As sandal season rapidly approaches, our patients will rush to the nail salons. My current and former students know that I am an anti-pedicure kind of gal and a fan of Death by Pedicure by Robert Spalding, DPM (http://justfortoenails.com/death_by_pedicure.html  ).
Dr. Spalding has worked to change the industry by educating both the consumer and nail technicians on the infections and injuries that can occur from a salon visit. Every day in my own practice, I hear, “This nail discoloration started after I had a pedicure … I didn’t have a wart until I went to the salon … They didn’t ask if I was a diabetic,” et cetera, et cetera.
Even though I hope they never return to the nail salon, it’s unrealistic for me to expect my patients to shun the nail salon totally even when I have discussed with them the issues with pedicures and am treating them for the onychomycosis, infection or verruca that possibly came about after a pedicure. That said, how can we educate our patients to have a safer experience at the salon? The Environmental Protection Agency (EPA) offers some suggestions and even has a printable PDF that you can direct people to (http://www.epa.gov/pesticides/factsheets/pedicure.htm  ).
1. Know how the salon employees clean their instruments. Sterilization can represent a lot of things but ultimately, autoclaving is the only way of killing spores and all infective agents (bacteria, viruses, fungus, etc.). You can show your patient the paper wrapping and color change strip in your own autoclaved instruments to bring the point home visually. Also, an alternative is for patients to bring their own instruments to the salon (http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/n...  ).
2. If they have any cuts on their legs or feet or have shaved/waxed/etc. 24 hours prior to having a pedicure, people should avoid going to the salon. If people still go to the salon, they should avoid the foot spa water as circulating microorganisms can easily gain entry through a cut or abrasion in the skin.
3. I advocate no pushing back or cutting of cuticles or cleaning under the nail (at the hyponychium). These portals are there to protect the skin from microorganisms. In my practice, I have seen abscesses, onychomycosis and verruca in and around the nail unit, all originating from this practice. It is safer to keep cuticles moisturized with a cuticle cream and avoid the practice of cutting them altogether. In regard to cleaning under the nail, a gentle scrub with a nail brush is a good place to start.
4. If your patient is concerned about chemicals in nail polishes due to a history of allergic contact dermatitis either around the nail unit or eyes (we touch our eyes over 200 times a day), Clinique has just introduced a new line of nail polishes, “A Different Nail Enamel for Sensitive Skins,” (http://www.clinique.com/product/4323/25256/Just_Arrived/NEW-A-Different-...  ). It is six years in the making and is safe for both eyes and skin.
There is also a line of 3-Free (free of dibutyl phthalate, formaldehyde and toluene) nail lacquers available. These products include Butter London (my personal favorite), American Apparel, CND, Deborah Lippmann, Essie, Estee Lauder, Hard Candy, Lancome, Le Metier, M.A.C., Nars, Nicole, OPI, Priti NYC, Spa Ritual and Wet ‘n’ Wild. Some are 3-Free and also free of formaldehyde resin and camphor. These products include Chanel, Dashing Diva, Dior, Givenchy, Hopscotch Kids, L’Oreal, Nubar, Revlon, RGB, Scotch Naturals, Uslu Airlines, Zoya. See http://www.goddesshuntress.com/2012/03/30/the-list-3-free-and-5-free-nai...  .
5. If you can’t beat them, join them. The idea of opening a medical spa within or adjoining one’s practice is always a controversial topic in our profession. It is a way of ensuring that your patients are getting the salon experience they crave while having access to autoclaved instruments and a physician on the premises if a client comes in with an ulceration or other skin issue that went unnoticed. There are plenty of podiatric practices around the U.S. that have adapted this as part of their business plan. I like to think of these docs as encouraging and educating the nail technicians in their employ to provide a safe environment for their clients and encouraging legislation, ultimately to provide a salon experience with little risk.