Overlooked and Unprotected
Nail Salon Workers Face Many Hazards
Working from Home but Missing Your Synergist? Update Your Address
If you’ve been working from home during the pandemic, please consider updating your address with AIHA. You can change your address by editing your profile through AIHA.org. To ensure uninterrupted delivery of The Synergist, designate your home address as “preferred” on your profile. Update your address now.
In nearly every United States community, a nail salon can be found tucked away in the local shopping center. We all know someone who regularly gets manicures and pedicures; it might be yourself, a family member, or a friend. However, the workers who provide these services are often invisible to the communities they serve. According to the Bureau of Labor Statistics, in 2021 there were approximately 163,000 nail salon workers (manicurists and pedicurists) in the U.S. But other sources, such as NAILS Magazine, estimate that count to be as many as 400,000 due to the number of undocumented and unlicensed individuals who work in this small business industry.
The U.S. nail salon industry is predominantly owned and staffed by foreign-born individuals (immigrants or refugees) who run small “mom-and-pop” businesses with 10 or fewer employees, making them subject to fewer OSHA regulations and recordkeeping requirements. As explained in a report published in 2018 by the UCLA Labor Center and the California Healthy Nail Salon Collaborative, nail salons mostly staff women of child-bearing age with limited English proficiency who work for low wages and few employment-related benefits. The study on which the 2018 report is based found that nearly eight in 10 nail salon workers earn low wages, defined as two-thirds of the median full-time wage, and most work overtime, or more than eight hours per day. According to the UCLA report, approximately 80 percent of nail salon workers are female; about 75 percent are of Asian descent, with Vietnam as the most common place of birth; 65 percent of the workforce is between 16 and 44 years old; and nearly 50 percent do not speak English or have limited English proficiency.
Nail salon workers in the U.S. are licensed through their respective state cosmetology or licensing boards, which have requirements that vary by state. Workers can be trained through a formal cosmetology program or through an apprenticeship; many workers opt for the latter given the lower cost and lower barriers. When it comes to occupational health and safety in the nail salon industry, the differences in state licensure requirements contribute to a lack of uniformity and baseline expectations regarding training and educational requirements, as explained in a study published in Health Science Reports in 2022. Thus, challenging working conditions and labor enforcement and rights issues are pervasive within this industry. Nail salon workers also experience occupational health disparities, which are described in a previous Synergist article. The often precarious work arrangements, combined with complex OHS regulations and product warning labels that are frequently only available in English, make it challenging for owners and workers to understand the long-term implications of their exposures and ways to protect their health.
Many nail salon workers feel that this work is the only way to earn their livelihood in the U.S., and many understand that they are regularly exposed to a number of occupational hazards—though they do not receive adequate training and education to fully understand what those hazards are and how to mitigate them, as discussed in a paper published in 2021 in the International Archives of Occupational and Environmental Health. For example, a more recent study published in January 2023 in Nature Communications found that radiation emitted by nail polish dryers used to cure gel manicures can damage DNA and cause somatic mutations in mammalian cells. The study attracted much media attention regarding potential cancer risk to nail salon customers. This instance is representative of how most of the discussion surrounding nail salons tends to focus on protecting customers’ health and safety, rather than that of the workers. This article is intended to shift that focus toward common occupational hazards encountered by nail salon workers.
CHEMICAL HAZARDS Numerous chemical ingredients are found in nail care products, and overexposure to them can cause short- and long-term health effects. However, many beauty products used in nail salons are not regulated by the Food and Drug Administration. For instance, acetone, typically used to remove nail polish and acrylic nails, may cause headache, dizziness, and irritation to the skin, eyes, throat, and central nervous system. Many nail polishes may contain what is known as the “toxic trio”: formaldehyde (or formalin), toluene, and dibutyl phthalate. Formaldehyde is a known human carcinogen, and short-term health effects of formaldehyde exposure may include irritation of the respiratory system and wheezing. Toluene, another known respiratory irritant, may also cause liver and kidney damage. Dibutyl phthalates and other phthalates found in nail salons are endocrine disruptors and have been linked to reproductive health issues, as described in studies published in 2022 in the International Journal of Environmental Research and Public Health and in 2008 in the Journal of Immigrant and Minority Health. And methyl methacrylate (MMA), a type of liquid monomer used in acrylic nail application, is a dermal sensitizer. The use of MMA in nail care has been banned since the 1970s, but the chemical continues to be found in nail salon products, resulting in exposures to some unsuspecting workers and customers.
Exposure studies of the nail salon environment have typically found chemical levels below relevant occupational exposure limits. However, multiple health studies of nail salon workers report short-term symptoms that are consistent with known health effects related to exposure to volatile organic compounds (VOCs) such as those mentioned previously as well as others. These studies—which are listed below as resources from the Journal of Community Health, the Journal of Immigrant and Minority Health, and the Annals of Work Exposures and Health—confirm adverse health outcomes resulting from low-level exposures to VOCs in nail salon settings.
Numerous chemical ingredients are found in nail care products, and over-exposure to them can cause short- and long-term health effects.
Early evidence of reproductive health issues among nail salon workers is emerging, including suggested associations between working as a nail salon technician during pregnancy and congenital heart birth defects, as described in Occupational and Environmental Medicine in 2022. A study published in 2015 in the International Archives of Occupational and Environmental Health that examined a small sample of California manicurists found elevated risk of low birth weight, gestational diabetes, and placenta previa. Research on cancer risks among nail technicians as an occupational group is limited; relevant studies include one on cancer incidence among female manicurists in California in a 2010 issue of the American Journal of Epidemiology and a 2023 article in Occupational and Environmental Medicine focused on occupational environment and ovarian cancer risk.
Being a mindful and considerate patron of nail salons can make a difference. We do not wish to discourage anyone from getting nail services. Instead, we urge consumers to use the power of their dollars to encourage salons to learn about ways to reduce VOC exposure or order less toxic products—efforts that can be beneficial for both customers and workers.
BIOLOGICAL HAZARDS Nail salon work is considered an “intimate labor industry”—partially due to the personal connections workers form with their clients, but also due to the proximity in which they perform their services. Bloodborne pathogens, such as hepatitis B and C, are of chief concern given that skin may accidentally be broken during manicure or pedicure services, or customers may come in with open wounds. Direct contact with respiratory droplets from coughing, sneezing, and close talking can result in respiratory illnesses such as the common cold or COVID-19. Bacteria commonly found in nail salon settings include species of Streptococcus, Enterococcus, Micrococcus, Bacillus, Enterobacter, Klebsiella, and Escherichia coli. Improper disinfection of pedicure spas or lack of sterilization of reusable instruments can lead to yeast and fungi breeding in the salon, and, in some cases, customers may already have fungi. According to a survey on microbiological risk in beauty salons in the Microchemical Journal, common pathogens include species of Candida, Rhodotorula, and Rhizopus as well as mycosis and tinea pedis, or athlete’s foot.
Protections against biological hazards in nail salon settings are naturally focused on customers. However, that means that protections for workers are often neglected or not prioritized, as found in a 2021 study of intervention needs among nail salon workers in Michigan.
PHYSICAL AND ERGONOMIC HAZARDS Nail salon workers frequently report complaints related to musculoskeletal disorders, including shoulder, neck, and lower back pain as well as body aches resulting from prolonged sitting in awkward positions. Repeated use of the hands and wrists during physical tasks like filing, buffing, and nail painting can cause pain in the hands and carpal tunnel syndrome as well as other cumulative trauma disorders. Use of electric files for acrylic nails can also pose vibration-related health risks such as numbness and pain in the hands and fingers, pain sensations, and tissue damage. Health surveys of manicurists published in 2008, 2019, and 2023 found that approximately 40 percent of workers experienced musculoskeletal symptoms.
PSYCHOSOCIAL HAZARDS Psychosocial hazards—or factors in the design or management of work (for example, bullying, violence, harassment, and burnout) that can increase work-related stress and lead to subsequent poor mental or physical health outcomes—are also present in nail salons.
At the beginning of the COVID-19 pandemic, a UCLA study focused on nail salon workers and owners in California—where a large portion of the industry is located—found that 90 percent of workers applied for unemployment benefits, only 6 percent of owners were able to keep their workers on payroll during mandatory state closures, and the majority of workers and owners were concerned about health and safety upon reopening. During the pandemic, many salons faced permanent closures. For those that were able to resume business, the significant increase in hate crimes against Asian and Asian American people (as described in a 2022 article in Health Affairs Forefront) created additional stress and fear among the working population. Chronic stress can result not only in mental health issues, such as anxiety and depression, but also in physical issues, including negative long-term implications on the cardiovascular system, nervous system, endocrine system, and immune system.
Nail salon workers often report chronic stress and burnout. In a focus group of Michigan nail salon workers (the results of which are further detailed in a 2021 paper in the International Archives of Occupational and Environmental Health), participants said they often felt pressure from customers to perform services outside of their scope of work—for example, cutting live skin or diagnosing foot fungi. Participants also noted that nail salon owners were constantly stressed trying to keep up with new trends and demands while functioning on slim profit margins. As with the UCLA report, the study of Michigan nail salon workers found that many work overtime and have little time off, with some pregnant workers on the job through the third trimester of pregnancy. Additionally, as many nail salon workers are immigrants or refugees, they cited experiencing microaggressions targeting their race or ethnicity, English proficiency, and commonly held stereotypes about nail salon workers, as well as direct racism from some customers. These cumulative negative psychosocial exposures take a toll on the mind and body.
RECOMMENDATIONS FOR IH AND OEHS PROFESSIONALS The Bureau of Labor Statistics projects employment in the nail salon industry to grow “much faster than the average for all occupations” in the next decade—by 22 percent. And with new beauty trends and products with unknown chemical compositions emerging on a daily basis, protecting the health and safety of nail salon workers will continue to grow in importance.
When promoting health and well-being among nail salon workers, it is important for IH and OEHS professionals to develop cultural competency skills and understand that these largely immigrant worker populations will require language- and literacy level-appropriate education and training. Starting with the fundamentals of OHS rather than jumping to higher-level concepts like ventilation systems is key. While not necessary, having racially or ethnically concordant IH or OEHS professionals on your team to communicate with nail salon workers may help build trust, as many workers and owners are skeptical of those affiliated with the government, academia, or industry organizations due to the precarious nature of their work and fear of disciplinary actions. Professionals may also leverage existing connections with their local nail salon worker community, such as through community-based organizations, religious organizations, community-based researchers, nail salon suppliers, and business associations. Promoting OHS among nail salon workers should be viewed as a partnership—one that requires dedication, patience, and cultural humility by the IH and OEHS professionals seeking to make positive, sustainable change for these workers’ safety and livelihood.
AURORA B. LÊ, PhD, MPH, CSP, CPH, is an associate professor of health behavior at Texas A&M University School of Public Health.
TRÂN B. HUỲNH, PhD, MPH, CIH, is an associate professor of environmental health sciences at University of Minnesota School of Public Health.
Send feedback to The Synergist.
Anderson Piza/Getty Images
American Journal of Epidemiology: “Cancer Incidence in Female Cosmetologists and Manicurists in California, 1988–2005 ” (2010).
Annals of Work Exposures and Health: “A Participatory Approach to Designing and Implementing an Occupational Health Intervention for the Nail Salon Community in the Greater Philadelphia Region” (2023).
Bureau of Labor Statistics: Occupational Outlook Handbook, “Manicurists and Pedicurists” (2022).
Health Affairs Forefront: “COVID-19 Has Driven Racism and Violence Against Asian Americans: Perspectives from 12 National Polls” (2022).
Health Science Reports: “Licensure and Citations Among Nail Salons in Michigan from 2017 to 2021: A Cross-Sectional Study of an Overlooked and Vulnerable Industry” (2022).
International Archives of Occupational and Environmental Health: “Adverse Birth Outcomes and Maternal Complications in Licensed Cosmetologists and Manicurists in California” (2015).
International Archives of Occupational and Environmental Health: “Perceived Work Exposures and Expressed Intervention Needs Among Michigan Nail Salon Workers” (2021).
International Archives of Occupational and Environmental Health: “VOC Sources and Exposures in Nail Salons: A Pilot Study in Michigan, USA” (2019).
International Journal of Environmental Research and Public Health: “Evaluating Indoor Air Phthalates and Volatile Organic Compounds in Nail Salons in the Greater New York City Area: A Pilot Study” (2022).
Journal of Community Health: “A Preliminary Survey of Vietnamese Nail Salon Workers in Alameda County, California” (2008).
Journal of Community Health: “Characterizing Occupational Health Risks and Chemical Exposures Among Asian Nail Salon Workers on the East Coast of the United States” (2019).
Journal of Immigrant and Minority Health: “Results From a Community-Based Occupational Health Survey of Vietnamese-American Nail Salon Workers” (2008).
Journal of Public Health Management and Practice: “Risk for Hepatitis B and C Virus Transmission in Nail Salons and Barbershops and State Regulatory Requirements to Prevent Such Transmission in the United States” (2014).
Microchemical Journal: “A Descriptive Survey on Microbiological Risk in Beauty Salons” (2018).
NAILS Magazine: “2017–2018 Big Book Statistics” (PDF, 2018).
Nature Communications: “DNA Damage and Somatic Mutations in Mammalian Cells After Irradiation with a Nail Polish Dryer” (2023).
Occupational and Environmental Medicine: “Maternal Occupation as a Nail Technician or Hairdresser during Pregnancy and Birth Defects, National Birth Defects Prevention Study, 1997–2011” (2022).
Occupational and Environmental Medicine: “Occupational Environment and Ovarian Cancer Risk” (2023).

OSHA: "Stay Healthy and Safe While Giving Manicures and Pedicures: A Guide for Nail Salon Workers" (PDF, 2012, also available in Korean, Nepali, Spanish, and Vietnamese).
UCLA Labor Center and California Healthy Nail Salon Collaborative: “A Survey of Nail Salon Workers and Owners in California during COVID-19” (PDF, 2020).
UCLA Labor Center and California Healthy Nail Salon Collaborative: “Nail Files: A Study of Nail Salon Workers and Industry in the United States” (PDF, 2018).