Having a pedicure can work wonders on your toes, but your shins may not fare as well. State health departments in California have been investigating numerous cases of an unusual bacterial skin infection that develops following salon pedicures. As of December 2004, Santa Clara County has reported nine confirmed cases, 34 probable cases, and 65 cases awaiting interview. These skin infections, called Mycobacterium furunculosis, are caused by a bacterium called Mycobacterium fortuitum.

In 2000, one of the largest outbreaks of Mycobacterium fortuitum took place in a California nail salon. In September of that year, a dermatologist in Northern California reported to the state health department that four of her patients had persistent boils on their legs below the knee. A common factor among the four was that they received pedicures from the same nail salon. Dr. Kevin L. Winthrop and his colleagues investigated the situation and performed the first case study on the outbreak of Mycobacterium fortuitum in a nail salon. They found that 110 customers had furunculosis, which caused boils on their shins. When the boils were tested for bacteria, 34 of the 110 were positive for Mycobacterium fortuitum. All clients had similar case histories. After receiving pedicures, small sores developed on their lower legs — and after several weeks or months, they became large, tender boils with some even progressing to skin ulcers. Additionally, each infected client had between one and 37 boils on each leg.

With all of this information, the next step was to determine the exact source of the outbreak. Through a series of tests on the boils testing positive for M. fortuitum, it was discovered that a single strain of M. fortuitumwas responsible for the infections. It was concluded that the bacterium was in the salon’s tap water and that it began growing in the accumulated debris of hair, skin, and nails behind the footbath inlet screens, which were rarely cleaned. The bacteria then multiplied rapidly due to the warm, nutrient-rich environment. The bacteria presumably gained access under the skin through tiny abrasions in the skin caused by clients shaving their legs with a razor before the pedicure.

Mycobacterium fortuitumis a bacterium found basically everywhere on earth, including soil and tap water. It is only a problem for humans when nutrient content and temperature are at the right levels, allowing the bacteria to multiply in large amounts. Most of the time it is not a problem when it comes in contact with the skin. M. fortuitumhas probably been around for a long time, but has only been known to cause harm to humans in the last few decades. The first record of a M. fortuituminfection in humans was in 1936 from an abscess that resulted from a vitamin injection.

Mycobacterium fortuitum is typically not spread from person to person. Usually humans acquire it from the environment when bacteria gain access through a break in the skin. Once humans have been infected with M. fortuitum, it can become harmful. The strength of one’s immune system also influences how susceptible a person is to developing an infection, and those with suppressed immune systems have a greater chance of developing infection. If M. fortuitumdoes cause a skin infection, treatment is available with antibiotics. At least two antibiotics are needed to treat M. fortuitum because drug resistance against a single antibiotic is common. The treatment can last as long as 6 months. If antibiotics do not solve the problem, surgical removal of affected areas may be necessary.

Infections associated with nail salons are under-recognized and may increase in prevalence because a large number of salons are deficient in their cleaning practices. There is no preventative method available to guarantee that one will not develop an infection caused by Mycobacterium fortuitum.However, there are measures one can take to decrease the likelihood of contracting this infection.

Prevention Measures
Do not shave legs before a pedicure.

If you have broken skin or lesions on your legs, do not get a pedicure.

Once you enter a salon, look around to see if the salon is clean, free of trash, and set up with clean, sanitized instruments.

Ask or watch how the operator cleans the foot spas.

If you have any doubts about the cleanliness standards at a salon, call the Department of Consumer Affairs Board of Barbering and Cosmetology at (800) 952-5210

There is nothing more important to us than your safety and comfort when you visit our salon. That’s why we pledge to
adhere to the highest industry standards. We welcome your questions and will address your concerns concisely and openly,
and we will provide backup if you request it.
With your safety in mind:
• We sanitize and disinfect all reusable manicuring tools in accordance with state regulations and industry “best practices.”
Any tools that can’t be disinfected are disposed of or given to the client after a single use. If you would like to bring in
your own tools, you are welcome to. We still disinfect your tools before using them, as required by state law.
• We clean our hands prior to each service and ask you to do the same.
• We use clean towels or manicure mats for each client.
• We never use a blade to cut any skin, including calluses. Heavy callus needs to be taken down gently and sometimes
over the course of a few services.
• We use only quality, professional-grade, legal, and safe products.
• We take steps to minimize your expose to odors, vapors, and filing dust in the salon. These steps include using covered
waste cans, keeping products tightly covered, and taking out only enough product to be used on your service.
• We have Material Safety Data Sheets (MSDS) on all the products we use. If you have any question about the safety of a
product being used in your service, ask your technician.
• If we used an electric file, we are trained to use it safely and painlessly.
We take pride in our professionalism:
• Our licenses are up-to-date and displayed.
• We will evaluate the health of your nails before your service and refer you to a physician if indicated. Be sure to let us
know if you have any health conditions — like diabetes — that may affect your service.
• We will make recommendations for at-home maintenance of your nails. We encourage you to understand your own
role in keeping your nails in healthy and attractive condition.
• We regularly take classes in techniques, health and safety, and product knowledge to enhance the quality and safety of
your services.
You may be concerned about safe pedicures. Here is what we do to ensure your total safety:
• Whirlpool pedicure spas come in different types: pipeless, piped systems, and non-electrical pedicure basins. Our salon
uses _________________________.
• We have cleaning protocols, required by the state and recommended by the product manufacturer. We have safety
procedures that are done after every client, at the end of every day, and once a week. You are welcome to look at the
specific and detailed cleaning protocol we follow (ask to see our “Best Practices for Cleaning Pedicure Equipment”).
We keep a log of our cleaning schedule, and you are also welcome to see that.
• Our pedicure tools are disinfected or disposed of according to the high standards set by the Nail Manufacturers Council
(which in many cases, exceed the requirement of the State Board). Any pedicure implements that can’t be disinfected
will be disposed of after use on a single client.
• Tools and implements that can be safely reused — such as nippers and electric file bits — will be disinfected according
to state regulations.
Sincerely,
Our Pledge to You:
a safe and clean salon