Fingernails:
Looking Good While Playing Safe

With the ease that comes from years of practice, Julie Le, of Nails R Us in Alexandria, Va., sets out to remake customer Natalie Harris' nails. She buffs, files, snips, clips, smooths, and then, with a nod from Harris, paints on ruby red polish.

It's a process repeated every day throughout the country as thousands of women like Harris--and men, too--strive for beautiful nails. They seek the services of nail and beauty salons or manicure their nails themselves with a host of nail products available on the market.

The reason, said Kim Siridavong, owner of Nails R Us, is simple: "Everybody wants to look good."

But achieving that look is not without potential hazard. Infections and allergic reactions can occur with some nail services and products. Some chemicals in nail products, if ingested, are poisonous. Many are flammable.

Relying on nail and beauty salons is not risk free, either. They use the same products, and they may present a greater risk for disease transmission.

Federal and state regulations help reduce the risks, but consumers also need to take care that their pursuit of beautiful nails ensures healthy nails.

Growth of an Industry

With the increased use of nail services and products in recent years has come growing concern about safety. According to Nails 1995 Fact Book, U.S. consumers will spend an estimated $5.2 billion on nail services in 1995, half a billion more than in 1994. They can choose from 34,852 freestanding nail salons across the country--nearly 2,000 more than a year ago--or hundreds of thousands of beauty salons that offer nail services.

The most requested service, according to the Fact Book, is artificial nails. Manicures are No. 2. Other popular services include nail jewelry and nail art.

Because of the variety of nail services, the preferred term for a person who provides nail services is "nail technician" rather than manicurist, said Suzette Hill, managing editor for Nails, a magazine for professionals and students.

"Twenty years ago, they mainly did manicures," she said. "Now, they're doing so much more."

They use a range of products, including polishes, paints, artificial nails, glues, and laminates, many of which are available for home use, too.

Nail Products as Cosmetics

Nail products for both home and salon use are regulated by the Food and Drug Administration. Under the Federal Food, Drug, and Cosmetic Act, these products are considered cosmetics because they are "articles other than soap which are applied to the human body for cleansing, beautifying, promoting attractiveness, or altering the appearance." (See "Cosmetic Safety: More Complex Than at First Blush" in the November 1991 FDA Consumer.)

By law, nail products sold as cosmetics in the United States must be free of poisonous or deleterious substances that might injure users under the usual or customary conditions of use intended by the manufacturer. These uses are printed on the package or on a package insert. Many nail products contain poisonous substances, such as acetonitrile in glue removers, but are allowed on the market because they are not harmful when used as directed. They're poisonous only when ingested, which is not their intended use.

Products sold for home use also must be labeled properly, with the names of the ingredients listed in descending order of predominance. (See "Decoding the Cosmetic Label," originally printed in the May 1994 FDA Consumer.)

FDA does not review or approve nail products and other cosmetics before they go on the market. However, the agency inspects cosmetic manufacturers and samples and analyzes cosmetics as needed. If a safety problem arises, the agency can take legal action against the product.

FDA also tracks safety problems through its Cosmetic Voluntary Registration Program, in which cosmetic manufacturers voluntarily report to FDA the types of adverse reactions their customers have reported to them. FDA uses this information to determine a baseline reaction rate for specific product categories, such as cuticle softeners, nail extenders (artificial nail ends), and nail polishes. The agency gives this information to participating companies so they can compare their adverse reaction rates to FDA's determined baseline.

FDA also learns about potentially harmful products from manufacturers' competitors, consumers, doctors, and nail technicians, who report adverse reactions directly to the agency.

Salon Safety

The salons and their technicians are regulated by the states, usually their cosmetology boards. Lois Wiskur, past-president of the National Interstate Council of State Cosmetology Boards, said that as far as she knows, every state has some type of licensing requirements for nail salons, nail technicians, or both.

Under these requirements, salons providing nail services usually must meet certain requirements, such as:

• Employing nail technicians who have had a minimum number of hours of classroom and practical training.

• Properly sterilizing manicure implements. The preferred methods are autoclaving (heat sterilization) or chemical sterilization.

• Undergoing a state inspection periodically.

• Maintaining sufficient equipment, such as at least one manicure table and one sink that runs hot and cold water.

• Making sure that employees wash their hands before beginning work on a customer.

Nail Infections

More common nail problems, dermatologists report, are infections from bacteria, such as Staphylococcus; fungi, such as Candida (also known as yeast); and skin viruses, such as warts.

Bacterial and fungal infections frequently result from artificial nails, whether applied at home or in a salon. A bump or knock to a long artificial nail may cause it to lift from the natural nail at the base, leaving an opening for dirt to get in. If the nail is reglued without proper cleaning (with rubbing alcohol, for example), bacteria or fungi may grow between the nails and spread into the natural nail.

Also, as the natural nail grows, an opening develops between the natural nail and artificial nail. If this space is not filled in regularly, it can increase the chances for infection.

A fungal infection can take hold when an acrylic nail is left in place too long--such as three months or more--and moisture accumulates under the nail.

Bacterial, fungal and viral infections also can occur from using insanitary nail implements, especially in a salon, where the same implements are used on many people.

Unclean implements are especially dangerous if the skin around the nail is broken. This can occur with overzealous manicuring--if, for example, too much of the cuticle is cut or pushed back too far. If the cuticle is cut or separated from the fingernail, infectious agents can get into the exposed area. This is why dermatologists recommend leaving cuticles intact.

Symptoms of an infection include pain, redness, itching, and pus in or around the nail area. Yellow-green, green, and green-black nail discolorations are signs of a Pseudomonas bacterial infection. A blue-green discoloration signals a fungal infection.

If an infection appears while wearing artificial nails, they should be removed and the area cleaned thoroughly with soap and water. If symptoms persist, the person should consult a doctor, who may prescribe a topical or oral anti-infective medicine.

There are no approved nonprescription products to treat fungal nail infections, and over-the-counter products to treat other types of fungal infections should not be used for nail infections. In a review of OTC antifungal products, FDA found that fungal infections of the nails respond poorly to topical therapy, partly because of the nail's thickness. So, in 1993, the agency ruled that any OTC product labeled, represented or promoted as a topical antifungal to treat fungal infections of the nail is a new drug and must be approved by FDA before marketing. This rule, which went into effect in 1994, does not include prescription antifungal products.

Despite the rule, some companies continue to sell unapproved OTC nail products, such as nail glues, with antifungal claims. FDA has warned these companies it might take legal action if they don't stop selling the products.

Allergies and Other Hazards

Other common problems associated with nail products are allergic reactions, such as contact dermatitis, a skin rash characterized by redness and itching and sometimes tiny blisters that ooze. (See "Contact Dermatitis: Solutions to Rash Mysteries" in the May 1990 FDA Consumer.)

Certain nail ingredients are known for their tendency to cause allergic reactions. Residual traces of the basic building blocks of acrylic resins ("acrylics") used in artificial nails, for example, can cause redness, swelling and pain in the nail bed. In some cases, the reaction is so severe that the natural nail separates from the nail bed, and although a new nail usually grows in, it may be imperfect if the nail root has been damaged.

Nail strengtheners that contain "free formaldehyde" may cause an irritation or reaction, as can certain other chemicals in nail glues and polishes.

In the late 1970s, use of methyl methacrylate, then a common ingredient in artificial nail products, resulted in FDA receiving a number of reports of injuries and allergic reactions, including damage and deformity of fingernails and contact dermatitis. The ingredient now is rarely used because of legal action against a former manufacturer of methyl methacrylate-containing products and numerous seizures and recalls of such products. Methyl methacrylate has since been replaced with other chemicals, such as ethyl methacrylate. However, according to John Bailey, Ph.D., acting director of FDA's Office of Cosmetics and Colors, the replacement chemicals have never been fully studied for safety, and they may be as harmful as methyl methacrylate.

"Our current guidance is that products containing ethyl methacrylate should be used only by trained nail technicians under conditions that minimize exposure and skin contact because of their potential to cause allergies," he said.

Whatever the cause, allergic reactions usually take place where the product has been applied or where it has inadvertently come in contact with other skin surfaces, such as the face, eyelids and neck.

When the offending agent is no longer used, reactions clear up. Sometimes, the user can identify the chemical causing the allergic reaction and avoid it.

Though rare, some nail products can cause illness and even death, particularly if ingested by children. In 1987, a 16-month-old toddler died of cyanide poisoning after swallowing a mouthful of solvent used to remove sculptured artificial fingernails. At least one other youngster was rushed to the emergency room for intensive care after swallowing a similar product. These products contained acetonitrile, a chemical that breaks down into cyanide when swallowed. Since 1990, the Consumer Product Safety Commission has required household glue removers containing more than 500 milligrams of acetonitrile in a single container to carry child-resistant packaging. This includes glue removers for artificial nails.

Nail products also can be dangerous if they get in the eyes. And they can easily catch on fire if exposed to the free flame of the pilot light of a stove, a lit cigarette, or even the heating element of a curling iron.

Consumers should read labels of nail products carefully and heed any warnings.

Healthy Nails

From current consumer habits, one might surmise that the main function of nails is to look good. But nails serve several physiological purposes: They enhance fine touch and fine motor skills and protect the fingers and toes. Doctors also may examine them for indications of serious underlying diseases; for example, clubbed nails (a condition in which fingers or toes thicken and the nails wrap around them) is a classic sign of chronic lung and heart disorders. For those reasons, it's important to keep nails healthy.

With proper care and precautions, nails can be both healthy and attractive.

Paula Kurtzweil is a member of FDA's public affairs staff.

Precautions for Artificial Nails

• If there is any question about sensitivity to the materials in artificial nails, have one nail done as a test and wait a few days to see if a reaction develops.

• Never apply an artificial nail if the natural nail or skin around it is infected or irritated. Let the infection heal first.

• Read the directions for do-it-yourself nails before applying them, and follow the directions carefully. Save the ingredient list for your doctor in case you have an allergic reaction or other injury.

• Treat your artificial nails with care. They may be stronger than your own, but they still can break and separate. Try not to bump or knock them. Find new ways to do ordinary tasks, like using a pencil to dial or depress the numbers on the phone.

• If an artificial nail separates, dip the fingertip into rubbing alcohol to clean the space between the natural and artificial nails before reattaching the artificial nail. This will help prevent infection.

• Never use household glues for nail repairs. Use only products intended for nail use, and follow directions.

• Don't wear artificial nails for longer than three months at a time. Remove them for one month to give nails a rest.

• Keep nail glues and other poisonous substances out of the reach of children.

Selecting a Safe Nail Salon

• Is the salon licensed? Licenses often are posted. If you don't see one, ask.

• Are the nail technicians licensed? These licenses also are usually posted. Ask if you don't see one for your technician.

• How are nail implements sanitized? Autoclaving (heat sterilization) is best, says Ralph Daniel, M.D., a dermatologist in Jackson, Miss. 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? 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.

Reporting Adverse Nail Product Reactions

FDA's Center for Food Safety and Applied Nutrition, Adverse Events Reporting System (CAERS) by phone at 301-436-2405 or by e-mail at CAERS@cfsan.fda.gov.