Mysterious Leg Lesions? Ask About Pedicures
Nail salon footbaths are implicated in furunculosis caused by atypical mycobacteria.
Despite our near-constant exposure to rapidly growing nontuberculous mycobacteria (RGM), which are common colonizers of water supply systems, these organisms seldom make us sick. Or perhaps they do so more often than we recognize.
Spurred by two local cases of RGM leg furunculosis apparently acquired in nail salons, North Carolina researchers combed public health records of two counties for additional cases during a 4-year period; they found 40 confirmed or probable cases in women and teenage girls, whose single or multiple leg lesions were caused most often by organisms in the Mycobacterium chelonae/abscessus group. The researchers visited some of the implicated nail salons, where they noted debris or visible biofilms in the footbaths more commonly than they did when they visited control salons without associated cases. However, footbath water samples yielded organisms in 15 of 24 salons, with no differences between case and control salons
Comment: Women commonly shave their legs before pedicures; resulting nicks can provide a portal of entry for whatever organisms splash up from the footbath. Clinicians should keep this scenario in mind when patients with leg furunculosis fail to respond to standard empirical antistaphylococcal treatment.
Abigail Zuger, MD
Published in Journal Watch General Medicine November 3, 2011