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Oral Abstracts (Session 4 of 5)
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(Presentation 35.3) Incidence of mycobacterium infections related to nail salons Kara Couch, NP, CWS; Stacy Loeb, MD; Jaime Schwartz, MD Two patients recently presented to the authors’ clinic with nonhealing lower-extremity ulcers after visits to a nail salon. Both patients reported either shaving or waxing their legs prior to the pedicure. The ulcerations were raised and indurated with violaceous borders and purulent exudate. However, both patients denied significant pain related to the ulcerations. Aerobic and anaerobic cultures were negative. Punch biopsies were performed and confirmed the presence of mycobacterium. Acid-fast cultures were sent, and the patients were treated with oral antibiotics. Both patients then underwent surgical debridement of the ulcerations in the operating room. There is relatively little data in the literature regarding mycobacterial infections after footbaths in nail salons. In 2002, Winthrop et al performed a case-control study to examine the risk factors associated with mycobacterium outbreaks in nail salons. Winthrop found that shaving prior to receiving the pedicure was a risk factor in both groups. In this series, all affected patients were treated successfully with oral antibiotics without the need for either intravenous antibiotics or surgery. Potentially pathogenic mycobacteria may be present in many nail salons. Individuals undergoing pedicures or footbaths at salons should be aware that there is a risk of mycobacterial skin infection and should be advised to avoid shaving/waxing prior to the salon visit. For patients who present with mycobacterial skin infections from salon exposures, the prognosis is excellent using oral antibiotics alone. The length of therapy ranges from 3–9 months currently. However, a clinical guideline for treatment has not yet been established, and the role of surgical debridement to promote wound healing has not been fully explored. As these infections are historically underreported, the incidence of these infections represents a potential public health crisis. References Winthrop KL. N Engl J Med. 2002;346(18):1366–1371. Sniezek PJ. Arch Dermatol. 2003;139(5):629–634. Winthrop KL .Clin Infect Dis. 2004;38(1):38–44. |
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