By Michelle Bengal
As a woman who regularly receives manicures and other salon services, I am familiar with the products and circumstances present in such establishments. One might know that acrylic nails are not necessarily healthy, but falsely assume that they cause minimal harm, as the products are attached to the nail beds and are changed on a monthly basis. The recipients of manicure and pedicure services should not be concerned, but rather the technicians who perform these services, inhaling chemicals found in common solvents, glues, and shellac polishes. Many nail technicians accumulate both short and long-term pathology due to constant exposure to airborne volatile chemicals, insufficient ventilation, and a lack of personal protective equipment (PPE). Research studies show undeniable evidence that the conditions present in nail salons directly produce reproductive, respiratory, and oncological issues in the nail technician community, which mostly consists of immigrant women of Asian descent.
The nail salon industry brings in a whopping 48.2 billion dollars a year, with over 54,000 established in the US, and counting. There are around 380,000 nail technicians, most of whom are uneducated immigrants earning an average salary of $29,000 annually. According to a study assessing work-related symptoms, perceived knowledge, and attitude among nail salon technicians, 84% of respondents demonstrated an inaccurate knowledge of nail cosmetics’ risk. Most are unaware that the level of total volatile organic compounds (TVOC) that they inhale daily is comparable to that emitted by gas lines.
Moreover, the lack of personal protective equipment usage and other safety mechanisms pose serious risks to salon workers. Post-pandemic, it is understood that the usage of gloves and masks are imperative in substance-body isolation when breathing in contaminated air. Additionally, because many of these chemicals regularly cause adverse dermatological reactions and rashes, the wearing of long sleeves can actively prevent dermal exposures.
There are innumerable organic compounds, carcinogens, and toxic chemicals present in this line of work, but the most prevalent and threatening include toluene, ethyl acetate, high levels of carbon dioxide, ethyl methacrylate, formaldehyde, and benzene. Toluene is a toxic chemical that is found in nail lacquers and glues. According to the CDC, it is “irritating to the skin, eyes, and respiratory tract and can cause systemic toxicity by ingestion or inhalation and is slowly absorbed through the skin.” Worsened symptoms include stumbling, irregular heartbeat, fainting, or even death. Ethyl acetate, found in nail polish removers and base coats due to its thin and basic film-forming properties, is flammable and highly toxic when ingested or inhaled. Such exposure can be seriously damaging to internal organs, form allergic reactions, and have chronic respiratory effects. In a combined research study that monitors TVOC levels in Boston nail salons, there was a discernible presence of organic chemicals in the air after analysis of the gas chromatography. More concerningly, it was found through a comparison of pre-shift and post-shift blood sampling that toluene and ethyl acetate actively penetrate technicians throughout their shifts. One individual had a blood VOC concentration of toluene of 0.2 micrograms per liter preshift, and a level of 0.8 micrograms per liters post shift. Another individual attained a blood VOC concentration of ethyl acetate of 0.3 micrograms per liter pre-shift, with a spike to 1.45 micrograms per liter post-shift.
Another risk factor is the high presence of carbon dioxide gas in nail establishments. Excessive inhalation of carbon dioxide is known to cause sleepiness, anxiety, and impaired cognitive function. Following the release of information that 15 out of 21 surveyed salons exceeded 800 parts per billion in TVOC concentrations, defining them as having insufficient ventilation, there is a reasonable means for concern. For instance, when no services were taking place, there was a level of less than 1,000 ppb of TVOC and CO2 concentration, compared to 12,000 ppb while services were occurring. Although one might hypothesize that TVOC and CO2 levels would be more concentrated by manicure stations where the actual services take place, that is incorrect, as research shows that levels were elevated equally throughout entire salons.
Ethyl methacrylate (EMA), is an additive in artificial nail enhancements, such as acrylic nails. Ethyl methacrylate is known to cause nose and throat irritation alongside asthma-like symptoms. In a study conducted in 2002 by the Cosmetic Ingredient Review Expert Panel where mice were exposed to EMA, findings concluded positive evidence of mutagenicity in a lymphoma cell assay and case reports cite examples of individuals suffering from rashes upon exposure.
Lastly, benzene and formaldehyde which are found in removers and hardeners, are classified as genotoxic class one human carcinogens, collectively causing symptoms such as rashes and wheezing alongside damage to lung function and chromosomal mutations in bone marrow cells. In a comet assay, a test that detects chromosomal aberrations, studying gasoline workers exposed to Benzene, research suggests that they suffer from “increased DNA fragmentation, higher frequency of micronuclei and decreased leukocyte viability.” Moreover, the National Cancer Institute states that formaldehyde causes myeloid leukemia and other cancers in the paranasal sinuses, nasal cavity, and nasopharynx.
There are three primary long-term effects to consider regarding nail technicians’ line of work: reproductive disabilities, occupational asthma, and the formation of cancer.
In a study on the occupational risks among Asian nail salon workers, many symptoms were found across the board, such as headaches, lightheadedness, irritation to the eyes, nose, skin, and throat, and most alarmingly an 11.7% rate of at least one miscarriage. In another study on spontaneous abortions, researchers outlined a direct correlation between spontaneous abortion and the number of hours worked per day in conjunction with the number of services performed per week. Additionally, due to their phthalate inhalation and disproportionate exposure, birth defects and various adverse effects on reproductive health and development are fairly common in nail technicians. The CDC adds that “women who breathed high levels of benzene for many months had irregular menstrual periods and a decrease in the size of their ovaries.”
Next, occupational asthma is common in nail salon workers. It can be defined as circumstantial asthma triggered by exposure to inhaled irritants in the workplace, meaning that irritation should subside when the causes of asthma are avoided. Consequently, a dual asthmatic reaction was observed in the bronchial provocation test, in which the patients simulated their work using their own products which include methyl acrylates, and reported chest tightness, coughing, and wheezing. Despite this specific study conduction occurring on a smaller scale, there are larger studies that studied exposure to methacrylates in dental technicians and found significant increases in adult-onset asthma.
Lastly, cancer, which is inevitably caused by factors experienced out of moderation, can come in all sorts of colors and sizes. As mentioned earlier with respect to TVOC levels, the concentrations of organic compounds in nail salons were comparable to those measured in studies of oil refinery and auto garage workers. Based on this, a handful of cancer risk models display that 20 years of exposure to formaldehyde and benzene are a surefire way to inhibit the development of cancer. The Department of Health and Human Services states that benzene causes cancer in humans, specifically leukemia, and this study concurs that adding formaldehyde is associated with squamous cell carcinoma, nasopharyngeal cancer, Hodgkin’s lymphoma, and leukemia.
While nail salons are extremely common and provide a pampering experience, there are necessary preventative measures that need to be taken in order to reduce the risks posed to nail technicians. Some safety precautions include enforcing proper PPE, improving ventilation, instating bans against the usage of certain products, and enriching the curriculum of nail specialty licensing to gain awareness. Other than prioritizing the usage of PPE, ventilation can be improved via opening windows, installing fans, and investing in a portable air cleaner, fume extractor, and nail dust collector machines, which are designed specifically for nail salons. Even something as simple as introducing raw charcoal into the environment, being that it is porous in structure and can collect bacteria, harmful pollutants, and allergens from the air, is a step in the right direction. Also, bans and regulations can be implemented on a government level, just as NYS has, which undeniably limits the risk factor. Since 84% of nail technicians report not knowing the genotoxic effects and risks of their job, it is crucial to reconstruct the education learned during licensing and inform those who are already involved in the profession of the genotoxic effects. Together, these actions can reduce the risk of abnormalities and diseases.
*** ***
Sources:
https://emergency.cdc.gov/agent/benzene/basics/facts.asp.
https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/formaldehyde
https://www.statista.com/topics/4624/nail-salons-in-the-us/#dossierKeyfigures
https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=157&toxid=29
https://www.hopkinsmedicine.org/health/conditions-and-diseases/asthma/occupational-asthma
https://pubmed.ncbi.nlm.nih.gov/32909894/
https://pubmed.ncbi.nlm.nih.gov/23765035/
https://pubmed.ncbi.nlm.nih.gov/31112343/
https://pubmed.ncbi.nlm.nih.gov/12042061/
https://pubmed.ncbi.nlm.nih.gov/29070767/
https://pubmed.ncbi.nlm.nih.gov/31297649/
https://pubmed.ncbi.nlm.nih.gov/8172989/
https://pubmed.ncbi.nlm.nih.gov/31906553/
https://pubmed.ncbi.nlm.nih.gov/18702110/