Nail Care Safety - Dr. Michelle Lam Power Point & Script

Nail Care Product and Equipment Safety Concerns

Nail care products are a category of self-care that is unregulated by the Food and Drug Administration (FDA) for content but are required to be safe for use when used as intended. This leads to products that contain harmful ingredients that can be hazardous to our health. Some of the harmful ingredients include acetone, ethyl acetate, formaldehyde, methacrylic acid, quaternary ammonium compounds, and toluene. These ingredients can cause systemic effects beyond local skin irritation, such as irritation of the eyes, nose and throat, cause breathing problems, and even cause fetal harm if the product is used by a pregnant woman.

                  When choosing a nail product, patients should be advised to look at ingredient lists and choose more natural products. Ingredients to avoid include methacrylic acid, and the ‘toxic 3’ which includes toluene, formaldehyde, and dibutyl phthalate. When using nail care products, proper ventilation is a key factor in reducing irritation of the eyes and airways. Opening windows and turning on fans are a great way to improve air circulation. After use, products should be closed tightly to prevent leakage and do not pour these products down the sink or toilet. It is also important to wash hands before and after use to remove any product from the skin during application to the nail.

                  Nail curing and drying lamps are another aspect of nail care that can cause harm to the body. These lamps are used to cure gel and acrylic nails using an LED lamp, which emits ultraviolet (UV) light, which can be carcinogenic with chronic exposure. UV light is also responsible for photoaging and can cause wrinkling of the skin around the nail beds. Additionally, certain medications can increase a patient’s sensitivity to UV light, thus increasing the risk for skin cancer and photoaging. These medications include antibiotics such as tetracyclines and fluoroquinolones, antifungals, antihistamines, statins, thiazide diuretics, and oral contraceptives. When using UV lamps, patients should be advised to wear UV absorbing gloves that cover the skin on the hands, apply SPF greater than 15, and do not use the lamp more than 10 minutes per hand.

                  The lack of regulation regarding nail care products such as polishes, conditioners, lacquers and equipment can have a negative impact on our overall health and it is important to be mindful in product selection and implementing preventive techniques.

Nail disorders, prevention and treatments

Society’s views on how individuals care for their nails is associated with a person’s importance of self care, with the assumption that lack of proper nail care determines lack of proper hygiene. However, while nail care plays an important role in overall hygiene, it doesn’t necessarily mean the person is unhygienic. There are a number of diseases and conditions that account for what can appear to be bad nail care and “nail changes may be a clue to an underlying systemic disease or infection.” There are an abundance of nail disorders that are often seen such as “Brittle nail syndrome, onychomycosis, paronychia and nail psoriasis.” All of these conditions can be the result of another disease, infection or trauma. Because these nail disorders present in different ways depending on the stage it is in and the patient’s personal description of certain aspects (such as pain and irritation levels), there are many occurrences where the nail disorder is misdiagnosed, which is why it is so important to gather all the details possible and provide nail care information to prevent this from happening in the first place. Caring for nails properly can be thought of as being too expensive and out of the budget for some, but this isn’t true at all. Basic manicures cost anywhere from $10 to $20 if needed, whereas others prefer to do at-home manicures. It is important that nails are properly cared for in order to prevent those disorders listed above. 

Brittle nail syndrome is when there is “increased fragility of the nail plate resulting in splitting, peeling and friability.” There are many causes of this, some being unavoidable like aging, along with infections and other inflammatory diseases. Secondary brittle nail syndrome is typically associated with dermatological diseases (such as psoriasis), nutritional deficiencies (Vitamins A-E, iron, selenium and zinc deficiencies), and certain medications (retinoids, antiretrovirals and chemotherapeutic agents). In order to treat brittle nail syndrome, the underlying cause must first be discovered and treated accordingly, which should help to resolve the nail symptoms. While the studies have yet to show great evidence, biotin is usually recommended for patients with brittle nails as an oral supplement. 

For fungal nail infections (such as onychomycosis) the treatment consists of antifungals to treat the nail and get it back to its normal state as soon as possible. This can be done with oral antibiotics (such as itraconazole) and topical antifungals (such as ciclopirox). For fungal nail infections, be sure the patient is aware of how contagious the infection is and any preventative measures (such as wearing shower slippers). Nail disorders associated with inflammation and infection (such as paronychia and nail psoriasis) have several ways of being treated. Paronychia is the inflammation or infection of the nail skin folds. Mild cases can be treated with warm soaks of a mixture of water and vinegar or antiseptic solutions (such as Burow solution) to help promote spontaneous draining. Topical antibiotics can be given and if the infection persists, systemic antibiotics will be needed. Nail psoriasis is most common in patients that have already been diagnosed with skin psoriasis. Treatment consists of maintaining top notch nail care and stressing the importance of no mechanical trauma to the nails, as this will aggravate the condition even more. For patients with no skin psoriasis, there are intralesional steroid injections that can be used, along with other pharmaceutical options. 

Resources:

Lee, Debra, and Shari Lipner. “Optimal Diagnosis and Management of Common Nail Disorders.” Shibboleth Authentication Request, 3 Mar. 2022, www-ncbi-nlm-nih-gov.jerome.stjohns.edu/pmc/articles/PMC8896184/. 

Moossavi, Meena, and Richard Scher. “Nail Care Products.” Shibboleth Authentication Request, 2001, www-sciencedirect-com.jerome.stjohns.edu/science/article/abs/pii/S0738081X01002036?via%3Dihub. 

Center for Food Safety and Applied Nutrition. “Nail Care Products.” U.S. Food and Drug Administration, FDA, www.fda.gov/cosmetics/cosmetic-products/nail-care-products. Accessed 17 Aug. 2023.

Nail Care Safety

Nails are not just a cosmetic feature; they also play a crucial role in protecting our fingertips and enhancing our sense of touch. Proper nail care goes beyond aesthetics; it's essential for maintaining healthy nails and preventing potential health risks. However, the pursuit of fashionable and well-maintained nails should never compromise our safety.

Maintaining proper nail hygiene is the foundation of nail care safety. Regularly clean your nails with mild soap and water to remove dirt and bacteria. Avoid using harsh chemical cleaners that can damage the nails' structure and surrounding skin. Filing your nails is essential for preventing snags and tears, but over-enthusiastic filing can lead to weakened nails. Opt for a fine-grit nail file and file in one direction to prevent splitting. Excessive filing or using rough files can thin the nails and make them more prone to breakage. Cuticles serve as a protective barrier against infections. Avoid cutting them to prevent infections and inflammation. Instead, gently push back the cuticles after softening them with warm water to maintain their integrity.

The nail care market is flooded with various products, but not all are safe. Choose nail polishes and products that are free from toxic chemicals like formaldehyde, toluene, and dibutyl phthalate. These chemicals have been linked to health issues ranging from skin allergies to respiratory problems. While nail polish can elevate your style, many nail products release harmful fumes. Ensure proper ventilation when applying nail polish to avoid inhaling these fumes, which can lead to headaches, dizziness, and even respiratory issues. Acrylic nails and extensions can provide a polished look, but incorrect application and prolonged use can lead to weakened natural nails and bacterial/fungal infections. Ensure that you get them done by a trained professional and take breaks between applications to allow your natural nails to breathe. When engaging in household chores or other activities involving chemicals, always wear protective gloves to shield your nails from harsh substances that can weaken and damage them.

Just as your skin needs moisture, so do your nails. Keep your nails moisturized with a nourishing oil or cream to prevent them from becoming dry and brittle. Well-hydrated nails are less likely to chip and break. When trimming your nails, use a proper nail clipper and avoid cutting too close to the nail bed. Over-clipping can cause painful ingrown nails and potential infections. Perform routine checks of your nails for any changes in color, texture, or structure. Unexplained changes could be a sign of underlying health issues that need attention.

In conclusion, nail care safety is essential to maintaining both the aesthetic appeal and health of your nails. By following proper nail hygiene practices, using safe products, and being cautious with treatments, you can enjoy beautiful nails while minimizing potential risks. Prioritize your well-being by incorporating these safety measures into your nail care routine.

References:

Arora, H., & Tosti, A. (2017). Safety and Efficacy of Nail Products. Cosmetics, 4(3), 24. doi: 10.3390/cosmetics4030024

U.S. Food and Drug Administration. (2020). Nail care products. https://www.fda.gov/cosmetics/cosmetic-products/nail-care-products.

Donna Salib & Natalie Eshaghian

Nail Care Safety

Nail Polish can be traced back to as far as 3000 B.C. in China and is said to have originated from a mixture of gelatin, beeswax, egg whites, and sap from an acacia tree. Many people go to the nail salon weekly to get their nails done, however, the beautiful colors and designs that we put on our nails contain more than just beauty for our hands. In nail polish, there is a group of toxins called the “Toxic Trio” or the “Big 3” and consist of Dibutyl phthalate (DBP), Toluene, and Formaldehyde. Formaldehyde (1) is a colorless gas, referred to as a nail polish hardener, and is a human carcinogen associated with lung cancer. Toluene (2) is a solvent that gives the nail polish a smooth finish and preserves its pigment. Toluene can affect the central nervous system and cause reproductive disorders. Dibutyl phthalate (DBP) is used as a plasticizer in nail polishes to prevent it from becoming brittle, however, it has also been linked to developmental defects.

Some nail polishes may be labeled as three-free and replace the toxic trio with a chemical called triphenyl phosphate (TPHP), which is also used as a flame retardant. In a 2015 study conducted by both Duke University and the Environmental Working Group (3), more than two dozen women were tested for a metabolite of triphenyl phosphate (TPHP) before and after they painted their nails. Researchers found that the metabolite was seven times higher in the bloodstream 10-14 hours after application, and within 20 hours it reached its peak concentration. This study demonstrated that what we put on our nails gets absorbed in our bodies. Someone as simple as nail polish, which many of us put on and have on ourselves daily, is seen to cause harm to our bodies in different ways. TPHP in animal studies acts as an endocrine disruptor, linked to reproductive and developmental issues but more research is needed to assess the effects of this chemical in humans.

Experts say that using classic nail polish from the bottle is great in moderation. In contrast, gel polish usually applied at a beauty salon by a professional can increase your risk for cancer due to its drying process. Gel manicures are appealing because of its glossy appearance and durability compass to classic nail polish. Gel nails are painted on then hardened under UV light in a process called photo-polymerization, where the nail polish absorbs the UV light to become solid. UV light has been proven to cause damage to cells and promote skin aging. According to the American Academy of Dermatology Association (4), it is recommended to apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to your hands to help protect your skin from the ultraviolet radiation used to dry the liquid gel nail polish to the nail. Gel nail polishes are continuously growing among people and creating different forms of gel nail polishes. The classic nail polish is slowly growing out of touch, and this can severely harm our population in the long run.

In addition to harm to the person receiving the nail care, it is important to discuss the workers who are constantly applying these harmful substances to others and being surrounded by it themselves. We don't usually link nail salons to potentially hazardous work environments but for many nail salon workers, regular exposure to these toxic chemicals is a concern. OSHA states that ventilation is the best way to lessen the number of chemicals in a salon. (5) The CDC also states that ventilation systems may reduce worker chemical exposure in nail salons by at least 50%. (6) A challenge that has been faced is that most nail salons are small mom-and-pop salons owned by people in the asian community, most having low to no english proficiency. This made clear communication, and education about health and safety a challenge since this information is usually provided in English. Coalitions such as the New York health nails salons coalition focuses on occupational health and advocate for better translation of materials used for safety training. (7)

Ultimately, as is always the lesson, it is important to understand the chemicals in our everyday products. As mentioned before, products such as lotions and gels that we apply every day need to be checked for harmful substances, too with our nail products. Nail polish is a product that is applied, typically once a week, and is kept on the nail for that time being. Within that time, our nail/skin is absorbing those chemicals we applied and going into our bloodstream, in return affecting other areas of our health. Next time you go to the nail salon, be sure to find out what you are really applying to your body and maybe think twice about that gel manicure!

References:

(1) Formaldehyde and cancer risk. National Cancer Institute. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/formaldehyde/formaldehyde-fact-sheet. Accessed Date Accessed: 5 August 2021

(2) What is toluene? EWG. Available at: https://www.ewg.org/skindeep/ingredients/706577-TOLUENE-TOLUENE-TOLUENE/. Date: Accessed 5 August 2021.

(3) Duke-EWG study Finds Toxic nail Polish chemical in women's bodies. Environmental Working Group. Available at: https://www.ewg.org/news-insights/news-release/duke-ewg-study-finds-toxic-nail-polish-chemical-womens-bodies Published July 30, 2021.

(4) Gel manicures: Tips for healthy nails. American Academy of Dermatology. Available at: https://www.aad.org/public/everyday-care/nail-care-secrets/basics/pedicures/gel-manicures Date Accessed: 5 August 2021

(5) Health Hazards in Nail Salons - Chemical Hazards. Occupational Safety and Health Administration. Available at: https://www.osha.gov/nail-salons/chemical-hazards Date Accessed 5 August 2021.

(6) An Evaluation of Local Exhaust Ventilation Systems for Controlling Hazardous Exposures in Nail Salons. CDC. September 2012. Available at: https://www.cdc.gov/niosh/surveyreports/pdfs/005-164.pdf

(7) NY healthy salons coalition. NYCOCH. Available at: https://nycosh.org/initiatives/healthy-nail-salons/ Date Accessed: 4 August 2021

Although nails are mainly associated with cosmetics, they have many beneficial functions. Nails protect the ends of our fingers and toes. The nails appear hard but the nail bed in which the nails are attached to the fingers is where the nails receive blood and nutrition from the body. The new nail cells grow due to the nutrition received from the body and therefore the nails grow to be healthy. Unusual nail growth can be a sign that there is a problem in the body. Certain nail changes can include but are not limited to painful nailbeds, changes in the color of the nails or nailbeds, changes in thickness and strength of nails causing them to become weaker, nail plate falling off, slower nail growth than usual, along with other nail changes.

Nail changes can occur due to certain types of cancers as well as cancer treatments. Chemotherapy treatments such as Bleomycin, Capecitabine, and Doxorubicin can cause hyperpigmented nails which make the nails appear dark. This effect on the nail might be reversed once the medication has stopped. Other chemotherapy treatments such as cyclophosphamide, docetaxel, and 5-fluoruracil can cause ridges, lines, creases, and other discoloration on the nail. These types of changes to the nails are usually not painful and usually grow out completely once the nail grows.

Possible ways to manage nail changes and maintain them include cleaning nails to avoid infections, avoiding professional manicures when being treated for cancer, check hands and feet daily to identify any changes in the nails, and keeping nails trimmed short. Patients who are being treated for cancer with taxane drugs such as docetaxel should apply cold packs to the nails for 15 minutes before the infusion of the drug, during infusion of the drug, as well as 15 minutes after the infusion of the drug. These specific drug classes can cause nail lifting therefore applying cold packs may help prevent such effect from occurring. It is important to protect the nails as much as possible from the surrounding environment. Clear nail polish can be used to keep the nails strong. Using nail and cuticle oil can help moisturize the area to prevent dryness and splitting of the nails.

Nails that are not taken for properly are prone to developing an infection such as bacterial or fungal infections. Treatment options that can be used for infections are Lamisil (terbinafine), Sporanox (itraconazole), and other medications that are within the same drug class. The typical duration of these medications can be from six to twelve weeks. An infection is not completely eliminated until the nail grows back completely which may take four months or even longer. There are also other treatment forms such as nail polish and nail cream. Ciclopirox is an antifungal nail polish and is painted on the infected nails and cuticles once daily. After seven days of the nail polish is applied, wipe it with alcohol and being a new application. This type of medication might be needed for almost a year in order to fully cure an infection. There are also antifungal nail creams which are applied directly onto the nails. It is preferred to think the nails first in order to help the medication work on the nail surface. In order to thin the nails, you can apply an over-the-counter lotion with urea in it. Last treatment option that can be provided is surgery. It might be required to remove a nail temporarily in order to apply the antifungal medication directly to the infection since some infections might not respond directly to the previous treatment options. It is important to check hands and feet daily and contact your doctor if you notice any changes on your nails right away.

“Nail Changes.” American Cancer Society, www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/nail-changes.html.

“Nail Fungus.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 July 2020, www.mayoclinic.org/diseases-conditions/nail-fungus/diagnosis-treatment/drc-20353300#:~:text=Options%20include%20terbinafine%20(Lamisil)%20and,for%20six%20to%2012%20weeks.

“For Patients & Families.” Dana, www.dana-farber.org/for-patients-and-families/care-and-treatment/support-services-and-amenities/friends-place/services-and-programs/caring-for-skin-and-nails/.

Nails serve an important role as a protective barrier for our fingers and toes. Nails need blood for nutrition and growth, and as nails grow the older cells harden to form the nail plate. Changes seen in nails can be caused by numerous factors and a major cause is chemotherapy.

Nail changes on the fingernails and toenails can occur on the nail plate, nail bed, the area surrounding the nail or under the nail. Nail changes include change in color (can be darker or discolored), brittle nails due to change in thickness, nail separation from skin, change in nail texture including ridges/spots, splinter hemorrhages, fluid under the nail, dry/cracked cuticles. Subungual lesions are dark areas near the nail cuticle that’ll appear as bruises under the nails, these color changes are caused by chemotherapy drugs or a symptom of melanoma. Onycholysis is when the nail plate lifts, when the nail plate lifts from the nailbed it could fall off making it more susceptible to infection.

Hyperpigmentation can be a temporary side effect of some medications that affects part of the nail, but it can also become permanent and affect the entire nail.

Treatment with chemotherapy drugs that may cause nail changes as a side effect include docetaxel, paclitaxel, fluorouracil, hydroxyurea, methotrexate, cetuximab and cisplatin. Some chemotherapy drugs will stop nail growth completely during treatment but when treatment is done in cycles the nails will grow in between the cycles. Sorafenib and sunitinib are targeted therapy antiangiogenic multikinase inhibitors that’ll lead to darker areas in cuticles. EGFR inhibitors such as gefitinib, monoclonal antibodies such as cetuximab, bleomycin, methotrexate among other drugs will lead to nail hyperpigmentation. Some chemotherapy drugs will lead to several different nail abnormalities such as 5-FU (5-fluorouracil) which may lead to nail loss as well as ridges, lines and other discoloration.

Normally, it will take the human body six months to regrow a fingernail and 1.5 years to regrow a toenail. Patients can take precautions to prevent nail changes such as using a water-soluble nail lacquer/prescription nail polish to protect the nails against any ridges or splitting. Patients may also request the doctor to prescribe biotin which is a nail supplement to increase nail strength. Patients undergoing treatment with taxanes should apply cold packs to the nails 15 minutes before, during, and after infusions. Patients should keep their nails short, clean, and protected when doing activities such as dishes or gardening. Patients should wear soft cotton socks and soft padded shoes/slippers at home, as well as keep hands/feet moisturized with thick creams such as eucerin, vaseline and vanicream.

However, in terms of nail treatment surgery of the affected nail plate may be required in certain nail abnormalities such as onycholysis and nail fissures. Antibacterial ointments can be used to treat any bacterial or fungal nail infections.

1. Nail Changes During Treatment. Memorial Sloan Kettering Cancer Center. Updated 2021 February 15. Accessed 2021 June 1. https://www.mskcc.org/cancer-care/patient-education/nail-changes-during-treatment-taxanes

2. Nail Changes. American Cancer Society. Updated 2020 February 1. Accessed 2021 June 1. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/nail-changes.html

Throughout the years, nails have evolved cosmetically, but they are still a good sign, indicative of one’s health. Healthy nails are strong with pink nailbeds, but it becomes evident when underlying health issues are present as the nail will change possibly with white spots, ridges, thickening, or other changes in color and texture. When nails are exposed to chemicals frequently in the form of detergents or nail polishes for cosmetic purposes, they may become thin or easy to break due to being brittle. Low levels of vitamin b, calcium, or iron can also be cause. Similar presentations include peeling, pitting, split, spoon, or curved/clubbed nails.

Lung cancer is the most common cause for clubbed nails. It can develop within weeks and can also go back to normal within weeks once the underlying cause is treated. The edge of the finger may appear bulging, possibly warm and red. The nail beds are soft and seem to “float” rather than be firmly attached. In addition, the most obvious sign is the nail curves downwards so it looks like an upside-down spoon as indicated by source 4. Other causes for clubbing include chronic lung infections, celiac disease, liver disease, dysentery, grave’s disease, overactive thyroid gland, or other types of cancers including gastrointestinal or Hodgkin lymphoma.

As a pharmacist, we should be diligent in identifying these physical changes in order to address the root health issue.

1. Nail health in women, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105659/

2. The diagnosis and treatment of nail disorders, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527843/

3. https://www.scripps.org/news_items/6820-what-your-nails-say-about-your-health

4. https://www.mountsinai.org/health-library/symptoms/clubbing-of-the-fingers-or-toes

Many women visit a nail salon at least once a month to get a manicure and/or pedicure to keep their nails looking fresh and beautiful, but nail cosmetic problems can arise from the materials, procedures, and equipment used in the nail salons. Most common are bacterial or fungal infections since nail salon equipment are usually not sterile or cleaned well enough in between clients. When the nail cuticles are cut, the skin becomes highly susceptible to entry of bacteria and fungi, so clients may request for the cuticles to be left alone or make sure the salon is using new and sterile tools. Excessive chemical exposure to the nails can make the nails dry, brittle, and fragile, especially with frequent visits to the nail salon or consistent nail polish and nail polish remover use. Clients may also experience allergic or irritant reactions to some of the materials used, such as acrylic monomers, formaldehyde, and cyanoacrylate glue. When the skin and nail come in contact with such materials, the client may feel itching and burning in the area that was exposed. Avoidance of known contact allergens is key when it comes to allergic and irritant reactions. When it comes to nail procedures, physical trauma and infection can damage the nails. Pushing back or trimming the cuticles with sharp tools can damage the periungual tissue and the protective seal that surrounds the nail plate. In addition, unsterile equipment may carry blood from previous clients, leading to disease transmission of bloodborne pathogens. Emery boards and other nail files used may also spread viral particles during the filing process on nails and calluses. Individual nail files should be used for each client and filing should be avoided in close proximity to other clients to limit the spread of viral particles. Electric drills for filing are typically not cleaned as frequently as they should be so they should be avoided as well. Pedicure spas are infamous for harboring bacteria and fungi if the filters are not cleaned regularly and the risk of infection is further increased if the cuticles are cut just before soaking in the footbath. However, this does not mean that all nail salons should be avoided at all costs. To be safe, clients should verify that the nail salon and the staff are licensed, ask about how and when the footbaths were last cleaned, avoid shaving their legs before a pedicure, bring their own sterile tools, request not to cut cuticles or dead skin around the nails, and ask about the materials being used.

References:

1. Chang RM, Hare AQ, Rich P. Treating cosmetically induced nail problems. Dermatol Ther. 2007;20(1):54-59. doi:10.1111/j.1529-8019.2007.00111.x

Nails are important to maintain function of the body. They protect the fingers and toes from infectious pathogens, and they can collect nutrients and blood from the surrounding tissues. Therefore, nail care is very important not only for cosmetic reasons, but for health reasons as well. Many healthcare professionals try to encourage patients of good nail hygiene practices and safety tips. This is to prevent brittle nails in many patients, especially patients older than 50 years of age. Brittle nails are described as nails that flake, split (onychoschizia or onychorrhexis), soften, or crumble easily. Typically, these conditions are not painful unless a pathogen may be involved or a deep split that can get snagged on material. Brittle nails can be caused by a variety of diseases and sometimes may present as idiopathic. Psoriasis, Darier’s disease, eczema, vitamin deficiencies, and infectious pathogens are just a few examples where the nail can be affected. Trauma can also damage the nails and surrounding tissues as well. Certain occupations such as carpenters, nail technicians, housemaids, or painters may accidently inflict injury to the nail or expose the nails to harmful chemicals that can dissolve intercellular lipids on the surface of the nail.

To prevent further damage to the nails or stop brittle nails from forming, patients are advised to limit exposure of stress or harmful chemicals. Limiting contact with detergents and irritants may help a patient restore the natural lipids found in the nails. Another way to prevent brittle nails is performing good nail hygiene. This includes cleaning and trimming fingernails to prevent organisms from building up which could lead to infection. Sanitizing nail grooming equipment is also important to stop the spread of possible disease. Patients are also advised to not bite their nails, cut the cuticles, or rip off hangnails.

Some supplements may have a positive effect in the restoration of nails. Biotin, trace elements, and amino acids (cysteine) have been reported to help strengthen nails. Biotin can be found in foods such as walnuts, milk, egg yolks, and cereals. It can also be produced naturally by abdominal bacterial. Biotin can synthesize keratin and keep keratinocytes in place in order to prevent the nail from breaking down and improve elasticity. Studies have shown that that a dose of 5-10 mg of biotin a day for 3-6 months can significantly improve the firmness of nails. A randomized trial was performed to assess the strengthening effect of a formulation containing amino acids, vitamins, and minerals. Patients with onychoschizia were receiving this bioformulation for 3 months. Patients on this combination supplement were proven to have hardened nails and the dose (not specified) was well tolerated with minimal side effects. Other treatments include nail moisturizers that contain occlusive substances and humectants that may enhance water-binding capacity. Patients can also try lacquers which are advertised to strengthen and fortify the nails. It is important for patients to share concerns that they may have with their provider. Brittle nails may look unappealing visually, but it can also be an indicator for other underlying diseases or drug-induced nail damage.

References

Chessa, M. A., Iorizzo, M., Richert, B., López-Estebaranz, J. L., Rigopoulos, D., Tosti, A., Gupta, A. K., Di Chiacchio, N., Di Chiacchio, N. G., Rubin, A. I., Baran, R., Lipner, S. R., Daniel, R., Chiheb, S., Grover, C., Starace, M., & Piraccini, B. M. (2020). Pathogenesis, Clinical Signs and Treatment Recommendations in Brittle Nails: A Review. Dermatology and therapy, 10(1), 15–27. https://doi.org/10.1007/s13555-019-00338-x

Centers for Disease Control and Prevention. (2016). Nail Hygiene. Retrieved from: Nail Hygiene | Handwashing | Hygiene | Healthy Water | CDC

Ayurveda is a medicinal practice that originated in India. This practice is focused on promoting balance between your body and mind. According to Ayurveda, five elements make up the universe — vayu (air), jala (water), akash (space), teja (fire), and prithvi (earth). In addition to the five elements, there are three main life force energies at play. These energies include Vata dosha (space and air); Pitta dosha (fire and water); and Kapha dosha (water and earth). In order to properly utilize the ayurveda method, the patient must first cleanse their body of toxins. Following the purification of the body, the patient must then adhere to a very specific ayurvedic diet regimen. Alongside this diet, herbal remedies, massage therapy, and meditation are considered essential to ensure that the ayurvedic process is providing maximum benefit to the subject. Herbs and other plants, including oils and common spices, are used extensively in Ayurvedic treatment.

A popular herb utilized in ayurvedic medicine is ashwagandha. This root herb contains many medicinal benefits--but most notably, it is known for its stress relief properties as well as its use in the treatment of cancer through ayurvedic medication treatments. In addition, Ashwagandha is known for its anti-inflammatory properties. The reduction in inflammation caused by ashwagandha use is incredibly beneficial for patients who may be experiencing chronic pain as well as conditions like high blood pressure.

According to studies conducted to assess ashwagandha use, the herb helped increase the stamina of rats during swimming endurance tests and prevented adrenal gland changes of ascorbic acid and cortisol content produced by swimming stress. The herb is also known more commonly as Indian Ginseng or the Indian Winter Cherry. In Ayurvedic practices, ashwagandha is considered a Rasayana, better known as an herbal or metallic preparation that promotes a youthful state of physical and mental health and expands happiness. The root of Ashwagandha is regarded as tonic, aphrodisiac, narcotic, diuretic, anthelmintic, astringent, thermogenic and stimulant. Studies have also shown that ashwagandha use is also beneficial for reducing the risk of stress-induced steroids with continued use. In addition, it has been found to be very useful in experimental carcinogenesis in the crude form. It prevented urethane-induced lung-adenomas in mice.

Overall, Ayurvedic medications is a unique healthcare system that is vastly different from Western medicine. The philosophies behind ayurvedic treatment is one that has centuries-worth of history behind it, showcasing its longevity. While many users of western medicine may deny the health benefits showcased through ayurvedic treatments, studies have shown that components of ayurvedic medications are incredibly beneficial through in vivo research.

REFERENCES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252722/

https://www.hopkinsmedicine.org/health/wellness-and-prevention/ayurveda

Pharmacists need to know about nail care because of the growing popularity in both men and women in this day in age. Nail care is a part of a multibillion-dollar industry around the world, including men and women. The ingredients used for nail treatments can be very toxic. Although there are many warning labels on these products, most people have been using nail products since they were young so they can often overlook those warning labels. Similar to when patients are on a medication for an extended amount of time- patients don’t think they need to be counseled, but it is sometimes more effective to counsel a patient after they have been on a medication for a couple of months to make sure they are taking their medication corrects and not experiencing any long term side effects.

Similar to over the counter vitamins and supplements, nail products are not FDA approved or regulated. They are required to be proven safe before marketed but many loopholes can be jumped through since they are not as tightly regulated as prescription medications. Warning labels are put on nail products to remind the user that the products catch fire easily, should not be exposed to flames or any heat sore, may injure eyes, should be used with ventilation, and harmful if swallowed.

Many ingredients in nail products contain toxic ingredients that can cause harm to patients. These ingredients include acetone, acetonitrile, butyl acetate, dibutyl phthalate, ethyl acetate, ethyl methacrylate, formaldehyde isopropyl acetate, methacrylate monomers, methacrylic acid, quaternary ammonium compounds, and toluene. Effects of these chemicals if inhaled or injected can lead to headaches, irritation of the eyes, skin, nose, mouth, and/or throat, fainting, and asthma-like reactions. These sometimes serious reactions can be reduced by using nail products with the least hazardous chemicals, using 3-free products- which means the products are free of toluene, formaldehyde, and dibutyl phthalate, properly ventilate the room, close products tightly to prevent leaking, do not pour product down the sink or drain, and wash hands often when handling these products.

Using nail drying or curing lamps for acrylic and gel nail polish has become very popular due to its long-lasting and scratch-resistant effects on nails. The UV light that radiated from these lamps which are known to cause premature wrinkles, age spots, and skin cancer. There is a low risk of these lamps causing these effects because of the short length of time that is needed in order to cure the nails, but it is a risk worth knowing and telling patients using this type of nail treatment. Patients can use UV absorbing gloves that expose only the nails to prevent these effects. Also, applying broad spectrum sunscreen and not using more than 10 minutes per hand. It is also important to note any adverse events with the lamp to the FDA.

References:

Reinecke, J. K., & Hinshaw, M. A. (2020). Nail health in women. International journal of women's dermatology, 6(2), 73–79. https://doi.org/10.1016/j.ijwd.2020.01.006

In nail salons, nail technicians buff, polish and file our nails to get a great manicure and pedicure, however expose themselves and us to chemicals that can pose major health threats. Shavings from filed nails can settle on the skin and cause irritation or can be inhaled into the lungs. Nail technicians who spend a majority of their time exposed to these chemicals could inhale harmful vapors or mists from the chemicals in the shop. The compounds that come from dusting and filing our nails can settle in the worker's eyes, or could be swallowed while eating, drinking, or even puffing on a cigarette during a work break. The U.S. Occupational Safety and Health Administration sets workplace safety standards in the nail shops, and listed chemicals nail salon workers encounter on a daily basis. Nail salon clients are not exposed to these chemicals on a daily basis, but workers who are exposed to these chemicals often are at risk for the long-term effects these chemicals can cause.

One of the nail salon chemicals that pose a risk for workers is Toluene. Toluene is a clear, colorless liquid that naturally occurs as a crude oil, and is a common ingredient in nail polish and fingernail glue. Inhaling large amounts of this chemical in a short period of time can produce lightheadedness, dizziness, or drowsiness. Significant exposure to this chemical can compromise the nervous system as well as irritate eyes, throat, and lungs. Studies have shown that breathing high levels of this substance during pregnancy can cause birth defects, slow growth, and cause mental disabilities to form. OSHA has set a limit of 200 parts toluene per million during an 8-hour work shift as the limit of how much toluene is too much. Formaldehyde is also a substance found in nail polish and nail hardeners, and studies indicate it can cause cancer. Formaldehyde can irritate the eyes, skin, and throat which can induce coughing, allergic reactions, or difficulty breathing to occur. Workers are advised by OSHA that wearing half mask respirators with chemical cartridges can protect them from inhaling these chemicals. Even at low concentrations, this substance can irritate the nose and eyes and has been shown to decrease performance on short-term memory tests. Additionally, methacrylic compounds are the main substances in artificial fingernails, and these substances are problematic because they can cause allergies, asthma, and dermatitis. OSHA advises workers removing artificial nails to wear safety glasses to protect their eyes from the acrylic dust. Lastly, dibutyl phthalate is a substance used to make plastics softer and more flexible, and is included in small amounts of nail polish and polish hardener. OSHA warns that exposure in humans can cause nausea and irritation to the respiratory tract. In animals, it was shown to cause developmental and reproductive issues as well as birth defects in mice. The state of California classifies dibutyl phthalate as a reproductive and developmental toxin in humans.

Avoiding chemicals in nail Polish products remains challenging to this day. Some nail products are labeled as “3-free”, but the California Department of Toxic Substances Control finds those labels are often inaccurate. Primers labeled as acid free are also typically claimed to be free of chemicals like methacrylate acid, which is not true.

https://www.scientificamerican.com/article/these-4-chemicals-may-pose-the-most-risk-for-nail-salon-workers/

As healthcare professionals we always emphasize the safety and proper use of medications but often do not discuss the importance in self care products and the safety measures required to maintain healthy and hygienic lifestyles. Most of the information patients obtain is what they have learned on their own about managing nails, hair or even skin which may not always be accurate or from reliable sources. Many consumers are not aware of the detrimental effects of substances they use on their nails or the toxicity level of these products. As nail polish and nail polish remover do not need FDA regulation, this allows companies to advertise products in whichever manner that seems beneficial for marketing without accessing safety precautions or risks. Nail care and safety are important not only just for safety precautions when using a product but also for health benefits. Lack of nail care can lead to fungal infections, warts, and skin diseases. It can also impact a patient's self confidence or their ability to perform day to day tasks. Brittle or weak nails can be an indication of a patient’s diet, health, underlying conditions or even side effects from medications.

A common class of medication that can cause weakening of the nails are chemotherapy drugs known as taxanes. Taxanes are predominately used for breast cancer treatment. Some taxane chemotherapy medications that often cause nail changes are docetaxel, paclitaxel, and albumin-bound paclitaxel. Some other anti-cancer drugs that also impact the nails are doxorubicin, of the anthracycline class and capecitabine, of the anti-metabolite class. Anti-cancer medications have a major impact on the patient’s hair, skin, nails and overall physique. Cancer medications eliminate cancer cells but it can also destroy healthy cells, which may reflect physically on the patient. Over a period of time and repeated sessions of chemotherapy, the nails can become brittle, it can change shape or texture, it may split, the color may become darker or lighter, reduce the growth, formation of discharge or fluid below the nail may be seen and in some instances the nail may fall off, known as onycholysis. Aside from weakened nails, this can lead to other complications. Having exposed skin or ruptured skin can increase the risk of infections. Cancer patients are already have an increased risk of infection because they are immunocompromised and infections can be extremely severe.

Treatment options for managing nail side effects are maintaining proper hand hygiene. When the skin is exposed, it is important to reduce moisture and bacteria on open wounds. Biotin supplements can be given to help the nail grow stronger with the increased production of proteins. Cooling therapy is also used. Ice water is given 15 minutes before the chemotherapy session and 15 minutes after it ends to prevent the separate of the nail bedding. Vinegar and water mixture help keep the nails dry and drain any excess fluid that has accumulated. Usually when the chemotherapy treatments end, the nail begins to grow back healthier and stronger. The best method is to prevent the occurrence of weak nails by taking precautions prior to chemotherapy and proper management.

References:

Nail Cooling During Treatment with Taxane-based Chemotherapy. (n.d.). Retrieved August 26, 2020, from https://www.mskcc.org/cancer-care/patient-education/nail-cooling-during-treatment-taxane-based-chemotherapy

Gradishar WJ. Taxanes for the treatment of metastatic breast cancer. Breast Cancer (Auckl). 2012;6:159-171. doi:10.4137/BCBCR.S8205

Woo IS, Shim KH, Kim GY, et al. Nail changes during docetaxel containing combination chemotherapy. Korean J Intern Med. 2004;19(2):132-133. doi:10.3904/kjim.2004.19.2.132

Office of Dietary Supplements - Biotin. (n.d.). Retrieved August 26, 2020, from https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/