations and other problems. But the nail industry's subsequent voluntary withdrawal of MMA short-circuited the regulatory process and federal health studies. Currently, the question of MMA's health risk is officially unresolved, debated by companies with a stake in the outcome.

For example, Doug Schoon, director of research and development for Vista, Calif.-based Creative Nail Design, a manufacturer of EMA, says he has found that:

* MMA does not adhere as well to the natural nail as EMA, so a technician should "rough up" the natural nail with a drill to get an MMA-based acrylic paste to stick.
* An acrylic nail made with MMA is stronger than EMA. Women could have their own nails ripped out because the acrylics did not break off when exposed to trauma.
* Acrylics made with MMA are difficult to remove with acetone or normal acrylic nail solvents. (It takes 30 to 35 minutes to remove a set of EMA-based acrylics but more than two hours to remove MMA-based ones, Schoon said.) Technicians often have to pry or nip the acrylic nail off, pulling layers of the natural nail with it.
* MMA is a "sensitizer" that can cause irritation and allergic reactions once it is in contact with the skin.
But CA Chemists' Hajali argues that most cosmetic products are sensitizers, including nail polishes, nail polish removers and scented lotions.

The FDA action against MMA was "based on a 1974 opinion [when MMA was made] using a different monomer than is used today and a different polymer," she said. "Back then, the products were designed for the dental industry, not the fingernail industry. They had to be much stronger. The FDA hasn't taken on any new information since then."

The effects of technicians' exposure to MMA are not well-researched, but the Materials Data Safety Sheet, the government-required listing of workplace hazards, mentions possible eye, skin and lung irritation from prolonged exposure. Severe side effects may include abnormal liver or kidney function, nervous system damage and reproductive problems, the sheet says.

The number of salon workers who have experienced these effects is unknown. A chemical engineer in Wilmington, Del., Nhu-Ha Le, believes that all chemicals used in nail salons, not just MMA, are hazardous to technicians. She devised a better-ventilated manicure table for Ipcair Industries after her sister, a nail technician, became ill.

"My sister was sick all the time with respiratory infections and a runny nose. She lost her sense of smell and was always coughing," Le said. "The first time I visited her salon, I couldn't believe the fumes. I said, 'You are killing yourself!' "

But Steve Miller, a member of the California cosmetology program's Advisory Council and owner of Gables Co., a hair care products firm in Los Angeles, asked: "Is there a health risk [with MMA]? No one has died of this. It seems to be more of an inconvenience than anything else. The most impassioned argument I heard was from a lady who had her nail torn off."

That's what happened to Susan Stein of Foothill Ranch, who snagged a finger on her soapy hair about a year ago. She expected to find a crack in one of her acrylic nails. But as the water cleared the shampoo bubbles away, she noticed that the acrylic nail was lifting off her finger, taking the natural nail with it. And the same thing was happening on other fingers.

At the emergency room, a doctor said that a fungus was rampant underneath her natural nails and that she might lose them permanently.

Stein does not know what caused the infection, but she decided it might have been the MMA that her discount salon may have used. She is wearing acrylic nails again, but not a $26 set from what she called a "chop shop."

"Now I pay $35 for a fill and $60 for [a] set, but it's worth it for my peace of mind," she said.

Minimum Investment and Low Overhead

Southern California's large community of Vietnamese immigrants discovered the nail business in the 1980s. It offers a low-overhead service that requires a minimum of investment and training, perfect for someone of limited means who wants to own a business.

From 1984 to 1989, the number of licensed nail technicians in Los Angeles County jumped from 9,755 to 15,238, about 80% of whom were Vietnamese-born. More recent numbers are not available, but editors at Nails magazine, a 62,000-circulation monthly based in Torrance, say the industry nationally is composed of 40% Vietnamese immigrants and that the proportion in California continues to be as high as 80%.

"The Vietnamese technicians don't have that much technical knowledge. They use whatever product is available and, since they are in the lower-end salons, they try to get the cheapest product they can to accommodate the prices they charge," said Trang Nguyen, who owns Odyssey Nails, an Orlando, Fla.-based manufacturer of EMA.

The price competition has driven some established salons to the wall.
"I've sat in seminars at these trade shows where women will start saying things like, 'Let's put down these Asian salons!' and it's awful," said CA Chemists' Hajali. She believes that some established white nail technicians have latched on to the MMA issue to get rid of the competition.

A nonprofit organization comprising primarily Vietnamese beauty salon owners and distributors was recently formed in El Monte to fight back. "We have been using it [MMA] for years," said Richard Nam Bui, director of the North American Nail Council. "They are only bringing it up now because of politics and economics."
Diane Cu, who manages a nail salon in Long Beach, believes that raising the MMA issue is a form of discrimination against Vietnamese Americans.

"I understand that salon owners get angry when they see their customers going to Vietnamese salons," she said, but bringing up MMA as the reason amounts to "slander."
"Members of these anti-MMA movements give the impression they are concerned about public health. If that's the case, they should work to ban nail polishes, primers, files, resins and even the monomer they are using, EMA," she said. "But they use nail polish just like we do and primer just like we do, so they can't lobby against those. They don't use MMA like we do, so they have decided that's why Asians are making so much money in the nail business."

Hard to Detect Use of the Substance
When Stein discovered the infection under her nails, she did not complain to state regulators about possible use of MMA. In fact, it is almost impossible to discover if MMA is being used, unless the salon owner admits it.
"It is supposed to have a strong odor, but a number of manicuring products have an odor," said Nancy Hardaker, a spokeswoman for the state cosmetology program. She said the program has not had a single complaint in 10 years regarding MMA.

The program's stand is that the FDA should take the lead by issuing regulations governing manufacturers and distributors of MMA.

The FDA last year did a cosmetic ingredient review of EMA, found it safe and reinforced its recommendation that MMA not be used in nail salons. But it has not pressed further.

"It is on our radar screen, but I can't say when we will take action. Frankly, resources are an issue," said John Bailey, director of the FDA's Office of Cosmetics and Colors.
Supporters of MMA contend that if the reported health risks really existed, the FDA would pursue the matter more vigorously.

Nail product manufacturers such as Creative Nail Design, OPI Products of North Hollywood and Tammy Taylor Nails of Irvine all say their greatest fear is that the salons using MMA are endangering the industry as a whole.

"We're afraid if consumers have a bad experience, they will think that's the only kind of nail service they