Fragrantly Beautiful

Beware beauty's risky business

Tanning, lasering and pedicures may seem harmless indulgences.

Ill-trained operators and lax regulation can make them hazardous.

By Melissa DribbenInquirer Staff Writer

Had a pedicure? Pan-fried yourself in a tanning bed? Been zapped by lasers to remove hair from your nether lands?

Then you, in all likelihood, have put yourself in harm's way.

Before going under the blade for breast implants or a face lift, patients generally do research to make sure their surgeon is properly qualified and knows what to do if problems arise.

But people are more cavalier about treatments that seem less invasive. So they put themselves in the hands of strangers with iffy training who lance toes with unsterile tools, wield dangerously powerful rays of light, and sandblast tender skin.

Fortunately, the vanity gods are merciful. Most of the time, nothing bad happens.

But as the number of nail salons, indoor tanning users, and cosmetic laser spas proliferate, casualties are mounting. These beauty services have led to bacterial and fungal infections, allergic reactions, burns, scars, damaged eyesight, and cancer.

The American Society for Dermatologic Surgery reports that in a survey, nearly half of its 2,400 members said they were seeing an increase in injuries caused by non-physicians doing high-tech beauty treatments - some who have had no more than one day of training.

While there are legions of qualified doctors, electrologists, nurse practitioners and cosmeticians gorgeousify-ing skin, hair and nails - there are countless others who are, for lack of a more delicate word, hacks.

For the consumer, the trick is knowing how to identify the trustworthy from the not. And it can be quite a trick.

Regulations, professional qualifications, standards and oversight vary from state to state. In New Jersey, for example, only medical doctors may perform laser treatments, while Pennsylvania law states only that a doctor must be on-site to supervise.

Even when stringent rules are in place, however, few states keep up with inspections and enforcement. And many people who have been hurt are reluctant to take formal action.

"People are embarrassed," says Terry Bowling, a 41-year-old office worker from Pittsburgh who was badly burned by an incompetent laser technician three years ago. "When people are having a mustache removed or getting their armpits done... they don't want to come forward, so they keep their injuries to themselves."

What makes it worse is that credentials can be misleading. Some technicians without medical degrees may be very well trained and experienced, while doctors in non-skin-related specialties who have taken up lasers for profit are winging it.

"Everywhere you look, it's laser this, laser that," says Eric Bernstein, a laser surgeon with offices in Pennsylvania and New Jersey. "More and more, they're getting into the hands of inexperienced people."

So the onus remains on the consumer - to check credentials, get recommendations from others who have used the service, and weigh the potential benefits from any cosmetic treatment against the risks.

Otherwise, things could get ugly.

Nails
No matter how carefully done, a pedicure exposes you to risk because it messes with the skin and cuticle around nails, which serve as a kind of protective seal.

"Cuticles are there for a reason. They're not meant to be touched," says Tracey Vlahovic, a podiatrist on the faculty of Temple University's School of Podiatric Medicine. "By pushing back the cuticle, you compromise the integrity of the tissue."

You may believe that high-priced nail spas with cushy chairs, sultry orchids and complimentary chardonnay are much more sanitary than a neighborhood nail salon where a mani-pedi costs $20 and the staff watches Korean soap operas.

Not necessarily.

Some low-budget salons are extremely conscientious. And conversely, $60 worth of foot pampering doesn't guarantee you'll be fungus-free.

At one elegant day spa in New Jersey, an overzealous nail technician nearly cost Christine Finken her toe.

Finken, a conference organizer from Gloucester Township, began getting pedicures three years ago after she was diagnosed with breast cancer. "When I was getting chemotherapy and had no hair, I would go to treat myself," says Finken, 54.

But in April, a technician cut her while trimming the cuticles on the big toe of her right foot. That night, her toe ached. A week later it was swollen and infected.

The pain, Finken says, was punishing. "I can understand why, in the Middle Ages, they tortured people by hurting their nails," she says. "I would have told you anything!"

Eventually, she ended up seeing Vlahovic, who cut away alarming chunks of her toe and nail, put her on antibiotics and gave her a lecture, which at this point, Finken hardly needed.

"I'm very anti-pedicure," says Vlahovic. Of the 30 or so new patients she treats at her weekly clinic, half a dozen have fungus. Several times a month, she says, a woman will come in with a yeast or bacterial infection. All because of pedicures.

It took several weeks of antibiotics for Finken's toe to begin to return to normal.

"Now I warn my colleagues not to get pedicures," she says. "But no one ever thinks it can happen to them."

Laser
The concept couldn't be more seductive.

Instead of turning to Medieval Depilatory Torture devices such as sharp blades, noxious ointments, or hot wax and muslin, you go for a little light treatment. Someone points a wand at your unwanted hair, and poof! Gone. Painlessly. Almost forever.

Or so you would like to believe.

As more people seek cosmetic laser treatments to remove hair, spider veins, tattoos and wrinkles, more are being harmed.

"We're seeing a tremendous increase," says Roy Geronomous, past president of the American Society of Dermatologic Surgery.

"It used to be we'd see a few a month. Now we're seeing a few a week. It's coming from homes, spas, salons, people working out of makeshift offices all pretending to be medically qualified."
Regardless of state regulations, abuses occur. Laser Me Beautiful had been a thriving business for several years in Collingswood. Last year, The Inquirer reported that the owner, podiatrist Steven Nielson, was performing laser treatments and had harmed one of his customers when removing an arm tattoo.

In May, the business closed and Nielson signed an interim order voluntarily surrendering his license. The state Consumer Affairs Division is investigating numerous charges that Nielson was illegally performing not only laser treatments, but giving Botox injections and doing liposuction in his home-based office.

Reached by phone last month, Nielson referred questions to his attorney, Alma Saravia, who said, "We are evaluating all the options."

Plastic surgeons and dermatologists command premium prices for their expertise in cosmetic lasering, generally charging several hundred dollars for each treatment. And because multiple treatments usually are required, the bills can be stratospheric.

Terry Bowling was thinking more about budget than safety three years ago when she went to the Steliotes Dental Spa near Pittsburgh, which was offering a special discount on laser hair removal.

She was greeted by a woman in a long, white coat. "I thought she was the doctor." Bowling asked, she says, if her deep tan was a problem and was told no.

Wrong. The light intensity needs to be adjusted for different toned skin. As soon as the treatment began, Bowling's skin began to blister. The pain was hideous.

Two days later, she went to see plastic surgeon Karen Roche.

"There will always be some sleazebag to do something they're not qualified to do," says Roche. "But why isn't our state doing anything to protect the public?"

Bowling filed a complaint with the state of Pennsylvania and sued the spa. A settlement was reached. Most of the money, Bowling says, went to pay her medical bills.

"This is a serious, troubling problem that we face," says Basil Merendes, commissioner of the Pennsylvania Bureau of Professional and Occupational Affairs. He describes the agency as "complaint driven" and says that unless people report problems, the state can't address them.

Doctors counted 777 burns on Bowling's body. Although the marks have faded, her legs have a permanent checkerboard pattern that becomes more visible when she goes out in the sun.
"I haven't been to the beach. ... I haven't worn shorts or a skirt. I don't show my legs anymore. ... I was scared to death that I'd be scarred for life," she says. "And I am."

Jennifer DeHuff, 24, has been going to tanning salons since she was 16 - despite both of her parents' surviving cancer.

"They said I was foolish," she said of her unlimited tanning membership at Second Sun on Second Street. "But it's a fun thing to do. All the people I hung out with did it." So far, she's had no problems, but most dermatologists say she's taking unnecessary chances with her health.
The dangers of indoor tanning continue to be bitterly debated by the medical community and the tanning salon industry. "The evidence that ultraviolet radiation causes skin cancer is overwhelming and convincing," began a recent paper by the Skin Cancer Foundation. "Despite this information, the use of indoor tanning devices which emit ultraviolet light ... has never been more popular."

To the $2 billion-plus indoor tanning industry and the 30 million people who put themselves into UV cocoons every year, the benefits of getting Vitamin D, an endorphin rush, and a prettier color on cheeks at both ends outweigh any fear of cancer down the road.

"The message is not getting across to minors because minors and people in their 20s feel that they're indestructible," says Leonard Dzubow, former head of Dermatological and Mohs Surgery at the Hospital of the University of Pennsylvania and a member of the Skin Cancer Foundation. "When you're that young, it's hard to project what the consequences will be."

In May, for the third time, bills were introduced into the Pennsylvania legislature to regulate and license tanning salons and keep minors from using their services without an adult present. Previous efforts have been defeated.

This time, the proposed laws would require salons to register with the state. They would also amend the criminal code so that local police could monitor noncompliance, said Bruce Brod, the legislative coordinator of the Pennsylvania Academy of Dermatology.

Although 30 states have licensing requirements for tanning salons, Pennsylvania does not (a similar bill in New Jersey needs only the governor's signature). "Anyone can have a tanning salon and anyone can tan as much as they want," Brod said. "There are no sanitation requirements, no requirements for protective eyewear, no requirements for age."

Those in favor of the laws feel they are necessary because of the rising incidence of melanoma, the most common cancer in young women, with rates jumping more than 60 percent since the 1970s.

Although dermatologists are nearly unanimous in their belief that any kind of tanning increases the risk of skin cancer, they do not agree on how to address the problem.

"Millions of people are tanning," says Steve Feldman, a professor of dermatology and public health sciences at Wake Forest School of Medicine. "The dermatologists are seeing the ones who get skin cancer. But a lot of people do it and don't have anything major happen to them."

Feldman says that in the absence of hard evidence, doctors may be overreacting. In tanning, as in nonphysician laser treatment, the majority of people have no problem, he says.

"I'm not saying tanning isn't bad for you. It is. Do I think people should go to tanning beds? No.

Do I think government should ban them? No."

Some salons voluntarily adopt policies to protect their customers' health.

"I want people to be educated," says Joe White, who has owned salons for more than 20 years. "I don't say it's safe, but you can reduce your risks while enjoying the benefits."

His salons have always denied access to minors without an adult's permission, he says, carefully monitored clients' exposure, and required goggles at all times.

White has skin cancer on his leg. He doesn't believe his lifelong tanning habit was a factor. And he still tans - regularly.

Contact staff writer Melissa Dribben at 215-854-2590 or mdribben@phillynews.com

Tips for Safer Beautification

Laser Procedures
Make sure a physician is on site and available to answer questions.

Check credentials and ask questions. Ask about background and training. What if something goes wrong? Who will perform the procedure? Can I see your before- and-after photographs? Are there any side effects?

Find out if the laser system is appropriate for your skin type, hair color, complexion and body area.

Request a test patch. It's easier to deal with complications on a small area than massive anatomical territory.

Be wary if the cost is dramatically lower than the average. Don't rely on price as the primary factor in choosing where to go.

Don't be afraid to walk away if it doesn't feel right.

Nails
Bring your own tools, including emery boards.

Ask about sanitary standards. How do they clean their equipment and how often? How often do they change the filters in their foot massagers?

Don't have your cuticles cut.

Don't shave your legs before putting your feet into a pedicure whirlpool. Tiny nicks in the skin can expose you to infection.

Make sure the technician has a cosmetology license that is current and visibly displayed.
If your fingers or toes become red or sore after a procedure, see a doctor. Don't wait until it gets worse.

Tanning Salons
Most dermatologists say don't use them at all, especially if you're under 18. But if you must:
Limit your exposure, and make sure a timer is set.

Use goggles to protect your eyes. Make sure the goggles fit snugly and that they are sterilized after each use.

Consider your medical history. Some conditions, such as lupus, diabetes or cold sores, can be aggravated through exposure to ultraviolet radiation. Your skin may be more sensitive to artificial light if you use certain medications - for example, antihistamines, tranquilizers or birth-control pills.

SOURCES: American Society for Dermatologic Surgery (ASDS); U.S. Food and Drug Administration

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posted by Cheryl Levesque @ 3:21 PM