Nail aesthetics have always been associated with beauty and status, and artificial nails have become a popular choice for those seeking trendy and polished nails. Advances in cosmetic ⁽¹⁾ techniques have made these nails more accessible and customizable. However, using artificial nails carries various risks, ranging from chemical exposure and allergic reactions to mechanical trauma and infections. These risks affect not only the users of artificial nails but also the professionals who apply them.

 Note: “Artificial nails” or “nail cosmetics” used in this article refer to enhancements such as gels, acrylics, wraps, and extensions.

Nail Styling and Associated Health Concerns

Nail Tips
Nail tips are pre-fabricated nail extensions glued to the client's natural nail, facilitating an instant lengthening effect. Though convenient, they can cause several issues, such as:

• Onychoschizia (nail splitting) due to the rigid nature of the tips.

• Onycholysis (detachment of the nail) due to loss of flexibility of nails.

• Allergic reactions, such as dermatitis from the cyanoacrylate glue used for bonding.

Nail Wraps

Nail wraps are overlays made of materials⁽²⁾ such as linen, silk, or fiberglass, secured with glue and acrylic. Primarily used for reinforcing split nails, they are considered relatively safe and pose relatively fewer adverse effects.

Sculptured Nails

•  Sculptured nails are custom-designed using acrylic or gel applied directly to roughened nail plates. The materials used in acrylic nails, such as ethyl and isobutyl methacrylate, can result in issues like:

• Allergic dermatitis, especially due to the HEMA (2-hydroxyethyl methacrylate) compound in the liquid monomers.

• Over-filing or excessive wear as a result of mechanical trauma.

• Paresthesia (tingling or numbness), though relatively rare.

• Psoriasiform onychodystrophy, which mimics psoriasis.

Contact burns from accidental spills of methacrylate.

Gel Nails
 Commonly used for cosmetic corrections, gel nails also carry risks, including:

Contact dermatitis, often due to HEMA.

• Infection of the nail fold (paronychia), usually seen with nail dystrophy (abnormal nail growth).

• Onycholysis (nail separation) and thinning.

• Pseudo-psoriatic nails, resembling psoriasis, especially with long-term use.

HEMA: Main Allergen in Nail Products

HEMA (2-hydroxyethyl methacrylate) is the most potent allergen in many nail products, including acrylics and gels. This highly sensitizing acrylate paves the way for many allergic reactions and is increasingly being recognized as a concern, particularly for professionals in the nail industry. Due to its potential for causing significant allergic responses, the EU (European Union) implemented a restriction in 2020, limiting its use to professional applications only.

Heavy Metals as Constituents of Nail Cosmetics: Raising Concern

Certain nail cosmetics contain trace amounts of heavy metals, such as lead, arsenic, cadmium, and mercury. These metals enhance pigmentation and durability, but they pose significant health risks with prolonged exposure:

• Lead and arsenic – potential to influence systemic health, such as neurological and reproductive diseases.

• Cadmium – linked to kidney damage and respiratory issues.

• Mercury – rare in nail products but may cause skin irritation and long-term toxicity.

Prolonged and repeated exposure to these heavy metals, especially for professionals working with nail products, can result in toxic accumulation in the body, highlighting the importance of safety precautions and opting for heavy metal-free formulations.

Discussing the Occupational Hazards Among Nail Technicians

• Ergonomic risks and musculoskeletal pain caused by prolonged sitting and awkward postures.

• Chemical toxic substances like formaldehyde, toluene, and phthalates can initiate respiratory and skin diseases.

• Biological concerns, such as injuries and transmissible infectious diseases due to unsterilized tools.

To mitigate these hazards, protective measures like wearing gloves, masks, and goggles, along with ensuring adequate ventilation in salons, should be mandatory.

Rare Adverse Effects of Nail Cosmetics

•  Desquamative gingivitis (gum inflammation) from the formaldehyde resin in nail polish.

• Altered sperm motility related to dibutyl phthalate in nail polishes.

• Acute toxicity from gamma-butyrolactone in nail polish remover.

• Paresthesia and respiratory issues associated with acrylates in acrylic nails.

• Interference with pulse oximeter readings due to dark nail polish.

• Neurological issues resulting from solvent exposure within the salon.

• Hospital infection risks from bacteria trapped under artificial nails.

• Pterygium inversum unguis (nail deformity) caused by gel nails and formaldehyde.

Precautions and Patient Safety

To reduce adverse effects associated with artificial nails, consider the following actions:

• Onychoschizia – Remove nail polish every two weeks to allow nails to recover.

• Paronychia/Infections – Use sterile tools to avoid infections.

• Nail plate fracture – Be cautious when removing gel nails to prevent damage.

• Allergic dermatitis – Use hypoallergenic products, especially for users with known sensitivities.

• Use sunscreen, gloves, and protective eyewear when undergoing UV curing.

• Avoid acrylic usage that may damage the nail matrix.

• Limit sculptured nail wear to three months, followed by breaks to facilitate adequate nail recovery.

• Reduce use of dark colours or prolonged polish wear to prevent keratin staining and degranulation.

• Avoid pedicure footbaths without proper bleach filtration.

• Bring personal tools or ensure salon sterilization protocols.

• Avoid leg shaving 24+ hours before pedicures.

• Avoid aggressive cuticle cutting or sub-nail cleaning with sharp tools.

• Prefer LED lamps over UV, and use protective gloves and eyewear during curing.

• Transmitting Infections and Trauma in Nail Salons
   Nail salons can act as breeding grounds for infections and trauma due to poor hygiene and aggressive nail treatments:

• Traumatic onycholysis can result from improperly applied acrylic nails or aggressive cleaning.

• Keratin degranulation, leading to white patches, may occur when polish is removed improperly.

• Mycobacterial and other bacterial infections can occur from non-sterilized pedicure footbaths.

• Transmission of HPV and HSV (human papillomavirus and herpes simplex virus) is possible through shared tools and cuts.

Debate on UV Light and Associated Cancer Risk
 Studies suggest that the risk of developing cancer from UV light exposure during nail curing is negligible; however, precautions can be taken to reduce potential risk:

• Use LED lamps instead of UV lamps⁽³⁾, as they emit less harmful radiation.

• Apply broad-spectrum sunscreen to exposed areas.

• Use protective eyewear and wear fingerless gloves during the curing process to reduce the extent of skin exposure.

Balancing Beauty with Safety

Artificial nails offer an opportunity for enhanced aesthetics, but they carry notable health risks. Chemical sensitivities, allergic reactions, mechanical trauma, and infections are all real concerns. Understanding these risks and adopting safer practices is crucial.

With greater awareness and proper safety measures, the application of artificial nails can be a safer and more enjoyable experience for everyone involved.

References:

1. Chen, Alice, Anish M. Patel, and A. Y. Finzi. “Nail Damage from Cosmetic Practices.” International Journal of Women's Dermatology 2, no. 3 (2016): 107–110. https://pmc.ncbi.nlm.nih.gov/articles/PMC4898583/.

2. Sardana, Kabir, and Sinu Rose Mathachan. “Adverse Effects of Nail Cosmetics and How to Prevent Them.” CosmoDerma 2, no. 16 (2022). https://cosmoderma.org/adverse-effects-of-nail-cosmetics-and-how-to-prevent-them/.

3. UCLA Health. “Nail Inflammation and Infection Can Occur after Manicures.” UCLA Health, January 23, 2024. https://www.uclahealth.org/news/article/nail-inflammation-and-infection-can-occur-after-manicures.

By Dr. Anjaly KTK, BDS

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