Concerns over nail salon safety typically focus on the dangers of UV lights or risks of a salon-acquired infection. A brief communication published in the October Journal of Drugs in Dermatology expands the thinking on the dermatologic hazards of nail products, both those used in the salon and at home. From unexpected nail changes to allergic reactions, the authors state that dermatologists should know – and communicate to their patients – the risks of using cosmetic products on the nails.
I interviewed lead author Emma Scott, BS, fourth-year medical student at the University of Toledo Medical Center.
What led you to want to study the dermatologic impact of nail products?
While working with Dr. Burkhart at his office, I had a conversation with his secretary who previously owned a nail salon. That conversation opened my eyes to dermatologic issues secondary to nail product exposure. From that conversation, I was committed to writing on the perils of nail products. I then reached out to Dr. Elston to join us on this project, and he additionally wanted to address the topic of allergies from these chemicals. My interest has led to reaching out to policy makers to try to start making public health changes.
What are some of the expected — and unexpected — negative effects that nail polish can have on the nails?
Nail brittleness is a relatively well-known negative effect of nail polish that consumers may expect. While nail products can lead to nail thinning, they can also cause discoloration, leukoplakia, onycholysis, subungual hyperkeratosis, paresthesias, and nail infections. These less known, and therefore, more unexpected, are often more severe than nail thinning itself. Therefore, it is imperative that dermatology providers are aware of these more unexpected negative effects.
What are some of the chemicals involved in these allergic reactions and how concerned should we be about the use of these chemicals?
The most common allergen in nail products is toluene/formaldehyde resin. Other allergens include polyester resin, pigments, nitrocellulose, and Methyl Methacrylates (MMA). The most common molecule in a methacrylate patch test tray that patients react to is 2-hydroxyethyl methacrylate (HEMA). The majority of patients who have reactions to these products will develop allergic contact dermatitis that will resolve with discontinuing the use of these products. However, some patients can develop chronic dermatitis, lichenification, and psoriasiform dermatitis. Additionally, although it is rare, patients can develop systemic contact dermatitis as well as lichen planus of the nail, lymphomatoid papulosis, and others. We do need to be concerned about these products because these conditions can significantly impact quality of life and they are preventable with safer nail product practices.
You also write about the impact of nail polish on other locations on the body due to hand transfer. How common is hand transfer and how have you seen this in your clinical practice?
Data on the frequency of hand transfer of nail products is highly variable. However, it is a well-known complication in dermatology. Many providers have seen patients with allergic contact dermatitis, around the eyes especially, and have linked that back to nail products. Additionally, patch testing can also help link allergic contact dermatitis to nail product usage. In fact, HEMA is one of the 15 most common acrylate allergens for eyelid contact dermatitis.
You point out that exposure to methacrylates is occurring primarily for cosmetic uses, yet sensitization to acrylates can have more profound impacts on a person’s health. Please elaborate.
MMA can be absorbed orally, though the skin, or through inhalation. Outside of dermatologic concerns, MMA can lead to occupational asthma and rhinitis, headaches, dizziness, fatigue, and memory decline. These risks are highest amongst those who work in the nail industry and have chronic exposure.
What does research show about the risks of UV lights used in gel manicures?
The research on the risks of UV lights used in gel manicures is variable. Some data suggest that over roughly 200 UV nail light sessions are needed to reach the energy threshold to cause DNA damage. Other studies suggest this number is closer to 10,000 UV light sessions. Some data shows no relation between UV nail light usage and skin cancer. However, there are multiple cases of squamous cell carcinoma on the dorsum of the hands in people who have very extensive histories of UV nail light use. As you can see, the current data varies greatly and this needs to be further explored in order to understand the true risks of UV nail light use. On another note, people who have a history of using UV lights for nail products have a significantly higher risk of HEMA sensitization, which can lead to other dermatologic concerns.
At the end of the day, patients simply want to have nice looking nails. In light of your findings, how should a dermatologist counsel patients about the use of nail products?
Dermatology providers should counsel their patients on the risks of nail product use. Many consumers are completely unaware of the plethora of risks associated with these products. However, patients are still going to desire nice nails. In order to more safely do this, they should recommend patients look for full ingredient disclosures. If a label lists “fragrance” or “proprietary resin”, this could be covering up harmful ingredients. Patients can check nail products on independent databases, such as Skin Deep by the Environmental Working Group and Made Safe. Research also shows that products that are free from harmful chemicals have similar end results. Products should be free of the “toxic trio,” which includes toluene, formaldehyde, and dibutyl phthalate (DBP). Safer alternatives that exclude these chemicals are available, however they can be more expensive. The overall quality of the nail art is maintained, but they have a better safety profile.
Patients should also do all their nail work in a well-ventilated area. They should avoid skin contact and not touch any other body site until the product is dry and they have washed their skin. In terms of UV exposure, patients can use fingerless gloves and SPF on the dorsum of their hands for extra protection.
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