Nail Care Services, Yesterday and Today

4 CE Hours

By: JoAnn Stills

Learning objectives: ŠŠ Describe the three treatment benefits of paraffin services. ŠŠ List the reasons for performing soakless manicures and ŠŠ Describe the two ways essential oils work. pedicures. ŠŠ State the purpose of LED and specify the wavelength of ŠŠ Describe the soakless manicure and pedicure protocols. those used in manicures and pedicures. ŠŠ Perform analysis of the skin and nails on manicuring and ŠŠ Describe how LED is used in a service. pedicuring clients. ŠŠ State where Mycobacterium fortuitum is usually found. ŠŠ List the treatments and home care products for the seven ŠŠ Explain the purpose of a health questionnaire for nail skin conditions of the hands and feet. salons. ŠŠ Describe how ingredients are listed on retail labels. ŠŠ List the steps to qualify clients for pedicures. ŠŠ List nail conditions and their treatment. ŠŠ Describe the differences between traditional and skin care- based manicures and pedicures.

PART I – A GROWING SPECIALTY Pedicuring – A long past The pedicure is enjoying a recent surge of popularity in the More recent than that but still long ago, evidence is found that United States. It is a service that was generally left off the in the ancient Egyptian Indus Valley civilization (300 BCE) menu of most salons as recently as 1990. When it was on men and women were concerned about their face care, body the service menu, most beauty professionals performed the care and foot care. There are references in the bible that, feet service reluctantly when it was appointed. When performed, were often bathed by servants. It was an honor for a guest’s feet pedicures were considered “a manicure on the feet,” but even to be washed, and considered a gesture of respect from the host. those who specialized in manicuring did few pedicures, if any, before the mid-1990s. They did not want to touch feet, even Both women and men have enjoyed manicures for thousands those of people who were willing to pay well for pedicures. of years, but pedicures are believed to have been mostly a male All feet were considered dirty and smelly by these beauty service. They were an important part of the grooming regimen professionals. of many men, possibly to treat their calluses or to reduce the pain of sore feet, and performed at home by servants, in a club The history of manicuring is also the history of pedicuring, or in a public bath. In early times, manicures were performed though its “coming out” as a popular public service was for the beautification of the hands, while most pedicures are delayed and more subtle for pedicures. Both manicuring and believed to have been performed primarily for cleansing. pedicuring have a past extending thousands of years, and Women were slower to come to beautification foot care. were offered in many cultures – including India, China, Egypt Until the very early 20th century, women wore long dresses and Rome – to the elite in their societies, and are mentioned with their feet and ankles out of sight, so pedicures were not in ancient writings such as hieroglyphics. Ancient cultural performed for beautification. For wealthy women, it was a rare writings, whatever the form, reflect that pedicures – more ritual of relaxation and pampering, not performed especially for accurately referred to as “foot care” – began being offered beautification, and usually provided at home. 5,000 years ago in India, with henna used as nail polish.

Pedicure development in the U.S. The professional license required by state regulatory agencies pedicures an unpleasant service to provide. Because few for performing manicures and pedicures in the United States professionals listed pedicures as a service, few clients knew was initially in cosmetology. Known as hair designers because the enjoyment and beauty they offer. Until recently, pedicures of a preference for working with hair, many cosmetologists were not considered a highly demanded or profitable service for would perform a manicure on a hair client, but considered salons.

Cosmetology.EliteCME.com Page 1 Pedicures are not a new service in the United States, though they inner specialty in the beauty industry. By 1980, nail salons were were ignored by most salons until recently. An advertisement in opening in most cities. the May 18, 1910, issue of the Denver Evening Post mentions pedicure services, and ads for pedicures could be seen in large For example, look at Columbus, Ohio: In 1980, three nail cities prior to that. Because they were a service that 1) did not salons were in business, soon to become four, on and on. In have special furnishings or implements, 2) did not have a special the years since, the phrase “a nail salon on every corner” has location in salons, 3) were not suggested during cross referrals of become an accurate description of the nail business expansion services, and 4) might have held a small, unnoticed place on the in almost every city. Now it is estimated that more than 200 menu that indicated “… and we also will do a pedicure, if you specialty salons in the Columbus area offer nail and pedicure ask or insist”, pedicures were not a big seller. services exclusively.

Then, in the 1970s, artificial nails, known as “acrylic nails,” In the very early 1990s, day spas became a quickly developing began to develop as a serious service in salons and an important reality, although many initially did not offer nail services specialty in the beauty business. They quickly became a fashion because they did not want to have the acrylic odor in their spas. statement for women. In just a few years, the services boomed, In fact, the American Spa Association listed nail services as and they officially came into the lifestyle of fashionable women “optional” in its definition of “day spa” in its early literature, when the leading ladies of the era’s popular TV shows “Dallas” and they were not required to be in the facility to be called a and “Dynasty” wore them. With this new popularity, the nail day spa. But clients wanted nail services, so spas added a few table came out of the back room to into the front of the salon, nail tables and pampering natural nail services; a few added the bringing the accompanying smells with it. It became a featured artificial nail service in a separate room because of the smell. In service, providing significant money to salons’ bottom lines. the early development of spas, it appears that the few spas that This popularity brought artistic respectability for the salons and offered acrylics in the formative years of the spa concept were professionals specializing in them. those developed through expansion of hair salons. These salons added spa-type services in a quiet area of the salon, but wished The speedy development of the popularity of artificial nails to maintain their currently active and profitable hair and nail quickly moved natural nail services into the background of the departments. However, pedicures were still not performed in beauty industry. Many nail salons took them off their service most spas, even in the ones that focused on relaxation. menus because the salons viewed them as a low profit service, and the cosmetologists specializing in acrylic nails did not Day spas eventually brought pedicures into the beauty industry want to perform them; they made more money performing in the mid-1990s. Although European Touch had developed artificial nail services. Their acrylic nail clients became high- and put the spa pedicure chair on the market in 1985, it wasn’t ticket “regulars” following their first application, immediately until day spas became significant in the beauty world that the scheduling standing appointments for maintenance. The acrylic product and concept took off. The day spas loved the new nail services brought in the most money per service in the nail chairs. These heating and massaging chairs with bubbling departments. Soon, finding enough cosmetologists to meet the whirlpools for the feet were perfect for spas and met their focus demand for these new services became a problem, especially of pampering services; they swirled and soaked, massaged and because few of them fully specialized in the service. The vibrated, bringing ultimate relaxation to clients who discovered industry’s answer was to develop a specialty license, titled pedicures when they were offered in these wonderful chairs. “manicurist,” and states added manicuring licenses over time About the same time, Creative Nail Design (CND) of Vista, through their legislatures. This new specialty required minimal Calif., developed the first Spa Pedicure Kit and protocol, education and was not restrictive in who could take the course. bringing more attention to pedicures. The pedicure industry Now all states, except Connecticut have a separate manicuring began to grow quickly, and by 1995, only a few spas did not license. Originally, the hours required were as low as 50 hours; have a whirlpool chair to offer the pedicure service. cosmetologists took that many hours in just a single long From these developments, the concept of the basic and spa hair design course. Some states have maintained low hour pedicure menu evolved, and pedicures became the service to requirements for licensure, such as Delaware’s (125 clock have in a spa package. The monthly pedicure, routine foot care hours), Ohio and Maine (200 clock hours), but most states have and beautification were soon accepted as a ritual for many raised the requirements over the years to as high as 750 clock women in the large cities where more spas were available. The hours in Alabama and others. services sold themselves, and once a client experienced one in The beauty industry began to change when the new nail specialty a package, the spas knew they would be back for the service became popular. The nail industry became defined and earned again. a listing in the U.S. Bureau of Labor Statistics databases. As When pedicures became popular in spas, nail salons began to the industry grew, the smell of the nail monomer that hair look for the dollars to invest in a pedicure chair to add them to salons found offensive, and the entrepreneurial spirit of the their menus. Because the prices for pedicures were established new specialists moved the services out of the hair salons into by day spas – which meant they were higher – salons found their own locations. Because the services were in high demand, they could bring in nice profits despite the high cost of the new many salons became dedicated to artificial nail services only; throne-type chair. Suddenly, nail professionals wanted to add “nail salons” were born, and they became the first profitable pedicures to their service talents, and soon, pedicure areas that

Page 2 Cosmetology.EliteCME.com were private and the ultimate in relaxation were added, making with the number of people who could be accommodated with the service even more pampering, popular and profitable. comfort and exceptional pampering restricted by the number of professionals to provide the services and the number of Many large salons and spas added multiple chair rooms, chairs available. Pedicure parties, including girls’ nights out, called “pedicure lounges,” bringing the comparative square bridal celebrations and any other excuse to party encouraged footage cost per chair lower in a setting that was still luxurious the development of even larger pedicure lounges. By 1999, and inviting. The additional pedicure chairs in these lounges pedicures were the fastest growing service in the global beauty attracted groups and couples to enjoy the services together, industry.

A new world for manicurists Spas and salons soon were expanding their pedicure menus cuticle softening and polish. This service is still on menus to include pedicures that exhibited the spa’s theme or were today. The longer and more luxurious pedicures providing the a specialty pedicure with the spa’s name in the title. These client with special treatments, such as masques, were called pedicures were high-end, stress-relieving treatments that “spa pedicures” and went up in price to $50-65, with some provided relaxation and rejuvenation even beyond the normally luxury pedicures even higher in especially high-end resorts luxurious spa pedicure service. Clients experienced softer and spas. This new spa pedicure developed by CND included feet and many felt even more revitalized post-treatment. They the skin of the legs and focused on exceptional relaxation brought in top dollar to both the spa and the professional techniques, with a longer massage, pleasant aromas and a skin providing the service. Many manicurists and cosmetologists softening masque. This service is still on spa menus; clients wanted to perform pedicures and to become a “pedicurist,” the leave the pedicure room very rejuvenated and relaxed when the new name for those who specialized in pedicures, and many service is over. performed them exclusively. Ambiance and added features are important to these pedicures The average price for a basic pedicure in a spa in 2000 was and their pricing. For example, some pedicure lounges with $35-50 for a 30-45-minute service, depending on the salon many chairs designed to provide exceptional ambiance and or spa. This pedicure was called a “basic,” without bells and luxury have curtains for individual chair privacy if the client whistles, and was a service performed only on the feet and not prefers it. A number of special features and add-ons have the legs. It included all the basic pedicure service segments: gained in popularity and can be added to a salon’s services. soak, nail trim, scrub, short massage, minor callus smoothing,

Paraffin Paraffin treatments have a long history of use in the medical the elastin and collagen fibers in the dermal layers of the skin industry for reducing pain from rheumatism. They are used are stimulated to regenerate by the heat and the product that in manicures and pedicures in the beauty industry to soften is absorbed. Third, hydration of the skin occurs as the heat skin. Originally, they were performed by dipping the hand or from the paraffin produces perspiration, which cannot escape foot in a temperature-regulated tub, called a “paraffin bath.” the surface of the skin because of the paraffin barrier and so These units keep paraffin wax heated to above its melting point is forced into the surrounding layers of the skin, plumping it to maintain a liquid form, in most units at a comfortable 120 up and providing hydration to skin cells. With all this in mind, degrees to 130 degrees Fahrenheit. But for sanitation issues, paraffin is a perfect add-on for a client wanting to improve her other methods of applying paraffin wax have been developed, skin, or it can be included in a luxury pedicure to enhance the including spray-on techniques, paraffin-dipped gauze strips, perceived value of the service. The add-on price for a paraffin one-time gloves or foot mitts, and dipped gauze sheets wrapped treatment in a pedicure ranges from $10-25, according to over the hands or feet. whether there is an additional masque or skin treatment applied before the paraffin and to the luxury of the facility where it is Paraffin is made from hydrocarbons of the paraffin distillate performed. portion of crude petroleum. It is able to absorb and retain a high amount of heat. As it melts, the paraffin becomes a liquid One advantage to this treatment is that it can be performed in and is easily applied by the above methods to the hands, feet, a pedicure without added time; the nail technician can apply even faces. It is in a solid state at room temperature and begins it to one foot while working on the other foot, or it can be just to enter the liquid phase when heated past approximately 98.6 applied over a masque so it will be included in the set time for degrees (37°C). the masque. Consider providing this treatment on the hands during the pedicure for an additional add-on price, or as a part Three benefits occur in a paraffin treatment. First, the paraffin of a luxury pedicure. serves as a barrier holding the treatment lotion to the surface of the skin while its heat opens the pores to enable greater Some technicians have problems introducing paraffin penetration of the product ingredients into the skin. Second, treatments to their clients, and no matter how effective the

Cosmetology.EliteCME.com Page 3 treatment is, it will not become a staple for their clients if they dramatic; once clients see it, many ask for the other one to don’t first experience the service. One method to stimulate have the service, too, or at least set an appointment for the demand for this service is to offer a free paraffin treatment on treatment with their next service. Free treatments of both hands one hand or foot to clients, regardless of whether they are in the or both feet aren’t recommended because clients might not see salon for new sets, fills, manicures or pedicures. the difference the service provides without the comparison. If the free treatment is only on one foot, the difference will be Prepping the skin on the foot before the paraffin application noted following the pedicure and even later, and clients are is important to the results of the treatment. Cleanse with an much more likely to schedule the treatment during their next exfoliating lotion, then remove the product thoroughly with pedicure. a warm, wet towel and dry it. Apply a hydrating lotion, then apply paraffin to the hand or foot according to your salon’s Paraffin can be used in many ways to expand profits in a policy; place it in a plastic cover and then into a terry mitt pedicure business and is a great way to get clients back into the cover. salon. Enclose a gift certificate for one when sending birthday cards, a new client thank-you card, or on the anniversary card During the set time (the time the paraffin is on the hand or when the client started with the salon. There are many ways foot, usually 10 minutes) and while working on the other foot, to expand this simple but profitable add-on treatment. Ask explain the benefits of the service and mention the price. Then, other salon and spa owners and professionals in the industry after the paraffin has been removed, compare the treated and how they market their paraffin treatments, and you will find a untreated hands or feet. The difference in appearance is usually myriad of ways it can bring in clients and expand tickets.

Aromatherapy Essential oils, the active ingredient of aromatherapy treatments, Training for the use of essential oils in aromatherapy is a have been used since antiquity in the art and science of healing specialty and may be difficult to find. Always investigate and to soothe the body, mind and spirit. These precious oils are the experience and reputation of every trainer or institute highly concentrated, non-oily, volatile extracts distilled from that specializes in this training. The use of pure oils is a the aromatic roots, stalks, flowers, leaves or fruit of plants. responsibility professionals must understand; good training Each oil contains its own unique, beneficial properties for use reduces their complexity and enhances their safety during their in aromatherapy treatment and product formulations. They use within a service. For example, a user of pure oils must contain vitamins, minerals and natural antiseptics and have know that essential oil of rosemary should not be used on hormone-like qualities that can be highly active – and even persons with high blood pressure. dangerous in the hands of the uninformed. These qualities make them complex in their choice for treatments; safe use of pure It is also generally believed that carefully blended products are essential oils is a matter of training and experience. best in the beauty industry. To prevent problems and support safe use of aromatherapy products, several companies have prepared Essential oils work in two different ways. Each unique oil blends of oils in synergistic products for safe use in manicures affects the body through the sense of smell to the limbic system and pedicures. These lotions, oils, aromasols and soaks are of the brain, and can work additionally through their absorption formulated with identical aromas in the product lines that contain into the skin from specially formulated products. Many of the a blend of oils that are safe for general use while enhancing the aromatherapy products can be used in manicures and pedicures, benefits – such as relaxation or energy enhancement – that are and can provide benefits through their inclusion to products in noted on their labels. Each blend is formulated into products for the services. In a pedicure, aroma can be in products for the use in each step within the service, such as the soak, massage, soak, the massage product, lotions, in aerosols for aroma on lotions and aerosols for spraying on towels. Other companies the towels, even in candles. These products enhance enjoyment build entire lines around a single aroma, building several single of services, some through their aroma and some through a aroma lines to provide choices. Clients relax into the subtle combination of their aroma and the product absorbed through aromas – they often purchase retail products from the line to use the skin providing its benefits. at home, too.

Reflexology Considered a massage technique, it is a form of thumb or finger reflect healing energy to a corresponding organ in the body. It compression applied to specific points on the hands and feet. cannot be provided or advertised as medical care in United States This special tension-relieving massage can be an excellent short salons. But even for just relaxation, it is a complex service to service or can be added to manicures and pedicures as an add- perform correctly. Pedicurists who wish to perform reflexology on treatment. Thirty minutes should be the appointed time as a in their services need to understand that training is a must, and separate service, but a good add-on application is ten minutes it should be an intense study. Clients love this treatment from a within a massage service, or time added onto a massage. trained reflexologist and will drive far to return to one they have found who performs the service correctly. Reflexology has been performed for centuries in many cultures as a health treatment. Each spot massaged on the foot is said to

Page 4 Cosmetology.EliteCME.com Know this: many clients know reflexology well because they reflexology training. They can tell the difference. They won’t have experienced it many times and love it. They will be very be back and can be very verbal about it both to management unhappy if they pay for a treatment with a technician who and to their friends. is trained in a four-hour course versus one with extensive

Light therapy Skin cells have been found to have phototherapy receptors be performed in a series of treatments, whether with a hand- that respond to specific wavelengths and colors of light held LED or a machine where the hand or foot is positioned emitting diodes (LEDs). These wavelengths of light can restore under the light. The elastin and collagen must be repeatedly skin’s cellular activity to healthy levels. LED therapy is a stimulated to redevelop the strength in their fibers. The protocol noninvasive, yet effective way to increase the energy levels in for LED in manicuring and pedicuring is to use it once a the skin through their photoreceptors, thus promoting collagen week during another service, or as a short stand-alone service synthesis and cell renewal. The anti-aging light for use at the between biweekly services. The client can experience it in a manicuring and pedicuring stations is red LED (660nm). Lights service, then come to the salon between services for a quick of this wavelength stimulate the production of collagen and treatment. (The treatment can be experienced more often with elastin, the proteins found in the skin that maintain its flexibility no harm.) The rejuvenation of the skin is progressive, meaning and strength. Collagen and elastin production is essential for the it will not be instantaneous, so it is suggested the pedicurist take health and beauty of the skin, and they also maintain the shape a digital picture before the initial treatment, then again four to and elasticity of the skin. Through the increase in collagen and six weeks later so the client can see the notable improvement. elastin in the skin, red LED can reduce fine lines and wrinkles, The client is told the function of the photo so he or she can making the skin look younger and more vital. The feet reflect anticipate seeing the change. This encourages commitment loss of these proteins, looking “old” to the person looking down to the needed appointments. This treatment is also known to at them; the acceptance and popularity of open shoes causes lighten “age spots” (hyperpigmentation) when experienced in them concern that can encourage them to try LED. tandem with glycolic lotions, lightening products and consistent use of SPF products of 15 and above. LED will, with repeated use, noticeably improve the appearance of the skin on a client’s hands and feet. It must

Nail art Nail art has been an established add-on in the industry for many complex art on the fingernails, but it attracts just as much years to bring attention to natural and enhanced fingernails. attention when applied to toenails when the client is wearing Only in recent years has it begun to be applied to toenails. open toe shoes or sandals – perhaps even more. The art on the toenails is usually simpler than the sometimes

Artificial toenails Until recently, most manicurists did not apply artificial toenails inflexible, and if the toenail gets caught on something, it because of the ergonomics of it and the unique sizes of the can rip off the underlying nail plate with the artificial nail, nail plates. Despite what some technicians say, it is a different leaving a bloody and painful nail bed. Gels are more flexible application. Many manicurists apply them now, and the clients and less likely to remove the nail plate in this instance. who want them are very pleased. But three things must be 3. The artificial toenail must be shorter than the tip of the toe considered before their application: to prevent pressure on the toe from shoes and to prevent 1. The nail technician must be certain the nail is not fungal or violently pushing the less-flexible-than-a-natural-nail pseudomonal. It is illegal for a nail technician to work on or product back into the nail matrix if it is stubbed. It also may apply a nail to a toe or finger that is not healthy. prevent the nail from catching on something on those rare 2. It is recommended that the product applied to the toenail occasions. be a flexible gel. Acrylic nails are extremely hard and

Changes in the nail industry The nail industry enjoyed a time of high profits, and that The onslaught of below-market salons hit the nail industry hard. always attracts competition. The climate began to change Prices plummeted, and many multi-service salons abandoned dramatically in the mid-1990s. The trend towards “below- the performance of nails as a service because they could not market” nail salons, as they are sometimes referred to, attracted compete at a profitable level; their facilities were too expensive, many women, and were welcomed by consumers who could and the prices needed to support them were no longer feasible. not afford services from traditional nail salons. These salons The incomes of manicurists in the traditional salons lowered quickly became profitable.

Cosmetology.EliteCME.com Page 5 dramatically, and fewer were able to make a good living at their coat, etc. Clients have a choice with this concept of how craft. much they want to pay through the elimination of some of the traditional pedicure services. When the industry first was enjoying the development of acrylic ●● The traditional salons charge for the full service, not by the nails, salons offering nail services were offering predominantly incremental units of the service. The clients of these salons acrylic services with occasional manicures. Then, spas added or spas do not care to price-pick their service and often are pedicures and the pedicure hit the mainstream. Clients who irritated by this type of pricing. went to nail salons, not spas, began wanting pedicures, and nail ●● Below-market salons do not require an appointment, salons began performing pedicures. Then, the below-market which is very attractive to busy people. salons noted the profitability of pedicures and also entered the ●● Traditional salons adhere to an appointment system and their market. Pedicures were now big business in both spectrums of clients want their specific time. They become irritated if they the nail business; many times, spa clients are getting pedicures have to wait. Many times these salons or spas will take walk-in more often than their hair cut. clients if they have an opening, but usually they are not set up for this type of service. For many years, a huge chasm existed between the two ●● The pedicure chairs in a below-market salon are lined up out in segments of the market, the below-market nail salons and the the open main room of the salon. traditional nail salons, even though they usually did not attract ●● The pedicure chairs in a traditional salon or spa usually are the same clients. in a separate room, individually or in a pedicure lounge, ●● The below-market salons attract clients who focus on price providing the privacy their clients prefer. and speed. ●● The traditional salons and spas focus on the clients who Many second-generation owners of the below-market salons want ultimate pampering and high-end customer service are now stepping into the traditional market, with upscale with their services. and luxury salons and appointment policies. Every market ●● The below-market salons charge by the increment of the evolves, and this one has also. They bring with them their solid service – an amount for the basic service plus added dollars business savvy, and many are enjoying their new niche for their for any additional part of the service, such as polishing, top businesses.

Problems in the nail industry As the nail industry grew, so did the problem it ignored: hand washing, disinfected A clean chair infection control. Poor infection control has always been a implements and fresh files problem in the nail industry. In the 1970s, infection control was were three situations they Mycobacterium fortuitum mentioned in the texts, but it was not a focus in the schools. were to evaluate, among is usually a harmless Basic bacteriology was taught, but many technicians did not others. Interestingly, three bacteria that is present commit to strict daily disinfectant change and correct mix of calls came in to the owner in all water systems. disinfection solutions; the textbooks did not emphasize perfect from other salon owners However, if a pedicure preparation of implements prior to disinfection, and many telling her that she was chair is not cleaned manicurists took it lightly. “ruining” their business, of skin cells and other two of them stating that biological debris, it can In the 1980s, during the explosion of artificial fingernails, it was in colorful language. Her become a pathogenic still not emphasized, so “greenies” were the constant scourge answer? “If you can’t meet bacteria and cause of artificial nail wearers. Manicurists re-used files constantly, state minimums, get out of lesions and scarring pulling them out of a dirty drawer with the prior clients’ filings the business.” on the legs. Numerous on them. In the 1990s, it is said that as few as 10 percent of injuries have been manicurists performed perfect implement infection control, and Times have not changed. It reported in the media fewer than that insisted on the clients washing their hands or is estimated that even now, concerning this bacteria feet prior to nail service. fewer than 30 percent of nail in poorly disinfected salons meet state minimums pedicure chairs. In 1994, a successful salon owner was featured in an article for infection control, even titled, “Choosing a Safe Nail Salon” in the Cleveland Plain with the continual media Dealer Fashion section. The salon owner listed the basics attention after 2000 to the poor infection control in the nail for consumers in choosing a safe nail salon. Pre-service industry.

Deaths and the downturn Every year, stories are aired on local and national TV news hurt, and even died because of poor infection control in these magazine programs about undercover visits to nail salons neglectful salons. with videos of poor sanitation practices. The shows feature disgusting stories about salons that do not conduct infection control at all, and worse, stories of persons who have been

Page 6 Cosmetology.EliteCME.com The most publicized incidents In 1999 and 2000, an outbreak of mycobacterium fortuitum 46-year-old died in February 2006 of a heart attack triggered by infections from pedicures in a salon in Watsonville, Calif., a staph infection. caused ugly, slow-healing lesions and permanent scars on more than 120 women. The outbreak was caused by the failure to Jessica Mears, of Sunnyvale, Calif., died in late June 2006 at clean the pedicure equipment properly, and brought intense age 43 after developing a bacterial infection from an injury in attention to the lack of infection control in the industry. a pedicure. She had lupus, a chronic disease that compromises the immune system, and the lesion never completely healed. In November 2004, another outbreak of mycobacterium She died from complications caused by the infection. fortuitum lesions occurred in San Jose, Calif. The assessment is that 27 salons were involved, with more than 120 people The results of these tragic stories and the national attention infected. No one knows why it occurred in so many separate they got is that the industry lost potential and current clients as salons, but the cause was linked to dirty screens in the foot soon as the stories aired. Many times, the publicity about these baths. kinds of problems paint the entire industry as a dangerous and potentially deadly one. Then a client died. Kimberly Kay Jackson of Fort Worth, Texas, was a paraplegic and could not feel the massages and bubbling Though the number of missed or lost clients cannot be water on her feet, but loved pedicures and the resulting pretty quantified, it is probably higher than we can imagine, toes. But after her heel was cut with a pumice stone during considering the rate the industry was growing prior to these a July 2005 pedicure, she developed an oozing wound that incidents. Potential clients who decide against having pedicures wouldn’t heal, despite repeated rounds of antibiotics. The are verbal about their fear, and those who stop having pedicures are even more so.

Times have changed... for the worse Sanitation and disinfection are extremely important, and everything (indirect transfer). The problem is its resistance to the key to preventing the transmission of infection, their the effects of antibiotics. perfect execution, is even more important. Illnesses are being transmitted much faster and with more consequences than they Manicurists are more at-risk, than the average person, to being were even 15 years ago. We must do more to protect ourselves exposed to and infected by CA-MRSA because they touch and our clients from the transfer of infection. and hold the hands and feet of their clients who may be ill or “colonized,” meaning they carry the MRSA infection, but Here are just a few examples of infections now rampant in our it is not pathogenic to them. Studies show that 30 percent of society from which clients (and nail professionals) must be the U.S. population is colonized, so it is probable that several protected. customer in a technicians clientele are colonized with the easily transmittable staph microbe and don’t know it. Methicillin-resistant staphylococcus aureus (MRSA) – This infection is from the bacteria Staphylococcus aureus, a microbe Symptoms of CA-MRSA infection proceed through stages, that is commonly found living harmlessly on our body. When it with each worse than the last. Too quickly, if not treated, it can becomes “out of balance” on our bodies past a healthy tolerance carry the infection into the inner body and to a person’s organs. or when a cut on the skin occurs, it can become pathological At this point, it is difficult to treat, and it can be lethal. Even (capable of causing illness). People with immune system the first stage is treated aggressively with heavy antibiotics, disorders also are particularly vulnerable. When the microbe because MRSA proceeds through the stages quickly and is pathological and resistant, meaning it no longer responds must be stopped as early as possible. Many manicurists have to a certain antibiotic, the person can develop an even more reported being infected and not knowing what the lesion was. dangerous illness that can quickly become deadly. They usually realize what it is when a client or their co-workers – who may be exposed – become alarmed and send the person Hospitals in the U.S. have been fighting the presence of staph to the doctor immediately. Professionals in personal care for decades because it became more and more resistant to industries usually will be ordered to stay home for a time until first-line antibiotics during the battle. Then, in 1990, the first the infection is controlled to prevent passing it on to others. methicillin-resistant staph was found outside the hospital, and it was no longer contained. Now, MRSA in hospitals is called Since MRSA infections are so serious and can be deadly, it hospital-associated methicillin-resistant staphylococcus aureus is important to learn to recognize the symptoms of an MRSA (HA-MRSA); in the greater population, the incidence of the infection so that early treatment can be initiated. infection is called community-associated methicillin-resistant staphylococcus aureus (CA-MRSA). Whatever its origin, MRSA symptoms MRSA is causing illnesses that kill more people every year The first symptom is a little red bump or bumps on the skin that than HIV and hepatitis. MRSA is very contagious, and is spread appear like spider or other bug bites. (For a very short time, by touch between people (direct transfer) and between people it isn’t even surrounded by redness.) But it doesn’t stop there. and surfaces, such as towels, clothing, tabletops, just about The area quickly becomes inflamed and painful, then develops

Cosmetology.EliteCME.com Page 7 a boil that is draining or is full of pus. Within 3-4 days, it Some people, such as older people, young children and people becomes a deep, damaging abscess that penetrates the skin. By with certain health conditions, are especially at risk for serious then, the person likely will have sought help from a physician flu complications. Manicurists are very susceptible to influenza, or emergency room and been prescribed heavy antibiotics even both minor and major, and new and usual forms, so they should before lab tests confirm the probable diagnosis. At the same always seek out administration of the yearly vaccination as time, the person will feel fatigued, much like the day before flu soon as it is available. These viruses can be transmitted more emerges, and will become irritable. If the lesion does not get than 24 hours before any symptoms develop – and a week after better immediately, even stronger antibiotics will be prescribed. illness begins. Children and people with compromised immune If it still does not begin to get better, other symptoms, such systems are contagious longer. as fever, difficulty breathing, chills or chest pain, would typically be signs of a more serious MRSA infection that has The administration of the flu vaccine was only by injection spread beyond the skin and to the blood, lungs or other part until recently. In 2009, the FluMist was released, a nasal spray of his body. These symptoms require immediate and intensive made with live, weakened viruses that do not cause the illness. medical attention and can potentially require hospitalization It is approved for use in healthy, non-pregnant people ages in an infectious ward of the hospital. It is not unusual for this 2-49. Another new way to administer the vaccine, which is person to be off work for months and be permanently incapable being tested, is a Velcro-like tape placed on the skin. The tiny of working or no longer allowed to work in a personal care or “needles” will disseminate the vaccine into the skin, and the food industry. skin will transmit it into the body.

MRSA bacteria are continually mutating and developing Overall, influenza is estimated to cause 30,000 confirmed resistance to medications, making it an even more serious deaths each year. Last year, H1N1 added to this number concern in the United States. Committed and effective infection significantly. However, because of the mobilization of control is the only means to prevent the transfer of this disease the U.S. health care industry, the final number proved to in a salon, whether from the professional to a client or vice be significantly lower than President Obama’s Council of versa. This illness is a legitimate concern to manicurists and Advisors on Science and Technology predicted. The report becoming more so every day. had predicted from 30,000 to 90,000 deaths as part of a “plausible scenario” due to large number of outbreaks in Upper respiratory infections (URI) – Infections of the schools, inadequate antiviral supplies and the virus peaking respiratory tract cause the highest number of days lost in before vaccinations could be developed and produced. As of the U.S. workforce. They are highly contagious, meaning mid-March 2010, the CDC estimated that about 59 million spread easily from person to person, and infectious, meaning Americans had contracted the H1N1 virus, 265,000 were transmitted by a pathogenic microorganism; there are over hospitalized as a result, and 12,000 died. People with at-risk 200 viruses that can cause URI. They require a high level conditions, such as congestive heart disease, asthma and of infection control in personal services such as in the diabetes, were among those significantly affected. It also nail industry. Manicurists and pedicurists are especially cost billions of dollars in the U.S. for health care and in lost susceptible to respiratory infections because they 1) sit productivity. directly in front of and close to their clients, and 2) hold the client’s hands or feet in their hands. H1N1’s track of infection was abnormal in that it caused illness at times of the year when flu does not normally appear; the first Symptoms are fever, sore throat and cough, and examples are case was diagnosed on March 28, 2009, a time when the flu is influenza, common cold, tonsillitis, rhinovirus, strep, sinus usually greatly on the decline. The nation was not prepared for infections, laryngitis, measles and many more. its high impact and the high number of flu deaths when it first became a reality. The vaccination, released in October 2009, was Influenza (flu) – is an acute viral infection involving successful in reducing the number of confirmed deaths to below inflammation of the respiratory tract and fever, chills, cough, the number predicted. It is included in the 2010-2011 vaccination sore throat, runny or stuffy nose, muscular pain and fatigue. medication. Some suffers might also have vomiting and diarrhea. It can cause mild to severe illness, and can lead to death. Its The significance of all these statistics and facts about flu for occurrence is somewhat unpredictable, but is predictable manicurists is that they must not consider protection from the enough seasonally to make it important that everyone over 6 flu shot a choice. Although only 10-20 percent of people in the months old should get a flu shot available in the fall of each U.S. willingly take the shots, manicurists should not be in that year. The CDC recommends the vaccine be taken in October number. For their protection, and for protection of their clients, and November for best immunization. they must get vaccinated as soon as the shots become available in late-summer or early-fall.

Believe it… The transfer of infection is becoming more and more likely in dangerous. With airplane travel, an infection can jump from one these times because the size of our world is shrinking. This is side of the world into a country on the opposite side in days, with one of the main reasons infections are becoming more and more infections happening quickly between exposure-incubation of a

Page 8 Cosmetology.EliteCME.com microbe to illness. One of the major problems with persuading education will change these attitudes as times become more and manicurists that they need infection prevention is they are not more dangerous, microbes become more and more resistant, and convinced that what they do will transfer disease. Many also are the world becomes smaller and smaller. not convinced because they cannot see the culprits. Hopefully,

Comprehensive prevention in the nail salon Prevention of the transfer of infection must come from a nail industry have always been confused about whether to wear comprehensive work philosophy in a salon or spa and requires them, saying, “Our state board does not require us to wear them,” knowledge and commitment. Every activity in the salon must and that may be true. However, the Occupational Safety and be considered important to and a part of this philosophy, from Health Act (OSHA) in its universal precautions standard does, client care to facility surface cleansing and maintenance. Below stating, are some of the considerations in a comprehensive prevention “The blood-borne pathogens standard applies to all plan in a nail salon or department. employees with occupational exposure to blood or other potentially infectious materials, even if no actual exposure Hand washing is a requirement in every state’s regulations for incidents have occurred.” pre-service infection control in beauty services. But it is also one of the most neglected practices in the performance of nail No nail technician can say he or she has never drawn blood. services. The hands must be washed, and some state regulations And it does not have to be a large amount. For that reason, the require the nails to be cleaned with a nail brush as well. This answer is: Manicurists must wear PPE, which includes gloves, activity is designed to remove dirt, debris and pathogenic masks and eye protection designed to protect manicurists microorganisms from a worker’s hands before working with the from disease-producing microbes that may be in their work next client. It is also can prevent the transfer of infection from environment. Gloves protect their hands from contamination the last client or from surfaces and other exposures since the from clients and surfaces. Masks protect their respiratory last client. Following are the techniques for hand washing as system from airborne infection, and eye protection protects recommended by the CDC: their valuable eyes from flying debris and microbes. OSHA 1. Hands should be washed using soap and warm, running requires wearing these, and salon and spa owners are required water. to provide them and to enforce their use. If they do not, and an 2. Hands should be rubbed vigorously during washing for at employee becomes infected, the salon or spa is responsible for least 20 seconds, with special attention paid to the backs the person’s illness. If they require their use and an employee of the hands, wrists, between the fingers and under the becomes ill, it is the employee’s responsibility. It’s as simple as fingernails. that. 3. Hands should be rinsed well while leaving the water Pedicure equipment disinfection has become a major issue in running. the nail industry. Poor disinfection of pedicure chairs is said to 4. With the water running, hands should be dried with a single- be the cause of several of the most serious injuries and deaths. use towel. Since those occurrences, most state boards have incorporated 5. Turn off the water using a paper towel, covering washed hands rules for cleaning and disinfection of these chairs. Most of them to prevent re-contamination. follow the Nail Manufacturers Council’s (NMC) recommended The CDC also has a recommendation on how to use hand protocol. (See www.pro-beauty.org) Experts say that if this sanitizers: protocol and implement disinfection are followed, the nail 1. Apply product to the palm of one hand. Follow the industry would have no more problems. That is somewhat manufacturers’ recommendations regarding the volume of simplistic, but it can be said that the infections and deaths product to use. described above might not have occurred if disinfection had 2. Rub hands together. been properly performed on implements and pedicure stations. 3. Rub the product over all surfaces of hands and fingers until hands are completely dry of product. Implementation of infection control is necessary for the protection of clients from the transfer of pathological The CDC recommends the use of water and soap in hand washing microorganisms. For an implement to be appropriately except when no water is available. disinfected or autoclaved, the surface must first be cleansed Environmental surfaces such as tables and counters may with a brush, soap and water, then rinsed and patted dry. contribute to the transfer of infection from hand contact or Neither disinfection nor sterilization can be performed properly contact with other contaminated surfaces. Every surface on dirty implements. potentially exposed to human contact should be cleaned daily Even a tiny injury with an implement that is not disinfected with a surface disinfectant. Every surface used during services can cause an infection. If the client is immunosuppressed, poor must be disinfected after every client. Effective sprays are healing will follow, and the damage goes on from there. A tiny available that take minimal time and effort. injury has the potential to cause amputation or death.

PPEs (personal protection equipment) are used during services Perfect implement infection control can only be performed to protect the employee from contamination. Professionals in the with an autoclave, a steam-under-pressure machine that

Cosmetology.EliteCME.com Page 9 kills everything on whatever is put through the process of label; it is changed in the time dictated by the instructions; sterilization within its chamber. Implements put through the mixed exactly as directed on the label; the implements are disinfection process in high-level immersion disinfectants kill cleansed with warm water, brush and soap; the implements are all microbes but not spores. Disinfectants are appropriate for dried prior to insertion into the product so the solution will not use in salons and spas if the product is virucidal, bactericidal become diluted over time; and the implements maintain their and fungicidal and is used according to the instructions on the state of disinfection during storage.

Safe services Performing safe services and developing that reputation ●● No pain should interfere with the enjoyment of a pedicure. demands maintenance of certain obvious practices in a salon or If a client has memories of pain, the quality of the pedicure spa. is reduced in his or her mind, and the possibility of an injury ●● Obvious cleanliness and infection control for implements, is there. equipment and surfaces will tell clients the story, and they ●● A relationship with a physician or podiatrist, or several, will tell their friends. enables cross referrals. ●● A thorough foot exam will provide the information for ●● A caring attitude will ensure all the above and will bring qualifying whether the client can have a pedicure. clients back to the salon. ●● Knowledge that supports the recognition of abnormalities will allow the technician to inform the client that he or she needs to go to a podiatrist, or that the feet are healthy.

Health questionnaire Many salons bypass the use of a new client sheet that includes with your state on this policy. It may instruct you to use the important health questionnaire. They feel it takes up service universal precautions and proceed. time. Others who do have them filled out do not use them. This is proving to be a dangerous mistake, even more so in recent It is also important to manicurists to check medications and years. Clients with certain health conditions require special usage of products and services. Many of the listed medicines care, and the most important thing a caring nail technician can will increase the response of the skin to treatments. For do is know the client’s condition, if one exists, then learn how example, the skin of clients taking certain antibiotics, and to perform their special care. Health questionnaires provide the using rapid exfoliants such as Retin A or similar products will information needed to protect certain clients – though all should turn red and even become inflamed or blister after treatments; be protected – and how the nail technician can protect him- or it can happen also after glycolic treatments for calluses, after herself from the transfer of infection. Below is a typical all- waxing the toes or legs, even after using scrubs. Use of a services health questionnaire list. tanning bed can cause skin irritation that is not evident if it was just before the treatment. The result may be a burn-like This questionnaire is extremely important to knowing client response that can be blisters, or the outer layer of the epidermis cautions in care. High blood pressure, diabetes, circulatory peeling, leaving a lesion. The skin of a client taking hormone problems, sunburn on the legs/feet, skin disease of any kind, replacements or certain birth control medications can be very and foot fungus are conditions that prevent soaking in a sensitive and respond with irritation and inflammation; clients whirlpool. A soakless pedicure should be performed. on chemotherapy require gentle and non-irritating products because there is no way to know how their skin will respond. Arthritis of the feet/toes, fibromyalgia, varicose veins, and Clients taking medications that cause them to be light sensitive lower leg/ankle swelling (lymphedema) should indicate a gentle cannot have LED treatments. or no massage of the legs. Have clients with these conditions check with their physician. The bottom line of all this is that you must know your clients’ health conditions and medications and their relevance to the In most states, it is against the law to perform services on service. anyone with an active foot fungus or other conditions. Check

Page 10 Cosmetology.EliteCME.com Please circle any medical problems you have or have had Are you using or taking Blood pressure (high or low) Circulatory problems Antibiotics Tuberculosis Stroke Accutane® Arthritis, tendinitis, bursitis HIV-AIDS Rapid exfoliants Diabetes (I or II) Sunburn Glycolic, acne products Heart problems Cold hands and/or feet Chemotherapy Thyroidism (hyper or hypo) Anemia Tanning bed Nail or foot fungus Cancer Hormone replacement Lymphedema Fibromyalgia Medications causing skin light sensitivity Open lesions of any kind Stress-related illness Kidney problems Scoliosis Varicose veins Any skin disease Hepatitis A, B or C

Pedicure explosion The number of these special care clients coming into nail salons prevention during their care because of chronic conditions. for pedicures exploded in the mid-’90s because of a decision Who would perform their routine foot care? Many thought that in Washington, D.C.: Medicare stopped paying for routine because they now had to pay for their foot care, why not go foot care for patients except under certain narrow parameters, where they can relax and leave with pretty nails instead of paying and insurance companies followed soon after with the same for clipped off nails with lousy shaping, no filing and of course restrictions. Routine foot care is the trimming and shaping no pretty polish in the podiatry offices? This was an entirely new of nails, debridement (reduction of a thickened toenail with group coming into nail salons, clients who have changed the nail an electric file) and curettage, which are usually legal for industry significantly in both good and bad ways. manicurists to perform on a healthy client. (Check your state regulations.) Suddenly, an entire group of people was without Many of these clients are at-risk people who are healthy, paid routine foot care even though a high percentage of these meaning they had no obvious disease or condition, but are people could not trim their own toenails because 1) many could always at risk for infection, and when injuries occur, they may not see their toes, 2) many could not reach their toes, and 3) heal slowly, improperly or never, and are more susceptible many could not hold or squeeze the nail clippers. Many were to infection. These special-care clients require foot-care elderly, healthy for their age, but just could not take care of their professionals who are trained in providing gentle, safe services feet. All required good infection control practices and injury for them or who care enough to refer them to pedicurists who are trained to perform those services.

Who are at-risk clients? Most times, one cannot determine if a client is at-risk for medications?” Clients’ health questionnaires should be infections by looks alone, so professionals must have a health consulted at every appointment. questionnaire and have a working knowledge of what the problems are for clients with certain chronic health conditions. Professionals are responsible for ensuring that their clients The following is a partial list of these conditions: qualify for a pedicure or treatment, and knowing how to ●● Circulatory conditions of the legs, such as lymphedema, perform their services in a manner that maintains the safety of varicose veins and many others. clients. ●● Diabetes, which adversely affects the feet; this client needs Pedicures require more expertise in qualifying clients and very special care. in performing services than any other beauty treatment, and ●● Immunosuppression and compromised immune systems, manicurists must perform pedicures that will not cause injuries, seen in persons who suffer from HIV/AIDS, transplant scarring, amputations or death. The reason pedicurists need patients, those in chemotherapy or who recently experienced expertise? The feet heal slower than any other part of the it, the elderly, those who suffer from lymphoma, and those body because they have less-than-optimal circulation, even in using certain medications that reduce the immune system. healthy people, and most at-risk clients have especially poor ●● Recent illnesses such as influenza, endocarditis, staph and circulation in their lower legs, ankles and feet, causing poor strep infections, pneumonia, food poisoning, shingles, healing and making them susceptible to infections. Injuries, septicemia, candidacies. even amputations, can and have happened during routine foot Even with questionnaires, a technician should keep up with care, and clients are at a higher risk when they come to salons what has happened to a client since the last appointment. and spas to manicurists who are not trained to perform foot care Questions to ask include “Has anything changed with your appropriately. health since you were last in?” and “Are you on any new

Cosmetology.EliteCME.com Page 11 Manicurists may say, “It has only happened a few times in now than before, and unless manicurists are trained to perform the U.S,” but that is not true. Lawyers are now becoming pedicures safely and maintain perfect infection control, their very astute at keeping these incidents out of the paper and the business and their clients are at-risk during every pedicure settlements quiet. Don’t think it cannot happen. It can, more so service.

Training for performance of pedicures on at-risk clients The industry has suffered a hit on its reputation because The training for providing pedicures for these clients pedicures have been performed on clients who are at-risk by generally is not being taught in schools, though some are now professionals who 1) did not know what at-risk meant (see incorporating this special education into their curriculum. It above); 2) were not trained to determine which clients were is new, and most manicurists do not know about it, or if they at-risk; 3) how to perform services on them; and 4) were do, they are not significantly impressed by its importance. not performing adequate infection control (or none at all). Educators are taking on this task, though, so it is becoming The result has been enumerable injuries to clients and many more and more available as time passes. It is also available lawsuits, known and unknown. online in advanced courses.

Qualifying a client for a pedicure Many manicurists do not understand that client qualifying and 3. Refer the client to a podiatrist, if necessary. Is this going to skin assessment is the most important portion of a pedicure happen often? Probably not if you have a diverse clientele, service. Alas, they never perform one, and many times do not meaning they are not all elderly. even look at the bottom of their client’s feet. This is dangerous, 4. Perform the appropriate pedicure with the client’s needs in for both the client and the pedicurist. This is the protocol for a mind and with comprehensive infection control. client assessment: Developing a relationship with a podiatrist is not easy because 1. Check the client health sheet and ask questions concerning they have seen so many fungal infections on clients who have the answers and the conditions that were circled. Also ask had pedicures in nail salons. There are podiatrists out there, whether the client has shaved her legs in the last 24 hours; if however, who are willing to refer clients to a nail technician so, the pedicure should be delayed, or the soak be omitted. who performs comprehensive infection control that includes the 2. Move the foot around and touch it to search for lesions use of an autoclave on implements. They know their patients and any abnormal areas. An abnormality can be redness, a love pedicures, so some do want to have a nail technician they blister, a shiny area on the skin, a scrape or scab, anything can recommend to their patients for safe pedicures. that is not normal. It is important that if the skin is broken in any way, the client be disqualified for a pedicure.

Pedicures for diabetics Diabetics represent the benchmark condition for requirements develop into ulcers or lesions. Even severely dry skin of the for protecting all clients from injury, illness and more serious feet (xerosis) can be serious because the cracks and openings consequences of unsafe pedicures. Forty percent of diabetics in the skin can become infected. Ultimately, these infections, will have minor to serious neuropathy on their feet and possibly if diagnosed late, can lead to amputation because of the poor on their legs. Nerve damage on their feet causes a lack of healing capabilities of people with diabetes. sensation; many cannot feel pain, a signal of injury on their foot or legs. Early symptoms may include tingling, numbness, Safe services for diabetics and all at-risk clients require: burning (especially in the evening) and pain. The condition ●● Perfect infection prevention on equipment and implements proceeds to total numbness. and in the environment. ●● Especially gentle care to prevent obvious and microscopic A nail technician can be a diabetic’s first line of defense against injury. severe consequences of this condition, or can be the cause of ●● Use of universal precautions and personal protective serious consequences. One who is caring and trained to perform equipment. pedicures on diabetics may see conditions and injuries during the ●● The safe use of implements. pre-pedicure evaluation that the client does not see or even feel ●● The ban of unsafe implements, such as blades and rough, because of neuropathy. The nail technician can draw attention porous pumice stones. to the existence of an abnormal condition to the sufferer and ●● Knowledge of which clients must be considered at-risk. suggest a visit to his or her podiatrist or physician. A client might ●● Knowledge of foot assessment for qualifying clients for get treatment much earlier than he or she would have if the nail pedicures. technician had not called attention to the problem. ●● Exceptional knowledge of foot diseases and disorders. ●● Knowledge of the relationship between pedicures and Injury is significant for these patients because neuropathy chronic illnesses. increases the possibility that foot injuries will go unnoticed and ●● Knowledge of a referral system, when needed.

Page 12 Cosmetology.EliteCME.com ●● A solid and trusting relationship with a podiatrist to whom a Practicing the methods for performing safe services on all who nail technician can refer clients to for care. are at risk for infections as well as for all other clients is the ●● Relational expertise in working with clients. responsibility of manicurists. Do not perform a pedicure on a person with a foot condition or injury.

Causes of injury during pedicures Damage in pedicures happens often, especially during 1) nail blades are a surgical instrument, one that is not legal for a nail trimming, 2) shaping, 3) callus care, 4) nail debridement, technician to use, regardless of whether it is prohibited in state 5) cuticle care and 6) removal of nail debris (curettage). If board regulations. For that reason, a damaged client will win a manicurists are honest with themselves, they will acknowledge lawsuit for damages with this instrument every time. Further, if having caused past injuries in the performance of these manicurists work outside the scope of practice for manicurists segments of nail care. The number of these possibilities alone in their state, some insurance policies are not obliged to pay suggests the need for training in working with at-risk clients. damages. The only deterrents against injuries are training, concentration during foot care performance, and sincerely caring for these Nail debridement is the smoothing or reduction of a clients. hypertrophic (thick) nail, usually a great toe, with a manual or e-file. This usually is a legal service that manicurists can Poor technique in nail trimming often causes injury to the perform – check your state regulations for confirmation. skin surrounding the toenail through misuse of the pedicure nail However, a poorly trained nail technician can cause an ulcer trimmer (nail clipper). to develop beneath a toenail just by moving too fast on the nail, causing unnecessarily intense heat. The damaged nail Shaping can also cause damage, especially with a poorly bed develops an ulcer beneath the nail of at-risk patients who prepped file, or even with concentration on achieving a result heal slowly. It cannot be seen by the nail technician or client, and not on the surrounding skin. Innumerable cuts have so can progress to serious damage before being treated. It is occurred from files that have not been prepared for use during a dangerous occurrence with an at-risk client, and can cause services, meaning the removal of the sharp edges surrounding serious injury and even loss of the toe. the file. These sharp edges are removed easily by rubbing the edges of a file over the edge of the file to be used. It is Cuticle care and removal of debris with implements can cause important to use a new or disinfected file to prep the new file. injuries to clients that may be dangerous even if they are not obvious to the client or technician. A microscopic injury with Callus care can be especially damaging if the nail technician the implement may not bleed but does allow a portal of entrance cuts or abrades the skin, allowing a portal of entry for microbes. for microbes. Examples would be rough use of a nail pusher and Manicurists should never fully remove calluses, and a healthy cutting cuticles. Cuticle trimming or cutting on at-risk clients amount needs to remain for protection of the area. Always leave should never be done. Careless cleaning out under a nail can at least one-eighth inch to one-fourth inch of callus to perform also break the seal of the hyponychium, allowing entrance for this protection. That means many times all a nail technician can pathogenic microbes. These injuries are extremely dangerous. do is smooth the callus. Manicurists also need to understand that

Marketing safe pedicures Salons that practice perfect infection control and market implement infection control is through the use of an autoclave for themselves as a “safe salon” will attract new clients and bring implements and an autoclave pouch system. The best scenario is those who are afraid of having pedicures back in to enjoy for the autoclave to be visible to the clients, though many salons the service again. Those that can prove they perform perfect cannot do that. The verification for those that cannot have their implement and pedicure chair infection control will always autoclave in the workroom will be through the use of sterilization enjoy the best reputation for providing safe services and thus, pouches. attract more clients. The only way to prove performance of

Verifying infection control Sterilization pouches hold the cleansed implements while they in front of the client is great proof that sterilized implements are in the autoclave. The implements are cleansed and placed are used. The mottled appearance of the pouch verifies the in the pouch, which is sealed and then placed in the autoclave. sterilization and provides obvious proof that the pouch has only After the sterilization cycle, the pouches are removed and placed been used and sealed once. in a clean storage area for later use. Usually the pouches hold a set of implements, all those that are used in one service. While Verification of disinfection of the pedicure chair can be the client is at the chair, the nail technician should retrieve and performed while the client is in the chair. The client enjoys her open the pouch in the view of the client. Tearing open the pouch pedicure and then during the set time for the mask or paraffin (after the whirlpool is needed), the nail technician should clean

Cosmetology.EliteCME.com Page 13 the tub and set it to soak with disinfectant. Then the tech will You can place a well designed sign on every chair after the final complete the pedicure. This client can be confident that the step of disinfection after the client leaves that says “Cleaned, disinfection step is always performed on the tubs because she disinfected and ready for you,” or something similar; remove it saw it happening. as the client climbs into the chair.

Teaching clients Educate your clients about the correct way a sterilization pouch this. If they go to another salon that is placing implements in will appear after the cycle, and tell them “if you see a pouch pouches for show, for example, they will know it. Clients also that has been resealed, the implements have not been sterilized.” should be shown that the color code on the pouches changes These pouches wrinkle from being steamed in the autoclave, and color, from a lighter one to a dark when sterilization temperature the pouches only close correctly once. Make sure clients know has been reached. That cannot be faked.

Benefits to good infection control The benefits of using an autoclave far outweigh the negatives. ●● Podiatrists may develop a referral relationship with the The negatives are the cost of the unit, which can run $800 salon for sending their patients. Some salons are enjoying and up, and a longer time to complete cycle than with liquid referrals from multiple podiatrists and physicians. solution disinfection. Liquid immersion disinfection is usually Autoclaves can be a marketing advantage for a salon or spa that about 10 minutes, while an autoclave will take 20-25 minutes. commits to its use. However, if a client who has come to the But with autoclaves: salon or spa because of its use sees other poor infection control ●● Clients know their implements are clean and safe. The number activities, he or she will not be back. Comprehensive infection of clients who will appreciate knowing their implements are control is the answer. Commit to it, or don’t bother to purchase safe is huge. an autoclave. ●● Marketing as a “safe salon” can bring fearful clients and those who have been told by their physician to avoid nail Pedicures are stress-relieving treatments that provide salons because of supposed poor infection control. relaxation, produce softer skin and leave the client feeling ●● Salons who have committed to this program are enjoying revitalized. They have a higher rate of retention in salons and growth with new clients who will bring in others. The spas than any other service offered. They also have the highest autoclave is paid for in a very short time – some in less than lawsuit rate and a reputation that must be overcome. Setting up a month, or 16 to 20 clients for a small unit. and performing safe services and letting people and physicians ●● These clients are very loyal; they feel there is nowhere to go know the salon is committed to that philosophy can greatly except to this safe salon. enhance the salon’s growth rate. This concept not only protects clients, it sets a salon or spa apart from others and supports growth that will surpass any former rate.

PART II: THE NEW MANICURING AND PEDICURING PHILOSOPHY

‘Just a manicure?’ Some manicurists say they feel like the stepchildren of the Prices for manicure services also have suffered from the “anyone professional beauty industry when other beauty professionals can do it” outlook. They were set decades ago as add-ons to discount the difficulty of the manicuring skill and say so. For hair services, where they were performed to fit conveniently in example, even though most cosmetology courses provide only the time the client was under the hair dryer hood. Seldom were 40 hours of education in manicuring, and cosmetologists seldom the services a full manicure; most were little more than a polish take added education in the skill, some cosmetologists will change because of the time constraints. The prices were low to fit openly say, “anyone can do a manicure.” This outlook shows the add-on concept; when stand-alone manicures later became a in comments like “a pedicure is just a manicure on the feet,” table service, clients still expected those prices for them. Pricing and imply again that no special training is necessary to perform did not grow to appropriately covered the products and time manicurist skills. Many cosmetologists can expertly perform used (scheduled units) in the special, natural nail services that these services, but those who get accolades for their manicuring were now performed by professionals trained in manicuring as a services usually have sought specialty training. Those who specialty service. specialize in hair design and perform manicure services as a side service usually have not, and some clients just might say their Manicure services were also menu driven, causing them to services reflect it. be viewed as “just manicures,” and causing the prices to stay low. Clients would call the salon or spa and say, “I just want a

Page 14 Cosmetology.EliteCME.com manicure,” and were scheduled for a half-hour basic manicure. This “just a manicure” attitude not only further nurtured a Then, when they came into the salon or spa, that is exactly what discount attitude towards manicure services, it also ensured they were given: a pleasant, basic cleanup of their nails. The lower profits for the nail department than the hair and skin-care only possible upgrade to this service, when menu-driven, was a departments, and with that came lower incomes for manicurists paraffin treatment that was performed while the manicurist was than other beauty professionals. (Artificial nails raised the working on the other hand. The other upgrade, a spa manicure, income of manicurists, but that also has gone away.) It seemed took 45 minutes so could only be scheduled in the next manicurists just could not win, despite loving their work. appointment unless the manicurist had an opening following the client.

Finally, changes for manicurists When acrylic nails became popular, manicurists avoided with lunch and with added luxury and pampering. A popular performing manicures because of their low prices. But the “mini package” is the spa manicure and pedicure combination. world of manicuring has changed in the last 15 years, and All the packages introduced new clients to the new spa the prices for natural services are going up. It all began when manicures and pedicures, and many became “regulars” for “natural” came back into fashion, and manicures came back to weekly, biweekly and monthly services in the nail department. the nail tables. Day spas initiated the rebirth of these services No longer did they ask for “just a manicure”; they wanted the because of their perfect fit into the pampering philosophy of new utter luxury manicure and pedicure services. Clients who “spa,” while the odor of acrylic nails did not. At the same time, came in for these services were introduced to all the other spa when the throne-type chairs were purchased by spas, pedicure treatments and many purchased them. services became popular and were added to spa menus. The marketing by spas of this service and their additions to luxury Basic manicures were still the same as they had been for packages exploded pedicures onto clients’ must-have service thousands of years: soak, push back the cuticles, massage, and so list. on. While enhancements had improved quickly over the last few years within the industry, basic manicures have not changed that Pedicures had a very different track in the development of their much. The upgraded spa manicure added in the 1990s had been pricing than manicures. Even though they had been around for the only change in the manicure menu. Then, spas added longer centuries, as were manicures, few Americans knew about them, manicures and pedicures with more products and treatments, and or if they did, they never gave them a thought. They were on usually they added one that represented the spa’s overall decor the bottom of the service menus of the few salons who offered and theme. The word “signature” is often used in the name of them, but most of those, even nail salons, had eliminated them these treatments to exhibit exclusivity and special design. An from their menus. This allowed spas to later reintroduce them example would be a Signature Citrus Spa Pedicure in a Florida as a new and very special spa service when the new throne-type spa that is designed to include products that have a citrus aroma. chairs were introduced. It also allowed them to set a new price Fruit juices might be offered to support the theme. standard for the service that was more appropriate to the costs, the manicurist’s compensation and products, and the higher Other spas and upscale salons design special manicures and prices were supported by the high demand for the service. Now, pedicures to celebrate holidays and to recognize the different manicurists could make more money, and the departments seasons. A holiday manicure and pedicure package could be became more profitable. With the addition of pedicures, the a Chocolate Cherry Cordial Valentine Manicure and Pedicure prices of the accompanying spa manicures were also pegged designed with decadent-smelling chocolate-aroma products and higher so everyone could make more money on those services, a small heart-shaped box of chocolate cherry cordial candies for too. Finally, manicurists have become respected in the eyes of the client. Chocolate drinks also might be offered. A seasonal other beauty professionals. package could be Harvest Manicures and Pedicures that are offered in the fall. This might include pumpkin aroma products The higher-priced spa manicures and pedicures became and services that support add-ons, such as pumpkin bread standard offerings in the new phenomena of spa gift packages, served with cider. This trend for more exclusively designed a group of services that allowed gift-givers to purchase the gift services in spas began at the turn of the century (2000) and of special relaxation for someone special. These services are continues to bring in new clients and add to the service tickets. offered on the same day, one right after the other, sometimes

The new world for manicurists The most significant change in manicure and pedicure services services. They changed their products to more skin care- came when a few manicurists added a second license to their oriented products, and the service protocols, even the basic, to skills, esthetics. These manicurists developed an entirely new be similar to the facials they were trained to perform in their and different view of their hand and foot services. Information esthetic training. The manicures and pedicures became more in the course for their new license showed them the obvious treatment-oriented for these professionals, including the skin synergy of the two specialties, and they began merging their of the hands, arms, feet and legs in the treatments rather than new knowledge of skin care into their hand and foot care focusing on just the nails and a comforting mask.

Cosmetology.EliteCME.com Page 15 These new skin care-based manicures and pedicures require following chart compares the traditional protocol with the new a trained manicurist who can recommend services that are skin care-oriented protocol: appropriate for individual clients’ hands and arms or feet The differences between the traditional and skin care-based and legs. This approach is much like that of the skin care manicure and pedicure services are: department when estheticians analyze the skin before choosing ●● Skin care-based manicures and pedicures contain an the facial treatment. In this new manicuring and pedicuring analysis of the skin and nails on the hands and feet. treatment philosophy, clients and their needs are the focus, not ●● The hands and arms, feet and legs are included in the the services, and it is central to the success of the service, not treatment. For example, the scrub pedicure is the answer to the resulting beautification – although that is also the result of scaly winter legs. this focus. ●● The skin is prepared for the products through a scrub exfoliation to facilitate penetration of ingredients. Manicurists may think, “There is nothing new we can do in ●● The massage is earlier in the treatment, warming the manicures and pedicures,” but the new choices that are oriented skin, opening the pores and allowing more penetration to skin care for manicures and pedicures prove this untrue. Even of ingredients. Clients also relax earlier in the treatment, the new protocol for them changes the outcome of the services. resulting in more pleasant experience. The new protocols warm the skin, and this opens the pores, ●● Treatment products in a skin care-based manicure or which allows a deeper penetration of the product ingredients and pedicure are chosen to meet the needs of clients’ skin. All an immediate and noticeable improvement in clients’ skin. The skin care-based services have a treatment of some kind.

Traditional manicure and pedicure Skin care-based manicure and pedicure 1) Shorten shape, remove polish 1) Shorten shape, remove polish 2) Soak 2) Analysis and recommendations 3) Cuticle treatment 3) Skin prep and massage 4) Mask 4) Treatment product 5) Massage 5) Cuticle work 6) Polish prep and polish 6) Polish prep and polish 7) Home care, reappointment and release 7) Home care, reappointment and release

Water – or not Manicurists have always soaked their clients’ nails in water. It similar.) Nail plates and the skin around them become weakened has always been thought to be important and the best option by these solvents, and that can result in layering. to soften the skin and thus, allow the best treatment. Few manicures were willingly performed without the soak. Now Another reason many manicurists are opting for the soakless this practice is being questioned for several reasons. First, protocol for manicures is the effect on the retention of polish a fingernail is constructed horizontally in layers that appear when nails are soaked. With soaking, water is absorbed into similar to fiberboard. They are held together by intercellular the nail plate, and it changes its shape, usually to less of a adhesive materials that stiffen and shape the nails – the horizontal curve. The nail maintains this soaked shape for the healthier the intercellular adhesive, the healthier the nail. manicure and while the polish is applied and dries. During However, when in water frequently or for extended periods drying, the acrylic in the polish hardens into the shape of the of time, these oils and natural adhesives may be softened or nail place – a flatter shape than the nail is naturally. Later, damaged, often causing a condition referred to as layering or after the nail plate dries to its natural shape, a deeper curve peeling. This condition is aggravating, and most times prevents from side to side, the polish is stressed into the new shape and much length past the hyponychium because of tearing of the weakened, often damaging the retention of the polish. The nail’s free edge. Manicurists are often asked to solve this polish will try to return to the shape the nail was when it dried, problem for clients. the flatter shape. The result is that the polish is more susceptible to chipping and peeling. For this reason, many believe the The natural adhesives holding the nails together on the free edge soakless manicure method allows for improved polish retention. are the root of the problem. Water is a universal solvent, meaning it will dissolve something when many other solvents will not. But The soakless manicure is best for several nail types: the this will not usually happen with the natural adhesives in the nail eggshell, the lacy and the post-acrylic, but many manicurists plates without the help of an additional solvent – and manicurists are changing to it completely just for the retention of polish. provide it. When soaking the fingertips, manicurists usually Pedicures are another issue, however. Most clients will prefer add something to the water to speed its ability to soften the nail the whirlpool soak because of the bubbling of the water, and plate and cuticles (eponychium). Many times, detergent is added pedicures generally have no problems with polish coming off. because it is effective in dissolving oils. (Other soak products are (Actually, polish will stay on so long, it may grow off because the feet are not working tools.) But there are some clients who

Page 16 Cosmetology.EliteCME.com should not have soak pedicures, the at-risk clients who heal The final word on it is this: Always ask a client to check with slowly. You must ask these clients to check with their doctor his/her doctor or podiatrist if the person has a chronic disease. to see whether they can have a whirlpool pedicure. Podiatrist It is the safe thing to do, and a responsible manicurist will insist generally will say, “Please perform the soakless” service if they on it. If a client has not consulted a doctor, you may help the know it exists because of their fear of infection for their clients. person place a call to the doctor, but understand that physicians Many pedicurists working in podiatry offices perform soakless may be unwilling to discuss the question with you because services only. And all podiatrists will say there should be no of privacy concerns. And finally, know that many clients will soaking on clients who have any type of lymphedema, swelling prefer the soakless method to the whirlpool protocol after trying of the legs. Some will say also that diabetics should not be it. soaked, nor should patients with immune-suppression illnesses.

The differences Soakless services are not difficult. The only difference between time as they would soak. In addition, while some pedicurists soakless and the whirlpool pedicures is in the whirlpool protocol replace the feet in the soak to keep them warm, in the soakless in which clients usually soak their feet at the start of the service. protocol, the foot is wrapped in warmed towels. The process is With the soakless protocol, the manicurist applies a good lotion the same for manicures: Where the fingers would soak, lotion is and cuticle softener, then puts the client’s feet in a thin plastic applied, and then their hands are placed in a plastic bag and put bag. Then they are placed in heat mitts for the same amount of inside mitts.

How to treat – and keep – a client At the entrance Skin care-based manicures and pedicures are upgrades say, “When she can see your back, she won’t be back.”) The to the usual services, are customized and require trust in more appropriate way to lead clients to the service location is the manicurist by the client. This trust begins with the to maintain eye contact as much as is safely possible, walking professionals’ activities when the client comes through the beside them with the body turned slightly toward them during door and it continues throughout the service into the following the walk. appointments. Clients must feel the professional sincerely cares about the condition of their hands and feet if they are to It’s also important to talk to these clients during the walk, and purchase take-home products; they must not feel the manicurist it is best to start with a question, such as, “Have you had a is just trying to increase sales. (service name) before?” The manicurist will already know if the client has had one before in this salon or spa. If the person say Usually, when a new client is in a waiting room filling out a no, the manicurist can say he or she is pleased to provide the new client sheet, initial trust can be established immediately, person’s first professional (service name), and know the person even before the person is seated at the table or in the pedicure will enjoy it. If the client says he or she has had the service chair. It is initiated by physical moves and attitude. before, ask how he or she enjoyed it (not where), and promise enjoyment will be even greater here at your salon or spa. The A beauty professional’s first greeting to clients is the most weather, by the way, is only a topic if it is severe. If it is, thank important moment in their retention of clients. People who are the client for coming in despite the storm, and promise it will waiting in the reception room must be approached correctly be worthwhile. and led to the nail table in an established and trained manner designed to stimulate the first feelings of trust. The manicurist Repeat clients get the same entrance procedure with enthusiasm should greet new clients with a smile and appear energetic and and smiles and the same walk to the service location, but if enthusiastic during that first interaction. A manicurist should the appointment is with the same manicurist, conversation stand squarely in front of new clients, lean forward slightly should include a personal comment to indicate the manicurist and offer them a handshake. The manicurist should greet new recognizes them. This can be difficult if there is not a method clients by name, and introduce him or herself, using the clients’ established to remember clients until they have been in a names again during the introduction. Then, and only then, few times to establish routine recognition. One way is to should a manicurist invite clients to enter the work area. define a shorthand notation on a client card or in “notes” on the computer profile to jog the manicurist’s memory for a The process of greeting and walking with new clients to nail few appointments. Establishing this takes imagination, but or pedicure stations is very important because it subtly shows manicurists are creative people and usually can do this very them the manicurist’s general outlook toward clients. It must quickly. An example would be “8-11-1tr/china”. The manicurist be welcoming and positive and not just a greeting and a walk will know then that a trip to China is either coming up or has to the workstation. First, professionals should never turn their already happened and can ask about it on the walk back to back on clients and walk ahead, saying, “Follow me.” (Some the table or pedicure chair. Another might be “nw.grchd 6-11”

Cosmetology.EliteCME.com Page 17 indicating a new grandchild is due in June 2011 – it is either the one thing that seals an intention to return to the salon or spa already here or coming, and a comment can be made about this and solidifies a feeling that the manicurist cares. new blessing. Recognition is important to clients and may be

At the table After the entrance and seating, the new philosophy of care while defining people as who they are in appearance. Its kicks in for manicurists. The routine performed upon seating structure is in layers: the top layer is the epidermis, the second clients at the nail table or in the pedicure chair is important and layer is the dermis, and below that is the support structure, includes steps manicurists are not usually trained to perform, the subcutaneous tissue, also known as the hypodermis or an analysis and consultation. These are performed at every superficial fascia. The epidermis is composed five layers that appointment, though familiarity may lessen the length, and a work together in an ongoing cycle of cells that continuously discussion of the treatment may be brief. Clients will come reproduce, push outward and die during the trip to reach the to expect it, and other salons and spas will be measured by outer layer, the stratum corneum. There they become flat and this activity. Still, this step is unfamiliar to many manicurists. scaly and are released from the surface. The process of the Performing this will set the service in a salon or spa apart from release of dead epidermal cells is called desquamation. the one down the street. The dermis is a dense, fibrous connective tissue containing an A routine, always-performed part of a service is one that abundance of circulatory vessels (blood and lymphatic vessels) trains clients to always look for it in every manicure and and nerve endings that are not present in the epidermis and pedicure service anywhere they are done. It is designed to set connect to the subcutaneous layer below. It consists of two a standard and, small as it may seem, it does. Clients soon layers: the papillary and reticular. The papillary layer is named believe the ritual is essential to good service. For example, a from the papillae arranged in curved, almost parallel ridges manicurist should check the condition of clients’ hands and on its surface. Since the epidermis conforms to these ridges, feet to decide which service to recommend. This is how it the papillae are also reflected in the contour of the epidermis, is done: After a client washes his or her hands and is seated, especially on the tips of the fingers and toes and are the basis of the seated manicurist should reach forward with both hands, fingerprints and toe prints. No two human beings have identical palms up, and take each of the person’s hands in one of finger or toe prints. The reticular layer consists mostly of hers and then survey them. If it is a pedicure, the manicurist collagen, protein fibers that provide the tone and suppleness of should reach forward and place each foot on the footrest in the skin, and elastin, which provides the flexibility to the skin. an individual movement, putting one hand on top at the ankle These fibers provide structural support for the cells and blood and the other underneath, and then pulling each one forward. vessels. They also aid in healing of wounds. After these moves, the analysis begins, and ends with a recommendation for services. The subcutaneous tissue (or hypodermis) is not part of the skin, but connects the dermis with the muscle tissue below. Fat During the analysis and throughout the appointment, the cells are in the subcutaneous to act as a cushion between the professional should educate clients on how to extend the muscles and skin and to provide energy to the body functions. beautification and nurture the improvements achieved by the The thickness varies with age, sex, the overall health and service through home care products and future professional nail weight of the person. One of its many functions also is to care. The manicurist should describe the ultimate results of a maintain skin smoothness, one of its most important functions treatment plan, recommend future care, and instruct clients on in beautification of the skin. It provides the contour to the skin, the use and importance of home care. also, defining individual appearance. It also provides energy (from fat), nourishment (from the blood) and metabolic support An analysis/consultation should follow this routine: (for functioning of the body). ●● Determine the skin type and condition of the hands. ●● Establish the probable causes for any conditions or The manicurist who has expanded manicures and pedicures problems. to include the skin care of clients will be working with the ●● Suggest the appropriate service. epidermis, the layer of the skin that maintains softness and ●● Prescribe home care products and their use. elasticity when healthy, and reflects damage when it is not ●● Define and recommend possible changes in client activities. healthy. To improve the skin, the manicurist must define the ●● Outline a specific program for improving the look and needs of the skin through analysis, then make appropriate condition of the hands and legs. service recommendations to clients that will bring the skin back ●● Determine the condition of the nails. to a healthy appearance, despite damage to its layers. A more ●● Recommend treatments for the nails. expanded description of the skin relevant to skin care-based Skin structure review: manicures and pedicures can be found in “Spa Manicuring for To perform an accurate analysis, the manicurists must first Salons and Spas,” by Janet McCormick, Milady Publishing. know the overall skin structure. The skin is a thin, flat organ that encases a human’s organs, bone structure, blood vessels, nerves and so on to protect them and perform other duties,

Page 18 Cosmetology.EliteCME.com Analysis of the skin The first thing that is performed in defining treatments is to During the same treatment, put a dot of the hydrating mask determine the skin types and conditions of the hands and on the inside of her wrist. If there is no response during the feet. Skin types for the face are listed as normal, dry, oily, treatment, move up to the gentle scrub and a mask in the combination, acneic, sensitive, mature and dehydrated. The next treatment. By the third treatment, the client should types for the hands and feet are basically the same, though no be ready for a normal treatment. This skin should not be oily or acneic skin will be seen. Following are a list of the usual soaked, and hydration is extremely important to this skin. skin types, as they are seen on the hands and feet. ○○ Home care: If the skin responds positively – fingers or ●● Normal – Normal skin is smooth, soft and moist and feet – to the lotion, send it home with the client. This springs back when a pinch of skin is pulled away from the client must use the products every night at home. hand. ●● Mature – These hands will be crêpe in appearance (usually ○○ Treatment: This skin should be treated preventively ­ dehydrated), with wrinkles. Hyperpigmentation may occur to maintain the texture and hydration of this skin. The in varying degrees, according to the amount of exposure professional treatment is the hydrating manicure or to sun over the years. The clients should be educated on pedicure. the cause of age spots (sun damage) and that prevention of ○○ Home care: Hydrating lotion and SPF. further hyperpigmentation is important now; recommend an ●● Dry – Dry skin will be resistant to movement across its SPF product and train the client on how to use it. surface, feel coarse and tight, and appear dull in color. ○○ Treatment: These hands will need an AHA series. Wrinkles will be obvious, not just creping (tiny, crevice- Hydration is important in both professional treatments like). and home care. ○○ Treatment: A scrub is included in the service to loosen ○○ Home care: This client must use a lotion with an AHA the dead cells off the skin surface and to encourage ingredient at night and regular lotion in the morning penetration of the hydration ingredients in the mask. and during the day. SPF is especially important. Use of A hydrating mask is the base treatment, but addition lighteners on the top of the hand. of a paraffin treatment enhances penetration of the ●● Environmentally exposed – These hands may be one ingredients. or more of the above, due to overexposure to chemicals, ○○ Home care: A hydrating lotion and a biweekly water/solvents, the sun, the wind or weather, and possibly exfoliation lotion. abrasion. Callusing is often present on these hands, and ●● Dehydrated – This skin will have fine lines and wrinkles and always on feet that have been excessively barefoot. will appear thin and stressed. Hyperpigmentation usually appears around age 40 on these ○○ Treatment: The first week, perform a scrub pedicure or hands and feet. manicure with a mask and paraffin. The second week, ○○ Treatment: The treatment will be the anti-aging program perform an AHA treatment, followed by a mask and with AHA. paraffin. A series might be required. This skin should not ○○ Home care: AHA and good hydration home care. be soaked. ●● Callused – Calluses on the feet are not unusual, and are ○○ Treatment: Hydration through the hydrating pedicure or from small to huge. Clients hate them and ask manicurists manicure is important to these feet or hands. The clients to remove them. To do so, the manicurist will use a callus should also be trained to protect the hands from the loss softening lotion that will make it easier to reduce them. of moisture from the hands through water exposure, such ○○ Treatment: Some clients are recommended a callus as during dishwashing. Encourage the client to use gloves control series, a series of 6-8 weekly or biweekly visits during these activities. for AHA treatments that will reduce the calluses slowly, ●● Sensitive – This is mainly on the hands, not the feet. so it will be less likely they will return. If they aren’t Sensitive skin will react negatively to many products, may softened and then reduced slowly, they will quickly appear irritated and will probably have a dry, possibly even return. The treatment can be a brush-on or a 15 percent rough surface. This client will need weekly manicures, lotion that is massaged for five minutes. A hydrating working up to a hydrating mask during the second or third treatment follows. treatment. ○○ Home care: An AHA lotion for application every night ○○ Treatment: The first treatment is a gentle introduction of the is important, plus the use of a pedi-paddle after showers. hands to the products. Perform a light scrub, very light, and A hydrating lotion applied in the morning is also use a hydrating lotion under paraffin, for only 2-3 minutes. important.

Nail structure – a brief review Nail structure likely was part of your pre-licensing training. the eponychium (cuticle) is at the peak of the nail fold. The Here is a short review: The hard surface of the nail has three perionychium or the nail wall is the skin overlapping the sides parts: the root, or base of the nail; the body or nail plate, the of the nail. The hyponychium is the attachment to the nail under hard exposed surface of the nail; and the free edge, the exposed the free edge. For more information, read “Nail Structure and tip of the nail. The lunula is the white half-moon shape that Product Chemistry.” Second Edition, by Doug Schoon, at the base of the nail. The nail fold overlaps the base, and

Cosmetology.EliteCME.com Page 19 Nail plate analysis and treatment After skin condition is addressed, the analysis continues ●● Eggshell nails – These nails are thin and weak and peel off with a thorough look at the client’s nail plates and your with very little pressure. They bend and straighten with little recommendations for their care and improvement. An effort. Many times they appear to grow over the end of the analytical look at the nail plate should not be seen as an finger, adhering tightly to the skin and having no arch of their afterthought or separate procedure. It should be seamless with own, appearing flat from the side. These type nails are more the analysis of the skin and nail plates; both are important to often on people who have flat (instead of arched) nail beds the recommendation of treatment for a client. when looking from the side of the finger. ○○ Treatment: The treatment will be according to the skin. Here are seven common nail conditions that manicurists see: ○○ Home care: The nails should have nail strengtheners and ●● Normal nails – These nails get a maintenance procedure. They nightly oil massage. are strong but flexible with a shaped free edge of whitened ●● Lacy nails – These nails also are weak and tear easily, but opacity. They resist breakage through their flexibility and have the free edge seems thinner than even eggshell nails. Some a uniform and healthy coloring in the nail bed. areas of the free edge will appear translucent, while others ○○ Treatment: The client must use oil on the nail plates and will be opaque. This causes a lace-like appearance. They the surrounding skin to maintain their flexibility and snag and tear clothing and hosiery, so these clients seldom strength. can growth free edge to any significant length. ○○ Home care: Application of a good oil will maintain their ○○ Treatment: The manicures and pedicures for the skin flexibility and strength. conditions are good treatments, but home care is most ●● Peeling/layering nails – This problem will send a client to important. a manicurist faster than any other. The nails lose the natural ○○ Home care: These nails should have nail strengtheners. adhesive that bonds the layers of the nail plate at the free ●● Stress breaks – These nails give the impression of being edge, and then peel apart, layer by layer, until they are thin too strong. They appear thick and healthy, then suddenly and weak. They tear easily until there is no free edge. there is a break on the side at the stress area. These nails ○○ Treatment: It is believed that layering is caused by having may have had long-term overexposure to high percentage the nails in water too often, especially with the presence formaldehyde in nail hardener, or it may be a hereditary trait of detergent that removes the oils. This person must have to have hard nails. waterless manicures or pedicures. These nails will need ○○ Treatment: Will respond to the skin care treatment. nail treatments to strengthen them. Many manicurists ○○ Home care: These nails need oil applied every night. brush a thin layer of glue horizontally across the free edge. ●● After-enhancement nails – These nails will vary in The theory is that if you can keep them together until the health according to 1) the skill and care of the application layering area has grown out and is filed off, the nails will technician, 2) the health of the client’s nails, 3) the general not layer. Others believe a tip wrap is the only answer. health of the client, and 4) the technique of the removal. ○○ Home care: These nails need a nail strengthener and ○○ Over-prepping and etching will cause thin or post- oil massage treatments every night. Maintenance of acrylic nails to have curved markings in the nail as it flexibility of the nail plates is very important. grows out. Incorrect use of a nail e-file during finish ●● Brittle nails – This free edge breaks with very little pressure. of acrylic enhancements will also cause severe trauma There is no crack in the nail; it just comes off in a chunk. and markings in the nail plate, “rings of fire,” curved Clients usually say the break makes a snapping sound. burns by the e-file into the nails, as the artificial nails ○○ Treatment: Manicures for the skin conditions are good are finished. Correct application of products and finish treatments, but home care is most important. will not produce an unhealthy nail, though it may be ○○ Home care: This nail is between being hard and dry. Oil more flexible for a short time after removal of the massage is imperative, and should be performed often. enhancement product.

Skin-care nail services Basic manicure and pedicure The difference between what used to be considered basic version is designed to produce a more vibrant and glowing skin manicures and pedicures and skin care-based basic manicures and more relaxation, even thought the service is considered and pedicures is the protocol, as discussed. The skin-care basic.

Scrub manicure and pedicure This is the basic manicure or pedicure plus a scrub step before the next step, the massage. In this manicure, an especially the massage. A scrub product is placed on the hand or foot, and hydrating lotion should be used for massage because the scrub then manipulated around the surface. A good product will remove has removed the oils – it will require reapplication of product the right amount of dead cells in one minute of even pressure during the movements. over the hand or foot. The product must be removed well before

Page 20 Cosmetology.EliteCME.com Hydrating manicure and pedicure These manicures and pedicures are the most performed in products, a mask and a paraffin product over the mask. Apply a salons and spas. It is the spa manicure with good, hydrating hydrating lotion, the mask, and then the paraffin.

Anti-aging manicure and pedicure Anti-aging manicures and pedicures require good treatment brush-on AHA product, the massage will not include the planning that usually includes a series of services. Clients must area where the AHA will be applied. If the product is a 15 commit to weekly manicures and/or treatments (a program) percent AHA lotion, however, the massage on the hand with their eye on the future result. This treatment can be for will include that product, while the non-treated areas wrinkles, dehydration, and hyperpigmentation. Hands will look would be the massaged with the usual massage product. younger, take on a more even and youthful glow, and appear The product must be removed after with a wet towel, and more toned for those who commit to this service. They love the then a hydration lotion applied. Paraffin is not used in this results. treatment. ●● Treatment: It usually includes chemical exfoliants, ●● Home care: Lotions and treatment products are important in lightening agents and hydration. A service would be the this program. A chemical exfoliating lotion with AHAs will performed as the basic spa manicure with anti-aging be important, as is a moisturizing lotion with SPF. Lightening treatments added, but if the professional product is a home care is also very important.

Callus control manicure and pedicure The function of this treatment is to remove calluses and to slow their return, which happens when they are removed quickly, or prevent their return. as they are with illegal blades. ●● Treatment: This manicure and pedicure contains the ●● Home care: The clients must use an AHA lotion nightly application of callus softeners and the use of a pedi-paddle and a pedi-paddle after each shower to slowly reduce the to address calluses. A good softener is required. Some calluses. manicurists perform an AHA treatment on the calluses to Aromatherapy manicure and pedicure soften them more, and then use the pedi-paddle. For heavy This is a spa manicure with synergistic products throughout, plus calluses, a series will reduce the calluses slowly, preventing support items such as drinks, candies, cookies and candles. This highly luxurious and pampering service is also very moisturizing.

Nail growth manicure This is not a specific manicure; it is a massage of the matrix to Toenails that grow slowly can also benefit from a matrix stimulate the growth of the nail plate. massage, though the result is not as fast. ●● Treatment: The manicure is performed according to ●● Home care: An oil is applied, and then the clients must the skin-care condition, and then the matrix massage is massage the nail from side to side on the matrix. Medium performed before the massage of each hand and arm. pressure is applied during the side-to-side movement.

Special services These manicures are usually not listed on menus, but the situations are important to discuss because of the special needs of the people receiving them.

Manicures and pedicures for the elderly These clients have thin and weak skin on their hands, arms and in more of a rub with very little movement of the skin. They elbows, and their blood vessels have weakened walls. Their love the attention and become loyal clients, but injury is always skin may easily split with a carelessly firm massage, or a bruise possible, so special care must be taken in the service. The can happen, showing up immediately even during the massage. service recommended is usually a hydrating manicure, but can Gentleness is the key. These clients are massaged by the be done with manicures for other skin conditions. manicurists using the palms of the hand, gently and carefully

Cosmetology.EliteCME.com Page 21 Arthritic hand and foot care These clients are special, and their massage must be gentle and gentle, slow-moving massages, with manicurists using only the carefully performed. Their hands and joints are stiff and usually palms of their hands to exert little pressure, and no pressure painful and will be even more painful if the manicurist does by the fingers. The manicure will usually include a paraffin not take special care. Do not perform the pull movement on treatment that provides soothing relief from pain. It is welcome the fingers or toes because it has been known to pull weakened relief for this client. joints apart, resulting in excruciating pain. These clients require

Anti-aging of the hands and feet Women have accepted skin care to help them look and feel spots on the hands. They are hyperpigmentation caused by younger, and it has worked. They want to find that special darkened, damaged melanocytes in the base of the layers of the manicurist who is willing to learn and perform those special skin that show through to appear as age spots. They are caused services that will keep their hands and feet looking youthful by the skin being exposed to the sun over many years and are as well. Add comprehensive infection control, and this very difficult to erase. Client after client will ask a manicurist, manicurist’s book will be full, and she will have a waiting list. “Can you get rid of these?” The answer is, “Probably not, but we can lighten them and keep them from getting larger and Sun spots (age spots), also known as lentigines, are hated by all darker.” Treatments such as exfoliation treatments with glycolic mature women. They are harmless, flat, brown discolorations of and/or microdermabrasion, plus red LED light will lighten age the skin on the back of the hands, neck and face of people over spots, but not totally remove them. Compliance to home care is 40 years of age. Manicurists must learn treatments for these very important.

Programs and series Programs are services recommended to clients to achieve a A series is a set number of About those labels certain result, such as anti-aging and maintaining beautiful treatments for a condition, skin and nails. There is no specific number of services. They sometimes purchased Products labeled are developed through analysis and recommendations and are before the first treatment. “moisturizer” are evening custom care for individuals similar to those for clients in the skin Callus control series might repair products and can care department. The most dramatic results will be in the first be a series of six or eight, have additional treatment appointment, followed by others that will show progressive according to the severity, or ingredients, such as results. Many salons and spas include a picture of the hands they may be a program with antioxidants, peptides and or feet prior to the first treatments to allow the client to see the no set number. lighteners. The morning difference in a later appointment. Clients watch the results and product may be labeled sometimes forget how their skin originally appeared. “SPF,” though it is usually a moisturizer with an SPF ingredient added. Products step up When manicurists first began performing skin care-based other manicurists discovered quickly that with a few technique services, they had to go to the skin care industry for products. modifications, they worked for these clients, too. Informed Manufacturers in that industry specialized in results, manicurists began incorporating these products into hand and penetration and improvement of the skin, not in momentary foot care services that made new clients loyal and all clients surface beautification as in the nail industry. Appropriate happy. Skin care products were available to help manicurists products were not available from the manicuring industry. produce impressive results. Many manicurists were not trained in how to read labels or to define the efficacy of products because their goal was Times have changed since the nail industry manufacturers noted beautification, not repair or changes in the skin. the trend toward skin care-based services in the manicuring industry. Now, new products are being regularly released from The new skin care-educated manicurists knew good quality the nail industry manufacturers that help manicurists perform formulations would penetrate or barrier facial skin and the changes their clients want for their hands. Retail hand- recommended them for their skin-care clients as needed. So care products are becoming more penetrating, and clients why not for their hand-care clients? Soon they began using are seeing changes with these more-available products. After well-formulated products from the skin-care industry to years of ignoring manicures and pedicures as uninteresting produce great results in their manicures. However, unless and unprofitable, these companies are now delighted with the manicurists were dual-licensed in esthetics, they did not know successful and profitable expansion of their product lines into about them or how to recommend them to address conditions care of the hands and feet, and so are manicurists. They now of their clients’ hands and feet. When the esthetics-trained rarely have to go outside of their industry for their products, manicurists began to use them in their manicures and pedicures, and treatment manicures and pedicures were born.

Page 22 Cosmetology.EliteCME.com Manicurists now introduce these products into services for their a new niche of clients who are serious about the health and clients and see dramatic results on very happy clients. They are beauty of their entire hands, not just the beauty of their nail stepping beyond the era of the basic and spa manicures into plates.

Choosing products High quality and appropriate products teamed with effective ingredients, however, so it will only be in higher-cost formulas treatment protocols can be the very basis of results in a in amounts that get results. (Products that list it lower in the treatment manicure or pedicure. To choose good products, ingredient list may or may not get the benefit of its inclusion manicurists must know what their ingredients are and each – or it can be “label dressing,” an ingredient that is not in product’s purpose in the treatment and in home care. The basic an amount for positive activity in the formula, but is on the products are: label list anyway.) This ingredient is listed as hyaluronic acid or as sodium hyaluronate. Hyaluronic acid is seldom seen in Scrub – This product has an ingredient that will loosen and inexpensive body care products because it is very expensive; remove, rough, dry or dead epithelial cells from the surface sodium hyaluronate becomes hyalonic acid when in the skin. layer (stratum corneum) of the skin in a gentle abrading massage. It should be in a lotion, and is usually in a water- There are many good moisturizing ingredients, and manicurists based product to allow its smooth movement over the surface. do not have to learn them all – and if they did, there would still It usually will not have penetrating ingredients, though the be new ones coming out all the time. For those reasons, it is home-care scrub product will, including antioxidants and best to purchase a cosmetic ingredient dictionary and carry it hydrators. Instead, it will have barrier ingredients to seal you when choosing products. Milady’s “Cosmetic Ingredient the surface of the skin while the abrading ingredients move Review” is an excellent list of ingredients, though it is only over the surface. These ingredients are usually smooth and revised every four years, making it quickly behind the times in round jojoba or polypropylene beads, and they gently but new ingredients. Laura Root’s “The Skin Care Professionals effectively remove the loosened cells when moved against Chemistry Ingredient Handbook” is more in-depth and larger the skin. Formulas will vary in 1) the size of the beads, and and more expensive, but she updates it every time she sees 2) the number of beads in a good lotion base. Those scrub something out there that should be included. The book is products in a professional service are a treatment for dry and published by her company, Esthetic Education Resource, Mesa, callused hands and feet, and they are used in some anti- AZ. aging treatments; home care scrubs are used according to the condition of the hands and the instructions of the manicurist. Moisturizing SPF lotion – The ingredients in these lotions These products are in every pedicure to remove dead skin are moisturizers and sun protection. Their job – an important from the feet and to prepare the calluses for easier reduction. one – is moisturizing and sun protection. The ingredients are important moisturizers, antioxidants and other ingredients plus In choosing a scrub, avoid products with rough granules, SPF ingredients that allow clients to purchase only one product such as ground walnut shells or apricot seeds, because they to perform these duties instead of two. Formulators accurately can scratch the surface of the skin microscopically and cause believe that if moisturizers and SPFs are in two different irritation. Most natural abraders that are crushed shells or products, clients will choose the moisturizer and bypass the seeds should not be included in a scrub, especially in one used SPF. on at-risk clients. Some manicurists will say, “The rougher, the better,” but this is a dangerous mantra when performing treatments on at-risk clients. These clients have skin that can Slip, Slap, Slop easily become infected, even with a microscopic injury, and that heals poorly. Jojoba and polypropylene beads work well “Slip, Slap, Slop, Seek, Slide” is a message most and do not damage the skin when used properly. Australians have grown up hearing. This government- sponsored campaign is thought to be the reason skin Moisturizing treatment lotion – Moisturizing products are cancer has been reduced in that sun-drenched country that many times formulated in a gel or serum because they move had the highest recorded rate of skin cancer. The message, into the skin more quickly than lotion and leave no residue. with an attention-grabbing seagull mascot named Sid, However, when purchasing a gel or serum, look closely at the emphasizes that sunscreen is an important aspect of sun list of ingredients for alcohol – usually it is there somewhere protection, and is used in combination with other measures and can counter the moisturizing property if it is used in and not as the only protection. Here is the message: excess by the client. A better moisturizing formula is a light lotion that has a balanced barrier (stays on the surface to seal Slip on clothing to cover your arms and legs. in the skin’s own naturally produced moisture); penetrating Slap on a wide-brimmed hat. hydrators (supports the production of water in the skin); and Slop on broad spectrum sunscreen with SPF 15 or moisturizers (supports the production and retention of sebum, higher. the natural skin moisturizer). Many experts feel the best Seek shade. moisturizing ingredient is hyaluronic acid, a barrier product that Slide on some UV protection sunglasses. also moisturizes. It is more expensive than most moisturizing

Cosmetology.EliteCME.com Page 23 The saying goes, “Daytime products protect, night-time ease in using them, which makes them more compliant in the products repair.” For that reason, daytime products usually do use of SPF products: Just brush and go, with sun protection. not include expensive treatment ingredients, and if they do, they are sometimes label dressing (low and mostly ineffective, Clients should be trained in how to choose the correct SPF. but look good on the label). First, the product should be usable on the specific part of the body they need to address, or on all parts. However, products Some types of SPF ingredients make the product thicker, for the face and those for the body are sometimes exclusive so they need to be put on a half-hour before going out to in use. This means that many people use the wrong products allow them to “set.” There are two types of SPF ingredients, on their faces. Generally, SPF products that state on their physical and chemical. label they are formulated for the face can also be used on ●● Physical: Products containing physical SPF ingredients the face and body, but they are usually more expensive than reflect and scatter the UV rays from the surface of their those formulated only for the body. Conversely, those that are metallic particles, namely zinc oxide and titanium dioxide, formulated for the body should not be used on the face because which are suspended in an emulsion. These products have they may clog facial pores. For these reasons, the labels must be been available for years and were called a “sunblock”; read carefully. If a product is we all can remember lifeguards wearing zinc oxide in a to be used on the body and Product ingredients thick, white coating on their noses to prevent sunburn. does not state it can be used Recently, however, the FDA banned the term sunblock for on the face, as in “Face and By law, the Fair Packaging use on SPF product labels because there is no ingredient or body SPF lotion,” it should and Labeling Act of 1966, product available that will truly block all UV rays. not be used on the face. a list of ingredients must ○○ Initially, physical SPF ingredients, usually zinc oxide be available on retail and titanium dioxide, caused a whitening of the skin All SPF products, whether products for the purchaser, because their large, white particles laid on its surface. designed for the face or either on the container, Their new micronization formulations (tiny particles of the body, can be used box or on a piece of paper the ingredient suspended evenly in an emulsion) now on the hands. Every nail that accompanies the allow uniform dispersion of the ingredients within a department should carry product. The ingredients short time after their application while maintaining a a good moisturizing SPF are listed according to high SPF with little or no whitening. lotion to sell to manicure their descending order ●● Chemical: These SPF ingredients absorb and transform and pedicure clients. All of predominance in the UV radiation to harmless heat. The ingredients include clients, no matter their product, and must be chemicals such as benzophenone, oxybenzone and ages, should be educated readily available for the avobenzone (Parsol 1789), and others. Chemical SPFs tend on anti-aging and age consumer to read. The to be more sticky and oily, and have an undesirable aroma spot-prevention qualities of purpose of the product is unless carefully formulated. They also cause more allergic moisturizing SPF products stated on the label, as well reactions than physical SPFs, and should not be used close and be urged to use them as in the marketing claims, to the eyes. faithfully. If the client is instructions on use and in an anti-aging or age warnings or precautions. SPFs are multitasking products. Aside from being cancer spot treatment regimen for preventives, they are also anti-aging products. The link between the hands, sun protection Professional-only products UVB and cancer has long been established, but since the first product is standard in their are not required to carry scientific evidence documenting the link of UVA to aging of home care sales. Without this information, though the skin in 1998, the use of SPFs as anti-aging products has use of an SPF product, the most do, as a service to boomed. It is known now that UVA rays cause 90 percent of treatments are futile. their nail professional the aging of the skin, and clients who wish to stay younger in consumers. appearance must purchase and use SPF products that protect Even with ideal sunscreen from both UVA and UVB rays. SPF is a “must sell” for a and sun protection, some manicurist to every client. When asked what the most important UV rays can get through to the skin and cause damage. The beauty product is, beauty professionals should answer with American Skin Cancer Society considers sunscreen one part certainty, “SPF,” and that includes products for the hands. of a comprehensive sun protection program, along with sun- protective clothing, sunglasses, shade and sun avoidance from A recent entry into the SPF range of physical SPF products 10 a.m. to 4 p.m. For that reason, sun protection of the skin is mineral makeup, a makeup formulated from minerals that is a personal responsibility for every individual and involves reflect UV rays. Mineral makeup is not only a great SPF personal decisions from sunrise to sundown. product for the face of all clients, it is also especially beneficial as an SPF for hands because of its ease in reapplication. A The sun protection factor industry is relatively new, and quick brushing with minerals and it is done. Mineral makeup there has been much controversy about it. Currently, the SPF SPF is from 15-22. Its benefits are from the zinc oxide and measurement’s usefulness and limitations are being debated. titanium dioxide ingredients that have great broad-spectrum Initially, SPF products were designed to protect from exposure capabilities. Many clients use a gel or lotion SPF for the first to Ultraviolet B rays – those that burn the skin and are the application of the day, but after that, they use a mineral makeup rays considered the main cause of basal and squamous cell reapplication on the face and the hands all day. Clients love the carcinomas as well as a significant cause of melanoma. But the

Page 24 Cosmetology.EliteCME.com SPF does not measure protection from UVA rays that penetrate being banned in Europe, Asia, Africa and many other nations the skin more deeply, and are believed to be the chief culprits because of concerns for health issues allegedly caused by its behind wrinkling, leathering and other aspects of “photo application, was allowed to be sold in the United States under a aging.” The latest studies show that UVA rays not only increase “tentative final monograph” issued by the FDA in 1982. Now, UVB’s cancer-causing effects, but also are indicated to cause after an extensive review of abundant scientific information some skin cancers, including melanomas. and resulting heightened concerns over its safety, the FDA is proposing to ban OTC sales of the hydroquinone products, Presently, standardized UVA testing and labeling are used limiting sales to medical offices. This ban will eliminate sales only outside the U.S., particularly in Europe. Here, there is of HQ products even at 2 percent in salons and spas. With this currently no uniform measure of UVA absorption. However, the in mind, it is time to look for other lighteners, many of them U.S. Food and Drug Administration (FDA) has proposed new proving in new combinations and formulas to be better than sunscreen rules, which would include the first U.S. standards hydroquinone, though some take more time. Following are for UVA testing and labeling. The proposed regulations would some ingredients that have proven good lightening powers. use a 1-4 star rating system to gauge UVA protection, with 1 Note that their action usually is centered around suppression of star the lowest and 4 the highest. Products without a star would tyrosinace, an enzyme required to produce melanin the skin. be marked “No UVA protection.” The agency was expected to ●● Kojic is derived from koji, a Japanese mushroom. It lightens issue final rules in October 2010. by inhibiting the production of tyrosinase. ●● Mulberry is extracted from the roots of the paper mulberry The phrase “broad-spectrum protection” is also being plant. It takes less mulberry/lower concentrations to lighten discussed. It is used on labels to indicate that a product shields than hydroquinone and kojic acid the wearer against UVA as well as UVB, but this is not always ●● Alpha and beta arbutin are derived from the leaves of true, because the product does not guarantee protection against bearberry, cranberry and blueberry plants and work like all UVA wavelengths. Actually, sunscreens with an SPF of 15 kojic acid, in that they inhibit the production of tyrosinase. or higher protect against UVB and short UVA rays only if used Alpha is stronger than the beta arbutin, but is more likely to properly and if they also contain avobenzone, zinc oxide or cause irritation. titanium dioxide. Clients should be educated on sun protection ●● Licorice root also works to inhibit the enzyme tyrosinase products that protect them, and those who purchase products for to limit the amount of pigment produced. It has anti- salons and spas should also learn how to choose products that inflammatory properties, as well as lightening. actually work. Callus remover: Actually softeners, these products make Chemical exfoliating lotions: The manicurist must choose smoothing and reducing calluses easier. Most of them contain two chemical exfoliating lotions: one for professional use and sodium hydroxide, a good tissue softener ingredient, but the one for selling as home care. Chemical exfoliating lotions formulation must also contain a hydrator to counter its drying usually contain glycolic acid (GA) or lactic acid (LA), the two properties. Callus removers have greatly improved in recent most used alpha hydroxy acids (AHAs) in skin care. These years, and hopefully will reduce the use of illegal blades by ingredients, when used on the skin, encourage the turnover of manicurists during pedicures. It can also be used to soften and cells, which makes the skin appear more youthful. reduce dead, hardened cuticles (eponychium) during services, though the callus remover companies have not added it to Chemical exfoliation can be performed with 30 percent AHA their label directions. (If so, this indicates they will not legally products or lotions with AHAs in them. The 30 percent AHA support its use in that manner yet. Check the labels and contact products are usually too potent for the hands as are the 20 the companies before using them in reduction of cuticles.) percent AHA lotions; services are usually performed with 15 Some products in lower percents are designed for home care percent AHA hand lotions in massage techniques. use to control fast growing cuticles and calluses and are ●● Treatment: The lotion is rubbed over the skin for 3-5 important home care products for these clients. minutes then removed with a wet towel. A hydrating mask is applied and allowed to set, then removed, and an SPF Successful manicurists have found that they must know their lotion is applied. professional and home care products well to produce the ●● Home care: An exfoliating lotion, usually a 10 percent AHA results that bring clients back to them. They or the persons in lotion, a moisturizing lotion and an SPF lotion. charge of choosing products must study the product ingredients These products are important in treatments and home care for incorporate the products into their manicures and pedicures and dry skin, callused skin, sun-damaged skin and in anti-aging. to their retail shelves. The nail technician should know how each will affect their clients’ skin. New kinds of manicures Lightening lotion: The former term for lightening skin was and pedicures have been introduced using these products, “skin bleaching,” but that term is no longer appropriate, and properly trained manicurists are excited about their new according to the FDA, unless there is hydroquinone in the capabilities in both meeting the needs of clients and in the formula of the product. That is the only FDA-approved potential for making money. ingredient for skin bleaching sold in salons and spas in amounts of 2 percent and below. Only medical offices can sell products with more than 2 percent. That ingredient, despite

Cosmetology.EliteCME.com Page 25 Selling in the nail care department Most manicurists have never liked selling, nor have they done ones that are needed by clients to get the skin and nails on their much of it. The median sales percentage for nail salons and hands and feet to help them appear as they want. nail departments in salons and spas is a pitiful 7.5 percent. This percent of sales indicates that clients are forced to ask to To sell these items, the mindset of most manicurists must be purchase an item, or that products are not being recommended changed. Sales of these items are not called retail sales; they to them by manicurists. This is not selling. It also indicates are called “home-care sales.” Changing this and explaining the poor training in sales and in how to recommend products, or difference can raise the percentage of sales in itself, though that these salons and spas do not have products for them to sell training still should be performed. The difference is obvious beyond polish, hand lotion and some fun items. once it is stated: Retail items are those that are picked up by clients just because they want them, not always because they Manicurists are no different from skin care and hair need them, such as a line of jewelry or purses in a salon. Home professionals in selling, though they usually believe they are, care products in a salon are those that clients realize they and most owners do also. Some believe selling is “pushing need to maintain or enhance service results. But the biggest products,” and when they sell products, they are stealing difference between retail and home care sales in salons is that from their poor clients who cannot afford them. That simply home care sales come from recommendations of a professional is not true. The focus for all beauty professionals, including for a product that meets the needs of the client in 1) improving manicurists, should be selling to needs, not pushing products. or changing the client’s skin or nails as initiated during the This, of course, does not prevent bringing in fun products that service, or 2) in maintaining or extending the condition of the might interest a client, but the main focus should be meeting skin or nails or the change that has been achieved during the client needs. Recommended items or products must be the service.

Selling and success Selling good home care products is a responsibility of Manicurists working in a salon or spa that does not do external manicurists, and not for just the dollars they bring to the salon marketing of the services will have fewer new clients, so their or spa. Clients spend their money on a service they want to last home care sales percentage will be lower than in one where more than 48 hours, and the only way that is going to happen external marketing is active. A good home care sales figure for is if they take home the appropriate products and instructions that person is 25-30 percent. These manicurists will not grow on how to use them. Disappointment in the longevity of the a full book as fast – nor will the salon or spa – as one with service results will adversely affect the retention of a client. external marketing, but should still grow at a rate of zero to full The products must be recommended, explained and sold. One book in about two years with supportive in-house marketing. measure of whether a manicurist is meeting this responsibility is defining the home-care sales percentage against production. Salon professionals should understand that home-care sales and client retention are linked, according to the International Experts say manicurists working in a salon or spa that markets Spa Association. Clients who purchase home care products are and brings in new clients should sell 40 percent of their more likely to return to the salon or spa, and the more home production in home care and, if so, their retention is excellent care they purchase, the even more likely they are to return and their clientele is growing at a good rate. At the same time, and to remain a client. This indicates that home care sales can the salon or spa grows. These manicurists will be fully booked initiate loyalty and the return of clients. in less than a year, possibly much less. This is how that figure is found: Ultimately, responsibility goes back to management. To attain ●● Determine the dollars in sold products, for example, $80. these home-care sales, the manicurists must be 1) expected to ●● Determine the dollars brought in through services, for sell, 2) trained in selling, 3) trained in the ingredients in their example, $200. products, and 4) have the products to recommend and sell ●● Now divide the service dollars into the home-care sales on the shelves. If these are not conditions in the spa or salon dollars =___200/80.00 = 40 percent. department, few, if any manicurists will reach their potential in 1) home-care sales, 2) client retention, and 3) bringing If manicurists in a salon or spa that markets externally are in the optimal amount of money for the salon or spa, or for selling less than 30 percent, they are going to be booked, themselves. but not fully booked with requests as quickly as the one at 40 percent, and the department will not grow as quickly. Many types of rewards are offered to interest manicurists in Manicurists in this kind of salon or spa who are trained but still selling. The traditional incentive is 10 percent of gross sales. selling less than 20 percent are not doing anyone – themselves, But there are others, such as education dollars, which a person their clients and their salon or spa – a favor and are not doing can use for training of their choice on the salon or spa when the job a professional manicurist should be doing. If there they have earned enough points (sold enough dollars). Another are not appropriate products on the shelf to sell, manicurists might be a trip of financial bonus when a certain dollar goal and owners should define the reason and take action. These is attained. Some salons use more immediate rewards, such as manicurists (and the spa or salon) are not making the money gift certificates and other rewards for the highest producer of they should. each department in a certain timeframe. Rewards programs are

Page 26 Cosmetology.EliteCME.com limited only by the imagination of the management of salons important to client care. However, because it is clear that clients and spas. who purchase products are more loyal and come in more often, many others believe it is as important to the service as the Some experts in the industry dislike incentives, and believe protocols. beauty professionals should recommend products because it is

Conclusion Continuing education, beauty industry books and articles designed protocols and good products for changing the skin in trade magazines all can empower the manicurist to learn will perpetuate the beautiful results that clients desire. When about innovative as well as tried-and-true services and their that happens, the manicurist’s books will be full, clients will be appropriate uses. They also can help the beauty professional to happy, and they and the salon or spa will make the maximum formulate highly effective treatment plans for their clients. This amount of revenue. knowledge, coupled with consistent analysis procedures, well-

Reference and Source Materials for Manicurists Course

ŠŠ Denver Evening Post, Classified Ad, Volume LXXIX, Issue 116, 18 May 1910, Page 1. ŠŠ http://www.pedicuresandfootcare.com/pedicure-infections.html/ ŠŠ http://regalnails.com/home/about_us.html ŠŠ Mayo Foundation for Medical Education and Research ŠŠ “The Skin Care Professionals Chemistry Ingredient Handbook,” Laura Root, Esthetic Education Resource, Mesa, AZ. ŠŠ “Spa Manicuring for Salons and Spas,” Janet McCormick, Milady Publications. ŠŠ “Nail Structure and Product Chemistry” Second Edition, Doug Schoon, Milady Publications. ŠŠ http://www.cfsan.fda.gov/ ŠŠ http://www.ewg.org/reports/skindeep2 ŠŠ http://pubs.acs.org ŠŠ http://www.spatrade.com/news/index ŠŠ http://www.nightcats.com/samples

Cosmetology.EliteCME.com Page 27 NAIL CARE SERVICES, YESTERDAY AND TODAY Final Examination Questions Choose the best answer for the following questions 1 through 10 and mark your answers online at Cosmetology.EliteCME.com.

1. Paraffin baths are units that keep paraffin wax heated, 7. There are no differences in the basic protocols of traditional usually to 120 degrees to 130 degrees Fahrenheit. and skin care-based manicures and pedicures. ¨¨ True  False ¨¨ True  False

2. An artificial toenail must be longer to protect the end of the 8. The usual skin types as they are seen on the hands and toe. feet include: normal, dry, dehydrated, sensitive, mature, ¨¨ True  False environmentally exposed and callused. ¨¨ True  False 3. Methicillin-resistant Staphyloccus aureus (MRSA) is causing illnesses that kill more people every year than HIV 9. Daytime products usually do not include expensive and hepatitis. treatment ingredients. ¨¨ True  False ¨¨ True  False

4. Manicurists must wear personal protective equipment 10. Clients who purchase home care products are less likely to (PPE), which includes gloves, masks and eye protection. return to a salon or spa. ¨¨ True  False ¨¨ True  False

5. Arthritis of the feet/toes, fibromyalgia, varicose veins and lower leg/ankle swelling indicate the need for a vigorous massage. ¨¨ True  False

6. The skin of clients taking antibiotics and using rapid exfoliants such as Retin A or similar products will turn red and even become inflamed or blister after treatments. ¨¨ True  False

ENNC04YTI17

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