Last spring, with a predictable amount of fanfare, New York Governor Andrew Cuomo signed a new law protecting the wages and wellbeing of the state’s thousands of nail salon industry workers. Along with the law, the governor announced the creation of a special task force to safeguard workers in a variety of industries across the state. The new task force, comprising 10 state agencies and 700 investigators, is charged with preventing common workplace abuses such as wage theft, human trafficking, dangerous work conditions and excessive (re: uncompensated) overtime.

This was welcome legislation, as exploited workers most often are immigrants, already dealing with the “promise and peril” of living in a strange new city, said the governor during a speaking engagement at a New York City-area community college. The Governor’s task force grew out of legislation protecting nail-salon workers, and included an
employee “bill of rights” that must be posted at all salons.

While there’s hope that the New York legislation will be a harbinger of change, elsewhere across the nation it’s status quo. Besides the questionable labor practices that are de rigueur at a majority of salons workers face an entirely different threat from products, dust and fumes. It’s well known that many salon products, which technicians are frequently exposed to at close proximity and in poorly ventilated spaces, are hazardous. When combined, however, they may cause even greater harm. Yet, it’s difficult to know exactly how these chemicals affect the body because seldom are they studied collectively (and there are surprisingly few reports looking at the adverse effects of individual compounds).

Here’s what we do know. Salon workers ply their trade under incredibly onerous conditions, the results of which may not show up until years later. Dust shavings from filed nails can settle on the skin, causing irritation or they can be inhaled (and those small particles often contain chemicals from polishes or acrylics). Workers also inhale harmful vapors or mists and compounds settle into their eyes. These same vapors also contaminate air-born ambient fine particles, and together with the dusts from nail filings, settle on the foods ingested by these workers, both at the salon and at home. In truth, there’s a veritable laundry list of chemicals that salon workers encounter daily. Though limited exposure to this toxic brew doesn’t pose a large threat to the average salon client, who can always walk out and take their business elsewhere, technicians, stylists, and other employees have fewer options.

Indeed, the issue of toxic exposure at beauty salons has been a concern of mine for years. As a pulmonologist, I’ve treated dozens of salon workers with “adult onset” asthma, which not surprisingly, flared up around the time they started working in the industry. Employees are seldom trained in the proper handling of hazardous chemicals and
proper safeguards against toxic exposure are almost non-existent. How bad are some salon products? In a now infamous case, Brazilian Blowout, a California-based company that manufacturers a keratin-based hair straightening treatment, agreed to settle a class-action lawsuit for about $4.5 million, and in a separate matter, forked over $600,000 in
fees and penalties in a settlement with the California Attorney General after two independent lab tests confirmed that Brazilian Blowout emits formaldehyde gas, a known carcinogen linked to nose and throat cancers and leukemia, when heated during application. The treatment also has been linked to nosebleeds, respiratory difficulties (asthma),
and eye irritation, among other problems.

Hair salon workers are increasingly at risk for a number of adverse health outcomes. The constant handling of chemicals during the hair shampooing process — known in the industry as “wet work” because the hands remain wet or moist for a long period of time — can reduce the skin’s natural barrier and allow greater absorption of chemicals. A
1998 study found that hairdressers develop serious skin conditions like dermatitis, eczema, and rashes at 2-3 times the rate of people in other occupations. A 2000 American Journal of Epidemiology study found that hairdressers are four times more likely to be diagnosed with a chronic lung disease known as idiopathic pulmonary fibrosis. A 2001
study in the journal Carcinogenesis reported that the use of permanent hair dye increases bladder cancer risk in women. Perhaps this is why no less an organization than the International Agency for Research on Cancer (IARC) concluded in 2010 that, “occupational exposures as a hairdresser or barber are probably carcinogenic to humans.” Hair
salon workers also are more at risk for Alzheimer’s disease, pre-senile dementia, and motor neuron disease. They’re at greater risk of miscarriage and giving birth to babies with cleft palates. Other studies have suggested a direct link between chemical relaxers and uterine fibroid tumors.

And chemical risks aren’t salon workers only concern. Nail technicians and stylist can develop aches and pains from bending over, standing in one place, or being in the same hunched position for long periods. Filing and buffing pose additional hazards for employees, who are risk of acquiring an infection from contact with client’s nails, blood or skin.

Toothless Tiger

It would help if our government got off its collective keister and enacted better laws regulating toxic chemicals, while also giving the FDA more enforcement leeway. Under the U.S. Food, Drug, and Cosmetic Act, which hasn’t been updated since 1938, federal law doesn’t require premarket safety approval of products, nor does it require cosmetic
companies to disclose the “chemicals or gain approval for the 2,000 products that go on the market every year. And removing a cosmetic from sale takes a battle in federal court,” reported Scientific American. The lousy regulation system, which essentially renders the FDA little more than a toothless tiger, means that salon consumers and workers
have no way of knowing which products are safe, and thus are routinely exposed to hazardous chemicals. Even now, the Occupational Safety and Health Association (OSHA), and the agency responsible for establishing and enforcing the maximum exposure limit for chemicals, hasn’t updated its Permissible Exposure Limits (PELs) for chemicals used
in salon products that have adverse health effects.

On a practical level, there just aren’t enough federal agency personnel to enforce the safety and health regulations, so the burden falls to individual state cosmetology boards.
And those regulations are rarely specific enough to address toxic chemical exposures in salons. For example, there are very few guidelines establishing minimum ventilation requirements in salons. And the capacity to enforce regulations is also limited, given the large number of individual establishments, which nationwide easily number in the thousands.

Some have suggested that salon workers should decide for themselves what products they want use, and consequently to what risks they are exposed. However, few employees possess even a fraction of the knowledge needed to make those determinations. Compounding matters, many salon workers don’t understand English well enough to understand the few existing regulations. Hair products, as an example, are supposed to come with manufacturer descriptors, known as a Material Safety Data Sheet, but these sheets are published only in English, so an immigrant worker with limited language capacity, has no way of knowing what’s written on the sheet.

The lack of serious regulation means that salon owners aren’t required to disclose to clients the possible risks associated with relaxers and other commonly used products.
Even beauty schools seldom inform students that some products contain potentially harmful chemicals.

The Almighty Dollar Strikes Again

Despite the adverse effects, many salon workers may ignore potential health consequences of their products because these products are pricey, meaning they can charge more to carry out the hair treatments that have longer-lasting effects

(I wonder, however, how many workers know that a number of hair-smoothing treatments release formaldehyde—a known carcinogenic). Indeed, the beauty business is multi-billion dollar global business. Worldwide, sales in the beauty and personal care industry grew from $426 billion in 2011 to $458 billion in 2014, according to the website of
Euromonitor International, a strategic market research firm that creates data and analysis on thousands of global products and services.

Making Changes

I’ll admit that updating regulations and changing the beauty industry culture in general will be no easy task. Despite several state mandates, some high-profile lawsuits, and perfunctory government warning letters, the FDA has yet to enforce any actual regulations on these products. Government agencies regulate food, pharmaceuticals,
transportation, and even fishing, but beauty products still don’t undergo rigorous scrutiny. Also, adverse event reporting for cosmetics is entirely voluntary, whereas it’s mandatory for drugs and medical devices. For the FDA to take action there has to be proof that a particular product or ingredient is contaminated or misbranded. In short,
someone has to get sick, or die before the government will take action.

Even without regulation, however, there are practical steps that workers and clients can take today to minimize risk.

  • Workers should consider using nitrile gloves (not latex or vinyl) to help shield them from chemical exposures.
  • A mask can offer workers protection from chemicals or nail-filing dust. However, paper dust masks, which are most often used in salons, only protect against dust
    (large particles) but are useless against chemical coated fine and ultra-fine particles. A good ventilation system would partially eliminate the need for masks. Better
    yet would be an air-purifying NIOSH-approved canister gas mask, but if you’ve ever seen one, you’d quickly realize that compliance would be an issue. After all,
    patrons might wonder just how much danger they’re in if they see salon workers dressed as though they’re heading to a hazardous waste site.
  • There are a number of products that are labeled as “3-free”— meaning they’re free of toluene, formaldehyde and dibutyl phthalate. Also, look for “acid free”
    products. The best source for a list of these products can be found on the Environmental Working Group’s (EWG) website under the heading of “Skin Deep.”
  • The most effective and easy to maintain systems will vent to the outdoors, preferably to the roof and away from any intake vents for the salon and neighboring
    businesses. An effective exhaust system provides individual ventilation to each separate work table or station.
  • Salons should have their own ventilation systems and avoid sharing with adjacent businesses.
  • Fans and open windows are not substitutes for proper ventilation. Odor does not indicate whether a vapor is safe.
  • Don’t ventilate to control odors, ventilate to control toxic vapors and dust.
  • Avoid using ozone-generating air cleaning devices. Healthy people, as well as those with respiratory difficulty, can experience breathing problems when exposed to
    even relatively low levels of ozone, which can trigger an asthma-like response.
  • Dispose of all product-contaminated materials, e.g. paper towels, gauze, cotton, or other absorbent material, in a sealed container or bag.
  • Use trashcans with self-closing lids and place one at every station. Empty trash cans several times per day and change liners daily.
  • Do not smoke in the salon and post “No Smoking” signs.
  • If possible, avoid eating or drinking in salons. If this isn’t realistic, make sure all food and beverages are stored in sealed containers and prepared outside the salon.