Thanks to nail salons on every other corner, getting a manicure is remarkably easy these days—in fact, my nails have never looked better. But a new report from the Virginia Department of Health has me rethinking my routine nail salon visits. The report cautions that hepatitis B and hepatitis C—serious, bloodborne viral infections that affect the liver—are being transmitted in some nail salons and barbershops through cuts caused by contaminated instruments such as scissors, clippers and razors.

Knowing how easy it is to get nicked at a salon or barbershop, I found this news unsettling. To find out more, I called David A. Johnson, MD, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia, who presented the health department’s report at the annual meeting of the American College of Gastroenterology on October 31, 2011, in Washington, DC.


Prompted by news of a hepatitis C case in Virginia that resulted from a manicure/pedicure, the Virginia Department of Health performed a comprehensive search of published medical literature on the topic from all over the world. They found 18 published reports since 1995 that included nail salons and/or barbershops, with most of these reports coming from outside of the US. This obviously isn’t a large number of cases, but that shouldn’t lull us into assuming that US salons and barbershops are safe, said Dr. Johnson. Here’s what’s causing concern…

• It’s unlikely that most cases of hepatitis would ever be directly connected with a salon or barbershop, since hepatitis B or C symptoms typically don’t appear for 10 to 20 years after initial infection, he said. Let’s say that you do end up with hepatitis someday—what are the odds that you’re going to think to link your disease to that time a manicurist nicked your index finger 15 years earlier?

• Health regulations in salons and barbershops are weak to nonexistent, Dr. Johnson told me. He said that each state’s board of cosmetology determines the rules—not each state’s health department, surprisingly. And when it comes to regulations for disinfecting tools, there is wide variation. Some states, such as Texas, require sterilization of all equipment, while others lack specific regulations for disinfection. But even when a state’s rules are strict, there is often little to no enforcement or understanding by the salon employees performing the service, said Dr. Johnson—so the protection of customers is likely to vary widely from salon to salon.

So how likely are you to get infected with hepatitis at a salon or barbershop? “The true magnitude of risk in the US has yet to be defined,” said Dr. Johnson. “It hasn’t been thoroughly studied.”


The implements that are used repeatedly on many customers can—at any time—come into contact with a customer’s blood. This could be from a minor nip during a manicure or shave or possibly from a customer’s previous sore, scratch or insect bite. If this customer has hepatitis, the residue from even a tiny bit of blood will contaminate equipment. Without proper disinfection, hepatitis C may remain in an active state on a surface for two weeks or longer, and hepatitis B may remain on a dry surface for seven days. And then if that infected tool is used on another person and nicks him/her, too (or if the instrument merely touches an open sore), the virus may travel into his or her body.

Getting hepatitis B or C is particularly scary, because during its years undercover in your body, the virus damages the liver. Then one day your first symptom may suddenly be a severe health issue, such as liver failure.


The first thing you should do when you go back to your salon or barbershop is ask the manager, “How do you disinfect your tools?” Dr. Johnson said to look for a two-step procedure. First, they should clean off the implements with a brush or in soap and warm water or through ultrasound. The second step is to place the implements in a disinfecting solution for several minutes. (In many salons, this is the familiar blue liquid.) Caution: Those seemingly high-tech UV light cabinets that are found in many salons now do not necessarily kill all germs—particularly bloodborne pathogens, like the hepatitis B and C viruses.

If you ask your salon about its disinfection procedures and are satisfied with its answers—and personally, I’d ask them to show me, not just tell me, what they do—then OK. On the other hand, if you still don’t like what you see, shop around for a different salon—with hygiene procedures being the first thing on your check list. Another strategy: Buy your own implements and bring them with you to the salon. Many salons have “file bags” or drawers for regular customers to store implements that are used only on them. This may reduce your risk but won’t eliminate it, since there is still a chance that inappropriate disinfecting procedures might cross-contaminate your implements with another customer’s. So your safest bet is to bring your own tools back and forth with you and disinfect them yourself—or ask your salon if they have any disposable tools that they can use on you.

If you do get nicked with a tool at a salon, you should ask for first aid—or at least thoroughly wash the wound with soap—to kill as many germs as possible and ask your doctor immediately whether or not you should be checked for the hepatitis virus, said Dr. Johnson.

Dr. Johnson hopes that this analysis will trigger more research on the topic in the US—and also encourage state cosmetology boards to create and enforce stricter rules nationwide. Most importantly, he said, “I am hopeful that this analysis will make both health-care providers as well as the people who use these services aware of a significant potential risk for preventable infection.” But in the meantime, instead of reading a magazine during your next salon visit, keep an eye on that disinfectant solution—and make sure that it isn’t there just for show.