Understand your risk of allergic and irritant reactions to the products you work with and you can probably prevent problems before they start.

A nail tech since 1980, Nancy King, owner of Nail Care in; Laurel, Md., switched most of her clients over to ultraviolet (UV) light-cured gels in 1991. Six weeks later she noticed that file cuts on her fingers were red, swollen, and sore, but she didn't make a connection then between the irritation on her fingers and the fact that she was using a new product.

“The cuts would get worse as the week progressed, begin to heal over my days off, and then get worse again when; I went back to work,” she recalls. By May the condition had worsened to the point that a friend's child commented that her fingers looked like “hot dogs that had split in the microwave.” King sought out a dermatologist, who told her she had eczema.

“One day I laid my arm down on my table and I got some gel on it,” she says. “I wiped it off and washed the area, but: an hour later the area on my arm looked like my fingers.” She called the product manufacturer, who told her that she had very likely developed an allergy to gels, and recommended that she avoid all contact with them. Back she went to the; doctor, who this time diagnosed allergic\contact dermatitis. She heeded the manufacturer's and doctor's advice to switch; products and went back to acrylics. The rash eventually cleared, but 10 years later she still breaks into hives even when she breathes the vapors from a UV system. Happily, King reports she's developed no problems with other products she uses.

Less fortunate is Cheryl Dietz, a salon owner of 25 years. A year ago one of her pinkies became swollen and started peeling. She just happened to be going on vacation, but over the following week the condition worsened and spread to other fingers. "It went all through my hands; I couldn't peel a potato or fold laundry. I thought, 'I am in deep trouble here,"' she says. What was ultimately determined to be allergic contact dermatitis forced Dietz to cut her work schedule to live hours a day and necessitate double-gloving her hands. Those accommodations worked until a few months ago, when guilt led her to start working more and more clients back into her schedule, stretching time in the salon from five to six to seven, sometimes eight hours.

“When my hands broke out in January I thought I had slipped up with gloves, perhaps got a little hole,” she explains. “But the doctor says the reaction now is systemic and is caused by breathing the vapors.”

After 25 years of sculpting acrylics, Dietz isn't sure she's able or willing to try switching to a different system or going to natural nails only. “I don't think I can stay in my salon because just breathing the product makes me react,” she says. “And I'm 12 years old and I've owned my salon for 25 years. I've never had a boss! I don't think I could start over with a new system in a new salon trying to get a whole new clientele. I'm going to cut my hours back again, but I think I will end up having to leave the salon.”

Could It Happen to You?

King and Dietz share their stories not to scare their peers, but lo alert others to the very real, but controllable, risk of allergic reactions to nail products. While not “hazardous” or “unsafe” in normal salon usage with proper work practices, the products nail technicians work with do contain chemicals that are known allergens and irritants. According to the National Institute of Occupational Safety and Health (NIOSI1), acrylates— such as ethyl methacrylate in monomers and cyanoacrylate in nail adhesives—can cause contact dermatitis, asthma, and allergies in the eyes and nose.

If you are already genetically predisposed to developing an allergy, the odds that you will do so increase each time an allergen comes in contact with your skin. Even those who aren't at risk of developing an allergy may develop an irritant reaction from overexposure to products commonly found in the salon.

Even more to the point, there's no way to tell in advance whether or not you're likely to develop an allergy to the products you use. “We think there is some genetic susceptibility to allergies, but... it also has to do with the quantity of contact and the inherent protection of the skin,” explains Jonathan Bernstein, M.D., an associate professor of medicine at the University of Cincinnati College of Medicine, division of immunology and allergy.

Nor is it just your skin at risk: Asthma is on the rise in the United States, with occupational asthma (so-called because it's triggered by substances most often found in the work environment) accounting for 5%-15% of all reported cases. While the experts we consulted emphasize that nail technicians are in a lower-risk category, Dr. Bern stein notes there have been at least a few cases reported of nail technicians who developed asthma triggered by exposure to MMA and EMA. Too, NIOSH's 1997 study of ventilation in nail salons was triggered by a request by the Colorado Department of Health because of a surge in reported cases of occupational asthma in nail technicians.

Your work products are no more a threat to your health than the products you use to clean your home, fertilize your lawn, wash your clothes... but just as you take care to protect your skin and lungs from coming into contact with chemicals in your personal life, so too should you in your work. You probably don't wash the tub out with cleaner without wearing gloves; you should be as cautious in handling chemicals at work. You should not only understand the causes and symptoms of contact dermatitis and occupational asthma, but you should know how to minimize your risks for developing them as well.

Avoid Rough and Red-y Hands — Contact Dermatitis

In its earliest stages, contact dermatitis appears as mild redness and itching, symptoms easy to overlook during busy times or the dry, cold weather of winter when hands tend to be dry and chapped anyway. As contact dermatitis worsens, the itching and redness may intensify and spread, localized swelling may develop, and small blisters may appear. Ultimately, the skin may crack and bleed. While there are no statistics on contact dermatitis in the beauty industry, Boris Lushniak, M.D., medical officer and dermatologist for NIOSH, says when it comes to contact dermatitis, doing nails is a high-risk industry.

Contact dermatitis is the skin's reaction to a substance that either irritates the skin (called an irritant) or triggers an allergic response of your immune system.

“With irritant contact dermatitis you get an immediate reaction due to local damage to the skin cells," explains Debra Marr-Leisy, director of R&D for IBD (Gardena, Calif.). "With allergic contact dermatitis, it's a reaction of the immune system where the allergen binds to a protein in the body's cells. The immune system for some reason identifies the allergen as an invader and builds up antibodies against it.”

Why some individual's immune systems overreact and attack otherwise harmless substances isn't quite understood, say doctors. However, with each exposure to an allergen, the immune system builds up more and more antibodies against it, hence the body's increasingly severe reactions to subsequent exposures.

NIOSH estimates that, in general, four out of five cases of contact dermatitis are caused by irritants. Differentiating between an irritant and allergic reaction to a nail product containing a known allergen (in the salon these would include acrylics, gels, cyanoacrylates, and nail polishes containing formaldehyde) is challenging even for physicians because the symptoms are the same.

Nor does the test of time apply: “You can become allergic after 10 or 20 years,” Dr. Lushniak says. “Your immune system changes as you age, so cells may be more sensitive. You may have spent 15 years working with a product and then 'suddenly' develop allergic contact dermatitis because of severe dry skin that allows the allergen to get into your body in a large enough amount.”


“The only way to diagnose an allergy is to patch test the patient,” explains Toby Mathias, M.D., a staff dermatologist with Group Health Associates as well as a clinical professor of environmental health and associate clinical professor of dermatology at the University of Cincinnati. Dr. Mathias cautions against attempting to patch test yourself or a coworker or client, however, as the tests should be done by a physician under controlled conditions with diluted solutions of the suspect substances. For example, if the suspect chemical is not diluted properly the solution could cause an irritant reaction that mimics an allergic reaction or it could cause the individual to develop an allergy from overexposure where there was no allergy before.

Whether triggered by an irritant or allergen, once started, contact dermatitis can linger stubbornly for days, weeks, or even months after you remove the offending substance from your environment. “Once you have a breakdown of the skin's barrier, exposure to things that otherwise may not have caused a problem now will because the skin has been injured,” explains Mark Dykewicz., M.D., associate professor of Internal Medicine and director of a training program in allergy and immunology at the St. Louis University School of Medicine.

Regardless of the cause, the symptoms are the same, although an allergic reaction will tend to become worse with repeated exposure. “There's a good chance that the first signs will be just a little bit of reddening to an area and perhaps some light itching,” Marr-Leisy notes. Watch for those warning signs.

“As a manufacturer, we're always looking at new ingredients that are less irritating and that cure more completely,” she adds. “The problem is we're caught between a rock and a hard place in that larger molecules, which are less allergenic, react more slowly, increasing the length of exposure.” What it all boils down to, she says, is minimizing your exposure (more on that later).


At the first sign of contact dermatitis, you need to start trying to identity what is causing the reaction. This often will be a process of elimination. Second, you need to treat the symptoms. Milder cases of contact dermatitis can be treated with a good moisturizing lotion and, if necessary, an over-the-counter topical steroid preparation, says Dr. Mathias. More extreme reactions or ones that resist these at-home treatments require treatment with a prescription medication.

Breathe Easy — Occupational Asthma

Asthma is a disease in which the airways become blocked or narrowed, causing symptoms that range from shortness of breath, chest tightness, wheezing, and breathing trouble. Here's how it works: When you breathe, air travels into the body into the trachea (also called the “windpipe”). From the trachea air enters a series of smaller tubes, called the bronchi, which branch off from the trachea. The bronchi branch off into still smaller tubes call the bronchioles. When the airways (nose, mouth) come into contact with an asthma trigger, the tissue inside the bronchi and bronchioles becomes inflamed. At the same time, the muscles on the outside of the airways lighten up, causing the airways to narrow. Mucus entering the airways narrows them even further, and breathing is hampered.

“Everyone's airways constrict somewhat in response to irritating substances like dust and mold,” explains Colleen Horn, a spokesperson for the Asthma and Allergy Foundation of America. “But in a person with asthma the airways are hyper-reactive. This means that their airways overreact to things that would just be minor irritants in people who don't have asthma.” Some common asthma triggers include pollens and mold, cigarette smoke, perfumes, and exercise. Occupational asthma differs from asthma only in that a substance in the work environment triggers it.

“Lots of chemicals can induce irritant asthma or RADS [Reactive Airways Disease),” says Dr. Bernstein. “Individuals can form a hyperactive bronchial reaction after a single 'hyper' exposure or chronic low-level exposure.”

By the same token, Emil J. Bardana Jr., M.D., an allergist at Oregon Health Sciences University, department of allergy and immunology, and the president-elect of the American College of Allergy, Asthma and Immunology, doesn't believe that nail technicians have a significantly increased risk of developing occupational asthma because their chemical exposures are lower than those in industrial settings. “Although acrylics do have certain kinds of chemicals that can cause asthma, it's not rampant,” he says.


Dr. Bardana says that those at high- risk for developing asthma in the salon are those who already have asthma that is irritated by the dust and vapors from nail products and those who had asthma or respiratory problems as a child that is re-triggered by exposure to salon irritants or allergens.

Diagnosing occupational asthma can be challenging as the doctor has to determine what is triggering the attacks. “Diagnosis of occupational asthma depends on many factors,” Dr. Bardana says.

“We have to be very careful when making this diagnosis,” Dr. Bernstein explains. “We do it through taking a careful history, by physical examination, and by studies that use the work as a provocateur of the condition.”

Prevention Is the Best Medicine

The experts NAILS consulted urge nail technicians to take a proactive approach in preventing workplace illnesses rather than reacting to conditions as they occur. “There's a wide variety of agents in a beauty salon that might cause reactions with the skin or lungs,” says Dr. Dykewicz. “And there is reason to be concerned about minimizing your exposure. In general terms, the first rule of allergies is avoidance and reduction in exposures.”

In particular, Cherie Estill, an industrial engineer involved in NIOSH's study of nail salons, urges nail technicians to use a ventilation system or table that removes salon air to the outside along with an HVAC system that pulls fresh air into the salon. “On the vented table we put together, the face of the ventilation was about 4 inches by 13 inches, and the fan was fairly small, about 1/8-horsepower,” Estill says. “That gets the air close to where the nails are done so that it never gets into the worker's breathing zone. In our study, we saw about a tenfold decrease in nail technician's exposure [to vapors and dust by using this kind of ventilation system].”

While many salon owners cringe at the cost of developing or buying such a venting system, Estill says adding localized ventilation to a salon should be relatively inexpensive and in many cases can be retrofitted to existing workstations. To help salon owners, NIOSH published “Controlling Chemical Hazards During the Application of Artificial Nails,” a four-page pamphlet that details the procedure and required equipment to add local ventilation as well as other helpful hints on work habits to keep your salon air clean. These recommendations include common sense recommendations:

•Cap product between uses and use dispenser bottles with pressure-sensitive stoppers to minimize evaporation.

•Place monomer-soaked towels and pads in a sealed bag before putting them in the trash.

•Use covered trash cans and change the liners daily.

•Wash your hands, arms, and face with mild soap and water several times throughout the day to remove potentially irritating dust.

•Prohibit eating or drinking in the work area (dust can settle in food and drink and be injested that way).

•Ban smoking in the salon.

Wearing personal protective clothing such as long-sleeve shirts is also helpful, but if it's not a good option for you, Dr. Dykewicz recommends at the least minimizing skin contact by cleaning your workstation and changing your towels after each client (which is the minimum acceptable sanitation standard anyway). And, when you do come in contact with, say, acrylic monomer, immediately wash the area with soap and water.

This Doesn't Have to Mean Goodbye

By the time a nail technician seeks professional medical help, Dr. Mathias says, the condition is usually causing a lot of discomfort. Accordingly, at this point he and the other doctors we asked often recommend a change of careers to their nail technician patients as the best alternative when an allergy is diagnosed.

“People don't always want to try something else after all they've invested in their careers, but even if they wear gloves, working around the problem constantly is very difficult." Dr. Mathias continues, "Even if you wear gloves, for example, it's so easy to unconsciously push your hair back with your hand and get product on your face.”

However, Nellie Brown, state director of the workplace safety and health program at Cornell University's School of Industrial Labor Relations, disagrees. “This isn't just a livelihood for most people in the beauty industry,” she argues. “It has its own special rewards. Certainly if someone's asthmatic attacks are life- threatening that person may have to leave the business, but 1 would suggest alternatives. I would look for industrial hygiene services and get some good advice. Get someone to examine product formulations and see what options you have. There's plenty of expertise out there. I do believe it's possible to go on doing your job, as long as you use the proper procedures and controls.”

For people complaining of skin reactions, Brown's first approach is to review the person's work habits while beginning a search for an alternative product. “I usually find that's doable, in particular if I can get information on what's in the product. Oftentimes the manufacturer may have another item that's perfectly acceptable.”

If she can't find a substitute, Brown's next step is to introduce protective work practices and equipment. “The allergic reaction to these materials happens before they polymerize, so I would suggest you look very carefully at your work processes. Flow does it get on your skin? Is it an aerosol? Are you contacting the edge of the container?” She recommends asking a coworker to observe you working over the course of an appointment or a day because that person may observe many contacts with product that you don't even notice because they're so habitual.

As for respiratory problems such as occupational asthma, Brown reminds that some responses to odors are the body's learned response, “To see if it's a true reaction of the immune system, increase the ventilation to reduce the odor threshold so that the learned response won't trigger,” she advises. “Look to make sure fresh air is coming from above or behind you. With occupational asthma, though, once you become sensitized to an ingredient, you respond at such low levels.” By the same token, she cautions people to make no assumptions about what the trigger could be. “If you're in a full-service salon you could well be responding to something on the hair side,” she notes.

Equally important to these steps is partnering with the right doctor. “Most of the time when people go to the average doctor he doesn't have the expertise in occupational exposure,” Brown explains. “The issue never gets addressed at the source. I would ask for a referral to someone who specializes in these issues or get a referral to someone who is board- certified in occupational medicine.”

Finally, be your own advocate: “I would immediately formulate the hypothesis that it's work-related until it's proved it's not,” Brown says. “Pay attention to reactions early on and work on solutions immediately, thinking as creatively as possible.”


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