Could that day of beauty bring on breathing problems, scarring, even skin cancer? Health investigates the new risks at salons and day spas.

Credit: Jenny Van Sommers

Jenny Van Sommers

When Alexandra Spunt went for a keratin hair treatment at a Los Angeles salon two years ago, she hoped to walk out with two months' worth of silky-straight locks. What she didnt expect: two hours of burning eyes and a sore throat. "The stylist offered me goggles because my eyes stung and I couldnt stop coughing," says Spunt, 32. She was shocked to learn that the treatment likely contained formaldehyde—deemed a possible human carcinogen by the Environmental Protection Agency (EPA).

Youve heard that pedicure tubs are teeming with fungus. And you probably know that your waxer shouldnt double-dip. But new dangers have been popping up at salons, and its hard for clients, regulators, and even salon owners to keep up. The U.S. Food and Drug Administration (FDA) has a limited ability to regulate cosmetic ingredients, says Claudia Polsky, a deputy attorney general in Californias Environment Law section. For instance, "the FDA cannot require ingredient labeling on products intended for salon use only," she says. And theres no federal body overseeing the safety of salons, or how well-trained employees are. That means its up to you to get informed. Heres what you need to know to stay safe.

Great hair can be dangerous
Walk into a salon offering a keratin treatment, and you may see stylists in masks with fans pointed their way. And with good reason: Formaldehyde has been IDd as the key active ingredient in many hair-straightening treatments currently offered in salons. Recently, Oregons Occupational Health and Safety Administration found the chemical in samples of nine different products—one of which was actually labeled "formaldehyde-free."

Some epidemiological studies have linked exposure to formaldehyde over several months with certain forms of cancer, such as leukemia. In the short term, it can cause scalp rashes when it comes into contact with the head; when inhaled (whether youre receiving the treatment or sitting next to someone who is), it can lead to burning eyes, nose, and throat, and even asthma attacks if youre prone to them, says Julia Quint, PhD, a retired toxicologist from the California Department of Public Health. While it may be possible to get a safe keratin treatment if the salon is properly ventilated, "were advising that consumers steer clear altogether," says environmental scientist Alexandra Gorman Scranton, who directs science and research for Womens Voices for the Earth, a nonprofit organization that works to eliminate toxic chemicals that have an impact on womens health. "Formaldehyde sensitivity can vary from person to person, but you wont know you have a problem with it until you get sick."

[ pagebreak ]Some side sffects can be as tough as nails
Manicures and pedicures are perhaps the most common salon treatments, but theyre not necessarily the safest. A University of Texas study


Ilan Rubin

published in the Archives of Dermatology in 2009 reported on two women whod developed skin cancers on the backs of their hands. Both frequently used nail dryers that emit UV light.

Its unclear how much the dryers might increase your cancer risk, since lesions take years to develop. What we do know is that theyve become a fixture in salons everywhere. So until more research is conducted, many dermatologists advise that you slather on sunscreen before your nail tech applies polish, or stick to fan-based dryers, especially if you get your nails done weekly or monthly. "I will never use a UV light again," says Carolyn Jacob, MD, a spokeswoman for the American Academy of Dermatology and dermatologist in private practice in Chicago. "Yes, this report was only on two patients. But the UV lights drying your nails are primarily made from UVA light, which means there is potential for cell damage, wrinkling, and skin cancer. Go with the fan dryers instead."

Peels arent always so appealing
Theres no denying that they work: Chemical peels can brighten and lighten skin to dramatic effect, and help reduce the appearance of fine lines, wrinkles, and age spots. But some of these formulas are so powerful that they can cause burns and even scarring if handled incorrectly—and since theyre being used more frequently these days, and in more casual settings (like spas rather than a dermatologists office), the potential for danger is multiplied. Nia Terezakis, MD, a clinical professor of dermatology at Tulane University Medical Center and dermatologist in private practice in New Orleans, has seen patients come in with white doughnut shapes around their mouths after getting peels from inexperienced salon technicians who left the solution on for too long, permanently damaging the pigment there. "Theres nothing in the world that will put the color back in your skin after that," Dr. Terezakis says.

So if youre at the salon or spa, stick to "light" peels (such as glycolic peels), which have an alpha-hydroxy acid content under 10 percent and pH level above 3.5, per FDA rules. "Medium or deep peels should only be performed by a dermatologist with experience in giving them," Dr. Terezakis says. But know that even a light peel can cause a bad reaction if it isnt done properly. "Glycolic acid peels have to be neutralized after several minutes with a neutralizing solution or water," Dr. Jacob says. "If theyre left on too long, they can burn the skin, leaving blisters, scabs, and sometimes permanent redness." And even beta-hydroxy peels, which self-neutralize—eliminating the risk of keeping them on too long—can burn you if the acidic content is higher than it should be, she adds.

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Plamen Petkov

Consider the price of beauty
While the experts we spoke with agreed that its worth minimizing your exposure to salon hazards, nobody recommended going cold turkey on every spa service you love. But to stay safe, you must do your homework first. Before you try any new treatment—even if its just new to you—"look for any clinical studies on the active ingredients," Dr. Jacob says. Not comfortable combing through scientific research? Skin Deep ( has compiled thousands of reports on ingredient safety, and the FDA ( issues readable consumer warnings on ingredients. Ask your doctor if shes heard any reports about the dangers of a device or product, or has any specific concerns about its safety or its effects on you. When in doubt, it cant hurt to wait it out until more has been learned about the service in question. "Dont be a guinea pig!" Dr. Jacob says.

And if you have made the educated decision to go in for a treatment, investigate the place youre getting it just as carefully. "Find out if you know anyone whos been to the salon youre planning to visit" and can report on safety precautions it takes, Dr. Terezakis says. "Check with the Better Business Bureau to see if there have been any complaints. If youre going to a place with a good reputation, they are going to want to conduct business in a way thats safe." For facial treatments, "trust your dermatologist over anyone else," Dr. Jacob says. Yes, you may have to pay a few bucks more—but youll be glad to have someone on hand with years of medical training and experience if something does go wrong.

How safe is a medi-spa?
"Medi-spas," which promise the pampering of a spa with the expertise of a doctors office, have grown in number by more than 50 percent since 2006, according to SpaFinder, which reports on the global spa industry. In theory, a medi-spa offers salon fare, like facials and massages, as well as cosmetic medical procedures like superstrength peels and laser hair removal from estheticians working under an MDs supervision. But the regulations on medi-spas vary from state to state—and arent always enforced. "Before you go, make sure a doctor specializing in dermatology or cosmetic surgery will be on hand," says Soram Khalsa, MD, a doctor of integrative medicine on staff at Cedars-Sinai Hospital in Los Angeles. Here, services which dont, and do, require a physician.

See a licensed esthetician (at a medi-spa, regular spa, or salon) for: Facials, massages, microdermabrasion, mud wraps, and "light" peels, including glycolic acid and enzyme peels (which have an alpha-hydroxy acid content under 10 percent and a pH level above 3.5).
See a physician for: Botox, collagen wrinkle-fillers and other injectables, laser hair removal, and "medium" or "deep" peels.