The Price We Pay for Vanity 

Unsanitary spa practices may have cost Darlene Lopez a finger -- but the state does little to protect consumers like her from infection.

Darlene Lopez, a fifty-year-old Antioch grandmother, has devoted most of her life to raising her three daughters, working as a bartender to supplement her husband's electrician salary. With children to raise and bills to pay, she rarely had the time or means to pamper herself. And that's why her daughter Kathy decided to treat Lopez to a decadent manicure and hair styling for Mother's Day two years ago.

Kathy took her mom to Nails by Lee in downtown Pittsburg, where a nail tech soaked, filed, clipped, and accidentally stabbed the cuticle skin of Lopez's never-before-manicured nails, according to documents filed later in Contra Costa County Superior Court. After mopping up the blood with a Kleenex, the manicurist continued to paint Lopez' nails with porcelain cement.

A photo taken after the mother and daughter's day at the spa shows a beaming Lopez modeling her long acrylic nails and new hairdo. But after a month, when she returned to the salon to have her artificial tips removed, she noticed a disturbing green film under her real nails. The manicurist allegedly assured her there was no reason for concern.

Lopez took his word for it. But the green stains persisted. Six months later her doctor at Kaiser Permanente diagnosed her with an aggressive staphylococcus infection that had spread to the bone, and which eventually would require an amputation of her index finger below the second knuckle. The grandmother says she also now suffers from a recurring nail fungus, which causes her nails to abnormally thicken and fall off after they grow beyond her fingertips. She filed a lawsuit against Nails by Lee last November, demanding $274,000 in damages.

While tragic, experiences like Lopez' aren't unheard of. Dozens of Northern California customers have contracted infections linked to their visit to unsanitary nail salons. One of the worst incidents, three years ago, involved 110 patrons of a Watsonville salon's luxurious footbath -- a regal padded throne that slopes toward a basin of bubbling warm water. Many of the customers had already forgotten about their day at the spa when they began developing disfiguring skin abscesses and boils on their newly shaved and polished legs. The unsightly ulcers were caused by a nasty bug, Mycobacterium fortuitum, which a disease detective from the federal Centers for Disease Control and Prevention later tracked back to the dirty, warm reservoirs of the foot spa machine.

While all of the leg boils eventually healed, some of the women were on antibiotics for as long as six months, and others considered plastic surgery to mask the ugly red scars that resulted, according to statements by CDC investigator Kevin Winthrop.

A New England Journal of Medicine article describing the outbreak identified tiny lesions from freshly shaved legs as a likely portal for the bacteria. The authors also took random samples at spas around the state and found that the rapidly growing mycobacteria were "highly prevalent" in whirlpool footbaths. "After notifying local health departments," they wrote, "we were informed of at least six sporadic cases of mycobacterial furunculosis of the lower extremities in pedicure customers at other salons." Such infections, they said, were probably under-recognized and increasing in prevalence.

"There's great potential for this to happen anywhere," concurs Marci Abrams, a Santa Cruz County epidemiologist who first investigated the Watsonville outbreak. "These places usually see ten to twelve people in a row without cleaning out the debris in the filters between clients."

Abrams had demographics in her favor. "There are only 25,000 people in Watsonville and one dermatology office," she says. "In a larger town, it would be very difficult to pinpoint the source." For this reason, she adds, the true frequency of disease transmission at nail salons is unknown.

The Watsonville case was the largest recorded outbreak linked to a nail salon, but not the most serious. California codes governing salon sanitation offer no specific guidelines for curbing transmission of blood-borne diseases in beauty establishments. Last year in San Mateo County a pedicurist shaved off a client's calluses with a contaminated razor tool, causing the woman's toes to bleed and exposing her, county health investigators believe, to hepatitis C -- a deadly blood-borne virus that can slowly destroy the liver of those infected. "While it's very unlikely that HIV could be transferred in that environment, it's more likely that hepatitis can be transferred, and I don't think people really understand that yet," says Rebecca James Gadberry, co-founder of the Barbering and Cosmetology Legislative Alliance, a political action committee representing the beauty industry.

The State Board of Barbering and Cosmetology, which oversees the safety of California's 37,000 beauty salons and barber shops and the 420,000 professionals who work in them, currently employs only twelve inspectors for the entire state -- one for every 35,000 manicurists, hairdressers, cosmetologists, aestheticians, and electrolysis techs. From 1997 to 1999, the state had just seven to nine inspectors, and the Bay Area hasn't had a designated inspector for the past two years because of a state hiring freeze and the difficulty of recruiting qualified people at the $30,000 to $36,000 salary level the state offers.

Even beauty industry lobbying groups such as Gadberry's thinks the state needs to step up its inspections. "Our stance is pro-regulation," she says. "We're an industry that understands that we deal with health issues and that we need oversight."

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