Health: Pedicure and Bacterial Infection

(itching spots on legs have turned into ulcerated sores)

Hundreds of salons have been using whirlpool spas that soothe feet prior to a pedicure

Lack of sanitary conditions has multiplied the existence of a dangerous bacteria

The cause of the infections has been identified as a nontuberculous mycobacteria, which has been known to scientists, officials said; but, they noted, the new spas use circulation systems that trap the bacteria. Such skin infections seen after pedicures are also said to be caused by Mycobacterium fortuitum and other related mycobacteria, according to the California Board of Barbering and Cosmetology, which regulates nail salons.

Unclean tools can also produce an infection. Cutting the cuticles, a common practice, is not recommended, because the cuticles provide a natural barrier against organisms. It is strongly suggested that the cuticles be pushed, not cut.

In rare instances, dirty instruments can also transmit viruses, according to the California Board of Barbering and Cosmetology.

Contaminated foot baths can cause long-term skin damage

Most pedicure-related infections have been linked to contaminated footbaths used in the pedicure procedure. When footbaths aren't cleaned and disinfected properly, hair and skin can gather in the tub basin; and bacteria can grow to unusually high levels.

One infection that can result is called atypical mycobacterium, which is often misdiagnosed and treated as a common staph infection of the skin. The first symptom is usually a pimple that becomes larger, like an infected cyst or furuncle. To treat the infection successfully, a culture must be taken to look specifically for the mycobacterium organism. This can require several weeks to complete, with the appropriate treatment being multiple rounds of antibiotics lasting up to several months.

The boils typically developed anywhere from ten days to four months after a pedicure in the salon and numbered as many as 37 in one woman. The boils were often initially mistaken for insect bites

The infection, caused by a fast-growing microbial cousin of the tuberculosis bacterium, left some of the customers taking antibiotics for months, and even that did not always clear the infection. Some women suffered scarring or have needed skin grafts, and estimated medical costs for some have exceeded $10,000.

The bacteria swirls around the legs and feet of unsuspecting customers, typically entering the skin through tiny nicks caused by shaving.

Identification of the microbe, Mycobacterium fortuitum, usually requires a minor surgical procedure known as a punch biopsy of the skin. Then the treating doctor must instruct a laboratory to use the type of culture media on which the organisms grow. Otherwise, proper identification of the bacterium may not be made.

Nail care is a six billion dollar industry in the United States, and the more than 7,500 salons in California alone employ some 80,000 nail technicians.

Be aware and be forewarned

Consumers who enjoy pedicures can avoid painful skin infections on their legs by following these recommendations suggested by the Dallas County Department of Health and Human Services and the Texas Cosmetology Commission:

  • Do not shave legs or have any open wounds on legs or feet before the pedicure.
  • Ask if foot spas or foot bath units have been cleaned and disinfected after each use.
  • Check to see if the salon's Texas Cosmetology Commission license is clearly posted in the reception area and if the nail technician's license is posted. A recent inspection report by the commission should also be posted.
  • Manicurists/pedicurists should wash their hands with soap and water before touching a client's hands or feet.
  • Make sure the technician is washing the instruments in hot soapy water and that disinfectant is applied to the instruments. Soiled instruments must be stored separately from clean instruments.
  • Emery boards that are not approved for disinfection should be discarded after use to prevent transmission of yeast or bacterial infections.
  • Instruments and supplies that cannot be disinfected, such as orange sticks and the sponges placed between the toes, should be discarded after use.
  • Drill bits should be cleaned after each client.
  • Leave the salon if you have any doubts about its cleanliness.
  • A person who may have acquired an infection from a salon or spa should contact a physician for immediate treatment. Manicures and pedicures should not be painful; they shouldn't make your cuticles bloody and swollen.
—Compiled from information provided by
Fort Worth Star Telegram, Los Angeles Times;
California Department of Health Services, Berkeley, California, USA;
California Department of Health Services, Richmond, California, USA;
and Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and The New York Times.