3.4 Adverse Reactions to Chemicals, Allergy (Patch) Tests, Protective Barriers & Client Draping

Two kinds of skin reaction

Technicians are at risk too. Repeated skin contact with liquid monomer, gel or primer, including brush-wiping on your own hand, is the classic route to an occupational allergy. OSHA's nail-salon page also lists asthma among the possible effects of EMA, MMA, formaldehyde and quaternary ammonium disinfectants. Eye, nose and throat irritation from acetone and other solvents is common.

Recognizing reactions during and after service

During the service, watch for:

• burning, stinging or heat from a product
• a sudden "heat spike" under a curing lamp
• redness spreading past the nail area
• the client rubbing their eyes or coughing

After the service, clients may report:

• itching, swelling or blisters around the nails within a day or two
• tender or loosening nails
• a rash on the face or eyelids, where fingers touch

What to do if a reaction occurs

1. Stop using the product. Remove it as the manufacturer directs, without damaging the nail.
2. Rinse the area with water. For eye or skin contact, follow SDS Section 4, First-Aid Measures.
3. Do not diagnose or treat. Recommend the client see a physician if symptoms are more than mild, spreading or involve eyes or breathing. Call emergency services for difficulty breathing.
4. Record the reaction, the product and batch if known, and what you did on the client record (section 5.3).
5. Do not use that product, or that product family, on the client again unless a physician clears it.
6. Clients and technicians may report reactions to the FDA (section 3.3).

The allergy (patch) test

A patch test, also called a predisposition test, checks whether a client reacts to a product before the full service. Use it when the manufacturer calls for it and when a client reports sensitivity.

1. Ask about past reactions and record the product name.
2. Clean a small area of skin, often behind the ear or inside the elbow, or the area the manufacturer names.
3. Apply a small amount of the product as the directions say.
4. Leave it undisturbed for the time the manufacturer states, often 24 to 48 hours.
5. Check for redness, swelling, burning, itching or blisters. Any of these is a positive result.
6. If positive, do not use the product. Suggest the client see a physician, and record the result. If negative, record it and proceed as directed.

A negative test does not guarantee the client will never become allergic. Sensitization can develop with later exposures, which is why skin contact is avoided every time. Diagnostic patch testing for specific allergens, such as individual acrylates, is a medical procedure done by dermatologists.

Protective chemical barriers

Barriers keep chemicals off living skin:

• Technique barrier: the most important one. Keep uncured monomer, gel and primer about 1/16 inch away from the eponychium and sidewalls. Never flood product into the folds. Wipe brushes on a towel, not on skin.
• Gloves for the technician: OSHA advises the appropriate disposable glove for the chemical. Nitrile protects against many nail chemicals. OSHA notes latex or vinyl is appropriate when handling acetone. Replace gloves that are torn or soaked through.
• Eye protection: OSHA advises goggles when handling and transferring products. Safety glasses also help during heavy filing.
• Skin barrier for the client: some removal and soak procedures call for protecting surrounding skin, for example with oil or a barrier cream, as the product directions specify.
• Clothing: OSHA suggests long sleeves and knee-length clothing to keep acrylic and other dusts off skin.
• Ventilation and closed containers: these reduce vapor exposure for both people (section 3.2).

Client draping

Draping protects the client's clothing and skin and keeps the service area clean:

• Manicure: place a clean towel or disposable towel over the armrest and table, and drape a towel across the lap when liquids, acetone or monomer are used.
• Pedicure: cover the footrest with a clean towel. Roll or protect the client's clothing above the work area, and drape a towel over the lap.
• Paraffin and masks: use single-use liners or plastic wrap with a covering mitt (section 6.3).
• Sanitation: use a fresh towel for each client. Put used towels in a covered container for used items, as Michigan requires (R 338.2171). Launder them at 160°F or higher for at least 25 minutes.

In the PSI practical, "prepares client for" each service is a scored line. Hand hygiene, a clean drape and correct positioning are part of that preparation.