Most of us have heard salon horror stories -- and if you love splurging on a mani/pedi you may want to ask a few questions first. Do you know if the tools and applicators at your salon or spa are sterilized between clients? Have you ever asked how work surfaces and chairs are cleaned? Dr. Lisa Kellett, a dermatologist at DLK on Avenue Dermatology and Cosmetic Laser Surgery Clinic in Toronto, says that by frequenting spas and salons that do not adhere to proper cleaning and sterilization processes, you could be putting yourself at risk for infections, allergic reactions or other injuries.

Here's a sampling of what may be lurking in your spa or salon, and what to do if you think you've picked up an unwanted guest.

Wax or laser burns
Wax that's too hot and improperly used lasers can burn the skin. Kellett recommends undergoing laser treatments only in facilities that are licensed and supervised by a doctor. For waxing, choose an esthetician who is licensed, well qualified and experienced. Burned skin will be more sensitive to sunlight for up to a year, so be diligent about sunscreen. People of Asian or African descent who suffer burns are also at risk for hyperpigmentation: burning can spur the production of excess melanin, causing areas of the skin to darken. Hyperpigmentation can be treated with an over-the-counter bleaching cream, such as Neostrata HQ, or a prescription cream, such as Glyquin or Lustra, to restore the skin to its normal colour.

Burn
What it looks like: A superficial or mild burn will be red, painful and slightly swollen. The damaged skin could take up to two weeks to peel and heal. A more serious burn will look and feel similar but also have painful blisters, which can result in scarring.
What you should do: If the burn is mild, soak the skin in cool water and try a topical antibiotic cream, such as Polysporin. If the burn is more severe and there is blistering,
see a doctor.
Treatment: For blistered skin, antibiotic cream, a tetanus shot and an oral antibiotic to ease pain and swelling. Your doctor will dress the wound to help prevent infection. Depending on the severity of the burn, it could take about four weeks to heal.

Contact dermatitis: Double trouble
Contact dermatitis occurs when an irritant, such as the ammonia in a perm solution or the formaldehyde in acrylic nails, comes into contact with the skin, causing redness, scaling, swelling and sometimes blisters. If you think you may have developed contact dermatitis, call your salon for a list of product ingredients that you may have been exposed to before contacting your doctor. The list may help determine which ingredient has caused the problem. Contact dermatitis is divided into two main categories: irritant and allergic.

Irritant contact
This skin reaction can happen to anyone and is usually the result of a strong product ingredient that comes into contact with the skin. For example, many people react to the ammonium thioglycolate used in perm solutions. People with sensitive skin may be more at risk.
What it looks like: Red, scaly eruptions around exposed areas. They are often more painful than itchy. Reactions usually occur within minutes of exposure.
What you should do: Avoid contact with the product in future. If the skin is broken (by scratching or scaling), see a doctor to help prevent infection.
Treatment: Topical steroids, which help ease the itching and discomfort.

Allergic contact
This type of dermatitis only occurs if an individual comes into contact with a product that she's allergic to. Common allergens are nitrophenylenediamine and paraphenylenediamine found in hair dye and the paratertiary butylphenol formaldehyde resin in acrylic nail adhesive.
What it looks like: This type of dermatitis shows up in the form of itchy, red, scaly, hivelike bumps, and sometimes blisters. Although it's called allergic contact dermatitis, it can, in rare cases, spread outside of the exposed area. Reactions can occur up to 48 hours after contact.
What you should do: Try a cold soak or compress to relieve itching and burning until you can see a doctor. You can't test skin that's reacting, but after the irritation subsides your doctor can do a patch test to determine what you're allergic to and which ingredients to avoid in future.
Treatment: Topical anti-inflammatory cream for small areas of rash. If the rash covers a large area of the body, your doctor may prescribe oral steroids to reduce itching and swelling.

Page 1 of 3 -- Discover the signs of infection on page 2.

Infections: A quadruple threat
Kellett warns that using disinfectant or a UV light, both commonly used in spas and salons, is often not an adequate way of cleaning tools and work surfaces. Be sure that all instruments that are not disposable -- such as nail files and clippers -- are sterilized in an autoclave, a medical-grade device that uses superheated steam to sterilize. It's the only way to be sure that infectious organisms have been destroyed. Consider investing in your own set of tools: many spas and salons will sterilize and store them for you for free, or you can bring your own set from home each time you go.

Bacterial
What it looks like: Anything from red patches to pustules or sloughing of the skin. Can include pain, pus and fever.
What you should do: Depending on the type of infection, bacterial infections can get serious very quickly. The infections in this group range from mildly irritating skin conditions to life threatening infections such as Group A streptococcus -- aka flesh-eating disease. If you think you might have a bacterial infection, see a doctor as soon as possible.
Treatment: Topical or oral antibiotics. A skin infection usually takes about a week to clear up, but a more serious infection could lead to hospitalization for a few weeks.

Fungal nail
What it looks like: Nails can become thickened, brittle and discoloured. The nail may begin to lift off the nail bed. An overproduction of keratin, combined with dead skin, may collect under the nail.
What you should do: See a doctor immediately. The infection can spread to other fingers or toes and other people.
Treatment: Oral or topical antifungal medication. The infection may take up to 18 months to clear.

Fungal skin
What it looks like: A scaly, sometimes itchy red rash that sometimes produces pustules.
What you should do: See a doctor immediately. The infection can spread to other parts of the body and to other people.
Treatment: A topical antifungal cream to treat the infected area. Most fungal skin infections clear up in two to four weeks.

Atypical mycobacterial
What it looks like: Small, red, sometimes painful bumps and/or large, cystlike nodules under the skin. In severe cases may be accompanied by fever.
What you should do: See a doctor as soon as possible.
Treatment: Oral antibiotics. Prepare for a long haul -- you'll have to take the pills for a few months before the infection clears up.

Page 2 of 3 -- Discover how to assess your salon's safety on page 3.

Warts: Taking your lumps
The virus that causes warts, the human papillomavirus, can lurk in warm, humid areas, such as spa showers and salon treatment rooms. Warts are caused by the rapid growth of skin cells on the outer layer of your skin. Ask how footbaths are cleaned; many spas and salons use medical-grade cleaners, such as Tavicide, which destroy surface bacteria, fungus and viruses. If your spa or salon doesn't provide disposable slippers, take your own flip-flops to protect your feet.

Common
What it looks like: Bumpy, often round growths that usually appear on the hands or fingers but can also form on the feet or face.
What you should do: Try self-treatment with over-the-counter products, such as Compound W or Duoplant. The length of the treatment will depend on the size of the wart and can take up to 12 weeks.
Treatment: If you're not able to destroy the wart at home, or don't want to commit to a long self-treatment, a doctor can use liquid nitrogen, which burns at about -200 C, to destroy the tissue of the wart. Another option is doctor prescribed and applied Cantharone, a topical caustic agent that forms a blister on the skin and lifts off the surface of the wart, destroying it.

Plantar
What it looks like: Plantar warts appear only on the bottom of the foot and tend to be hard and flat with a rough surface and well-defined boundaries. Usually grey or brown with a black pinpoint in the centre, they're difficult to treat because they're rooted on the sole of the foot, which has the thickest skin on the body, and often reoccur.
What you should do: Since plantar warts can be difficult to destroy, self-treatment is not advisable.
Treatment: A doctor can remove plantar warts in the same way as common warts, using liquid nitrogen or Cantharone.

An ounce of prevention...
If sterilization and cleanliness standards are not maintained, your risks of picking up an infection, virus or other illness are the same regardless of whether a spa is lavish or low-end. Those with immunosuppressive diseases, such as diabetes, lupus and rheumatoid arthritis, or those receiving chemotherapy or radiation treatments are at higher risk and should be particularly cautious.

Lorraine Hamilton, who has 18 years of experience in the field, is the spa coordinator at Jeanet's Spa in Toronto. She suggests using the following checklist to assess a spa or salon before you make an appointment.

Friendliness. You should be welcomed in a friendly, professional manner. You have the right to be informed about a spa or salon's hygiene practices. Staff should be happy to answer any questions.

Qualifications. Look for a spa or salon licence. It should be displayed in a conspicuous place. Diplomas and training certificates should also be visible. Be sure to ask about the experience and training of the estheticians.

Hygiene. Always find out from salon staff how nondisposable tools are sterilized. Confirm that there are no double-dipping (putting a used tool back into the wax) and no double-using (reusing wax) policies to avoid product contamination. Ask how work surfaces and treatment chairs are cleaned, and how towels and gowns are laundered.

Cleanliness. Ask for a tour. The facility and treatment areas should all be clean and orderly. Staff should be well groomed and presentable.

It's expensive to maintain proper sterilization equipment, purchase medical-grade cleansers and hire well-trained estheticians, and these costs are often reflected in higher fees. So the old adage is true: You get what you pay for. Or, in this case, you pay for what you don't get. But don't assume that a high price tag will ensure your well-being. Be sure to ask the right questions -- then just relax and enjoy.


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