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

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The Orange County Register
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