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Author: Dr Ebtisam Elghblawi, Dermatologist, Tripoli, Libya. DermNet New Zealand Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. August 2019.
Professional manicure work has been recognised as a profession since the 1980s. It is a fast-growing industry popular with women and increasingly with men, as nails play an essential role in patient appearance. Billions are spent on nail salon services.
Nail salons offer manicure and pedicure treatments, acrylic, ultraviolet (UV) gel and silk or fibreglass coatings and extensions, and acrylic and UV gel-sculpted extensions. The increasing use of gel nails and sculptured nails has led to a rise in the incidence of (metha)crylate allergy among nail technicians. Methacrylate is a raw material that is used for adhesives, coatings, in the application of artificial nails, and in the gel nails, with polymerisation on exposure to UV light. Clients are exposed to volatile, strong irritants, and unstable chemicals.
People who work in nail salons are prone to skin disorders as a result of their work. Manicurists have also reported respiratory problems and headaches.
Nail salon workers are prone to skin problems because of:
The terms occupational skin disorder or occupational skin disease are used to refer to dermatological conditions that develop or worsen due to the nature of a person’s work. Skin disorders are believed to account for 40–70% of all occupational diseases. Skin disorders occur when the natural defences of the skin are compromised by mechanical, chemical or biological agents, leaving the skin more vulnerable to infections and the breakdown of the skin barrier.
Mechanical injuries may include minor abrasions and cuts, often associated with scrubbing floors or contact with other rough surfaces.
Exposure to UV radiation is known to cause premature skin ageing, wrinkles and brown spots. UV breaks the DNA strands within the cells predisposing to skin cancer  and also damages eyes [2,3]. Cutaneous squamous cell carcinoma has been reported in clients exposed to UV radiation for cosmetic nail treatment  but the risk has been calculated to be negligible [5,6].
People working in nail salons are repeatedly exposed to UV radiation each day, as nail lamps emitting UV radiation are used to speed-dry regular manicures. Typically, 3 separate coats of gel are applied, each followed by curing under UV light for 3 minutes. Nail fill-ins are often required every 2–3 weeks as the expected nail grows out, and the nails are typically replaced every 3–4 months.
Nail-curing lamps mainly emit high-intensity UV-A (95%) with a small component of UV-B (5%). UVA penetrates into the dermis and in high doses can cause damage to skin cells, photoageing, and increase the risk for skin cancer. Nail salons predominantly use fluorescent UV lamps although some use light-emitting diode (LED) lights. Exposure time to UV radiation is shorter with the more powerful LED lights.
Nail lamps deliver the same UV rays as tanning beds but have much lower power (typically 4 W to 54 W). It has been estimated that hundreds of exposures to a nail lamp are required to cause enough damage to raise the risk of skin cancer .
Some precautions are advisable:
Factors to consider in a nail salon include:
The most important piece of personal protective equipment for nail salon workers should be gloves, preferably of a non-latex type to avoid possible sensitisation to latex; nitrile gloves provide better protection than latex gloves.
The diagnosis of an occupational skin disorder should include:
The treatment of an occupational skin disorder can include:
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