Risks associated with gel manicures

Consumer Reports News: April 28, 2010 11:33 AM

"I'm in agony," the woman told my secretary last week, pleading to be seen for an emergency appointment. "Every time my thumb touches anything I get a severe electric shock, occasionally running through to my elbow," she explained. She had gone to six doctors in the past month since her injury, including two primary care physicians, two orthopedic specialists, a dermatologist and, a chiropractor and none of them could find a cause. She was at the end of her rope—her right thumb was still clearly swollen and there was a yellow, mottled, dimpled abrasion on her fingerpad. When I touched the tip of it, she cried out in pain and pulled away. My patient's thumb undoubtedly had nerve damage.

The day before her symptoms began she had what she was told was a gel manicure. My patient's experience involved the use of a vibrating electric file followed by the application of gel, dipping each finger in a powder, and repeat application of gel, finished by use of ultraviolet light. Coincidentally, I had had my first "gel" manicure the day before because I was told that it would hold the polish longer and be less likely to chip. As the nail technician was filing my own rather short nails, a little warning bell went off in my brain—the tips of my fingers were being sanded down along with my nails and I wondered about the risk of infection, abrasion, and cuts.

I should have been worried about much more. It turns out neither one of us had a true gel manicure, according to James McConnell, a chemist and president of McConnell Labs, Inc., the manufacturer of Light Elegance gel nail products. He says that my patient likely had a hybrid acrylic-gel manicure and mine was probably a glue and powder manicure. I discovered that there are a wide variety of techniques being marketed as gel manicures. Whereas acrylics use a liquid and a powder that are mixed together and applied to the nail, gels are a single component liquid that is applied to the nail and cured (hardened) under an ultraviolet lamp. To make matters even more confusing, there is a great variability in chemical constituents of gels, acrylics, glues, and powders.

Acrylics typically use a combination of monomers as their liquid component that may include ethyl methacrylate (EMA) and sometimes contain methyl methacrylate (MMA). Although the FDA first issued a warning about liquid MMA in the early 70's due to reports of fingernail damage and deformity, as well as contact dermatitis, and many state governments have banned its use on nails, some salons continue to use it today. During the application process, the nail needs to be roughened up with a file in order for the liquid to stick. This process can weaken the nail plate and bed. Once applied, the enhancement becomes very hard and is difficult to separate from the nail plate. That's because MMA is very difficult to remove.EMA is a related chemical but is formulated to be more flexible. Although the FDA backs the use of EMA, McConnell chooses not to use it in his products because most gels do not require it as one of the components. "It's not a product you'd want to have come in repeated contact with your skin," he warned, adding that you wouldn't want to breathe in its vapors on a regular basis.

Indeed the Methacrylate Producers Association warns that ethyl methacrylate may be just as harmful as methyl methacrylate. It also cautions that there have been numerous reports in recent years of increasing use of MMA in nail products. Mr. McConnell also warns of salons that use containers of unlabeled materials, "if the material does not have a label on it, be cautious and ask questions of the nail technologist," he advised.

And there are plenty of other chemicals to be concerned about. A US Environmental Protection Agency guide, produced to warn nail salon workers, indicates twenty chemicals found in nail glue, polish, hardeners, additives, powders or removers. A medical literature search shows that, in general, several of them—ethyl cyanoacrylate, formalin, toluene, and MMA—have been shown to induce neuropathy and can cause one or more of the following: irritation of the eyes, skin, mucous membranes, respiratory tract, or damage the kidneys or liver.

We're bound to hear about more consequences since enhancements seem to be growing in popularity. A 2009 survey conducted by Nails Magazine* reported a 24 percent increase in the use of gels from the previous year and a recent New York Times article described the latest nail trend, Shellac, a soak-off hybrid between a gel and polish that is reported to make its debut on May 1 in 2,000 salons nationwide.

In the case of my patient, I suspect she absorbed one or more toxins into her abraded skin causing damage to a small branch of a sensory nerve in the hand. Even without chemical exposure, vibration alone has been implicated in nerve damage and may have accounted for her condition, as could infection or allergic reaction. Regardless of the cause, it's a risk she'll never take again and neither will I.

Ten warning signs to watch out for: