Q. How common are nail infections?

A. 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.

Q. Bacterial and fungal infections

A. 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.

Q. What about nail salon safety?

A. The salons and their technicians are regulated by the state (in the U.S.) in which the salon or technician is doing business, usually through 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. To prevent blood-borne infections, such as HIV and hepatitis, the national Centers for Disease Control and Prevention recommended similar sanitary practices for salon employees in guidelines issued in 1985. The guidelines targeted, among others, personal-service workers, such as manicurists and pedicurists. To date, there have been no reports of transmission of blood-borne diseases to or from a personal service worker, according to CDC.

To help you decide if a salon provides sanitary nail services, nail and public health experts suggest considering the following:

  • 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, 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.
  • 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? If not, you may want to consider another salon, after all, would you eat in a dirty restaurant?
  • Is there a strong smell of fumes? If there is, it’s a sign that the facility is poorly ventilated. Inhaling the fumes from nail products can make you sick. If you have a complaint about a salon providing nail services, contact your state board of cosmetology.

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.

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. The Consumer Product Safety Commission requires 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.