Shops offering acrylic nail manicures have become a common sight on the high street in the past decade, with many people regularly having nail treatments. Dermatologically, there are many (potential) hazards lurking within the nail salon ranging from contact dermatitis, nail changes and infection of the nail unit. Most recently, the safety of the UV nail lamps used to dry nails has been called into question. One of the earliest reports raising this issue in 2009 was of two cases of regular nail salon customers with squamous cell carcinoma arising on their hands (1). At that time, the authors called for further investigation as there was very little research available to suggest if UV radiation from the boxes were to blame.
In response to the paper, a study was undertaken in 2013 on 6 of the most commonly used devices in the US to assess their safety (2). This concluded that there was a low risk in the use of these devices, particularly as they were not used daily by most members of the general public. This was followed up by a study from Markova (3) in the prestigious “Journal of Investigative Dermatology” who agreed with the earlier findings, suggesting that the initial case report was anecdotal, as they found only a low level of risk for regular users. Similarly, Diffey writing in the British Journal of Dermatology also suggested that the risk was negligible (4).
Latterly, two further studies challenged these findings and have suggested the risks may have been underestimated. Shipp and colleagues (5) and Curtis (6) further investigated the subject. Shipp, uniquely selected devices at random and found great variation in their UVA output and how they are used. In addition, Curtis suggested that long term exposure may have a risk of skin cancer development following their research. So where does that leave things?
Most recently, writing in the Australian Journal of Dermatology, Bollard et al., have reiterated the controversy, highlighting the variance in evidence in the safety of the UV devices. They undertook a survey of 424 members of the public to assess their knowledge and found that many were unclear on the risks posed by the UV boxes in nail salons. Consequently, they make a useful suggestion, that anyone using these would be best advised to apply a high protection UVA cream at least 20 minutes prior to exposure or wear some UV resistant gloves with the finger tips cut out to minimise the risk - whatever it may be. So, for the feet, perhaps we should be issuing the same advice – toeless socks maybe an option but certainly the use of a broad-spectrum sunscreen should be advised to protect the surrounding skin.
Where the risk to the surrounding skin is not clear, the evidence for the nail itself is more interesting. Of the limited evidence available, research has shown an intact nail plate is a very good natural filter against both UVA and UVB radiation. Nails can filter out all of the natural UVB with only a small amount of UVA actually getting through (7). Moreover, with a coating of nail varnish on them even less is likely to make it to the nail bed to cause damage. So for now, let’s just suggest to our patients that they should use a sunscreen before dipping their toes into the unknown of the UV nail lamp box!
References
1. MacFarlane DF, Alonso CA. Occurrence of nonmelanoma skin cancers on the hands after UV nail light exposure. Arch Dermatol. 2009;145(4):447-9.
2. Dowdy JC, Sayre RM. Photobiological safety evaluation of UV nail lamps. Photochem Photobiol. 2013;89(4):961-7.
3. Markova A, Weinstock MA. Risk of Skin Cancer Associated with the Use of UV Nail Lamp. J Invest Dermatol. 2012;133(4):1097-9.
4. Diffey BL. The risk of squamous cell carcinoma in women from exposure to UVA lamps used in cosmetic nail treatment. Br J Dermatol. 2012;167(5):1175-8.
5. Shipp LR, Warner CA, Rueggeberg FA, Davis LS. Further investigation into the risk of skin cancer associated with the use of UV nail lamps. JAMA Dermatol. 2014;150(7):775-6.
6. Curtis J, Tanner P, Judd C, Childs B, Hull C, Leachman S. Acrylic nail curing UV lamps: High-intensity exposure warrants further research of skin cancer risk. J Am Acad Dermatol.69(6):1069-70.
7. Stern DK, Creasey AA, Quijije J, Lebwohl MG. UV-A and UV-B penetration of normal human cadaveric fingernail plate. Arch Dermatol. 2011;147(4):439-41.