Barbershops and beauty salons are important venues for people to get their hair and beards done. However, these establishments can also be sources of infections. Barbershops are playing an important role in today's social life. The barber's profession brings the barber into direct contact with customers who may carry pathogens, and contaminated instruments or skin-to-skin contacts might transmit infectious agents.
Maintaining proper hygiene in barbershops and salons is crucial to prevent the transmission of various infections. Barbers and hairdressers use non-sterile sharp objects that are often reused, posing a risk of unintentionally damaging the skin through abrasions or cuts. Even a simple nick caused by a clipper, razor blade, or shaving knife can allow microorganisms to cross the compromised epithelial barrier of the skin, enter deeper tissue sites, and lead to an infection.
Several types of infections can be contracted from improperly sanitized tools or unsanitary conditions in barbershops and salons. These include bacterial, fungal, and viral infections, as well as infestations.
Folliculitis is the inflammation of the hair follicle, mostly caused by bacterial infection. It looks like tiny white pustules (filled with pus). It's usually caused by staph bacteria, which can be transmitted through improperly sanitized combs, scissors, or razors. Mild folliculitis will likely heal without scarring in a few days with basic self-care. More-serious or repeat infections may need prescription medicine. The two main types of folliculitis are superficial and deep.
Barber's itch is a form of folliculitis that develops in the beard area or scalp after infection from an unsterilized instrument. Bacteria invade the hair follicles, leading to red bumps and pus pimples that may be itchy. In mild cases, barber's itch can be effectively treated with a topical antibiotic; in more severe cases, it may require an oral antibiotic treatment.
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Tinea capitis is a fungal infection of the scalp that can take the shape of ringworm (red patch with scale around the perimeter) or it can look like a red flakey itchy patch. At the barbershop, it can spread via poorly sanitized combs or towels, and in severe cases, it can lead to permanent scarring and hair loss. Tinea capitis often needs to be treated with an oral antifungal medication because the fungus penetrates deep into the hair follicles, so it may be difficult to treat with topicals alone.
Impetigo is a bacterial infection that is caused mainly by staph or strep bacteria. While it's more common among younger children, you can get it at pretty much any age, and it's most commonly spread via skin-to-skin contact, clothing, or towels (something to keep in mind if you're getting your hair washed at the barbershop). Patients develop yellow or honey-colored crusts (on their skin). It is important to treat because it is highly contagious. Fortunately, it's usually easily treatable with a topical antibiotic ointment.
It's possible to acquire lice from a comb or other shared contact with someone who has lice. It's common in the scalp, but it also can occur in the beard. The most common symptom is significant itching in the affected area. In addition to the adult louse, it is common to find nits, which are eggs, in the hair as well. There are a variety of ways to treat lice, most common of which is to apply a topical anti-lice medication to the hair to kill the lice. You also may need to have individual nits removed from the hair as well.
Tetanus is a bacterial infection that usually occurs after breaks in the skin. It can come from bacteria in soil but can also be acquired from unclean rusted instruments.
There have been incidents of transmitting herpes or bacterial infections from waxing. Make sure that the waxer is not double dipping any applicator sticks while doing it or using roll on wax that has been used on someone else.
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Barbershops have been considered as sources for transmission of distinct infectious agents including blood-borne pathogens such as HIV or hepatitis B virus (HBV) that could hypothetically be acquired via a compromised skin barrier following cuts due to the barbering practice, for instance. Viruses such as HIV, HBV, and hepatitis C virus (HCV) can be transmitted via blood, making the barbering practice a possible risk factor for infection, especially in high prevalence regions. In addition to the infection routes that come to mind first, there are many other possible sources of infection via certain equipment including combs, hairbrushes, and water spray bottles. But also surfaces of working areas in barbershops could be a source of distinct microorganisms such as bacteria or fungi being transmitted to the customer (but also the barber) via smear infections.
Several studies have investigated the risk of infections acquired in barbershops.
To minimize the risk of contracting an infection during a haircut, consider the following precautions:
Occupational hand dermatitis in hairdressers was first described as early as 1898 and still today up to 70% of hairdressers suffer some form of skin damage during their career. Apprentices and juniors spend a lot of time at the basin, so are susceptible to occupationally related skin disease, especially if there is a history of eczema or asthma. Individuals with skin sensitivity and pre-existing atopic dermatitis at the pre-training/employment stage should consider whether hairdressing is a sensible career option.
The outermost layer of the skin (the horny cell layer of the epidermis) acts as a barrier to prevent infection and to prevent potential allergens from penetrating the skin. Its pH is slightly acidic which can help to neutralise the degreasing agents that are in soaps, which are alkaline. If the moisture content is too high (overhydrated skin) or too low (dry skin), the skin barrier may also be less effective.
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Irritant contact dermatitis occurs when physical or chemical damage to the barrier layer of the skin exceeds the skinâs ability to repair the damage. Where there is repeated exposure, previous damage may render the skin more susceptible to damage from the next exposure. Because contact irritant dermatitis is dose-dependent, it tends to be restricted to the site of primary contact, which is usually the hands. A reduction in the cumulative exposure to irritants lessens the risk of dermatitis.
Allergic contact dermatitis is an immunological response to an allergen. Only people who are allergic to a specific agent (the allergen) will show symptoms. The appearance can be exactly the same as irritant contact dermatitis. Dermatitis may occur not only at the site of primary contact but also at secondary sites. Approximately 11% of all adult women are nickel sensitive.
The shafts of a clientâs hair can be as sharp as a needle and may penetrate the skin on the hands or under the fingernails, and occasionally other exposed sites. Interdigital pilonidal sinuses ('pilus' meaning hair and 'nidal' meaning nest) are less common. They are typically found in the clefts between the fingers of hairdressers and barbers, where the skin is thin and moist.
Scissor and razor wounds often affect the web between the index and middle fingers of the non-dominant hand (the comb hand). The risk can be reduced by holding the hair with the index and second fingers of the hand pressed together, one on top of the other.
Workplace risk assessments identify âhazardsâ (anything that has the potential to cause harm) and âriskâ (the likelihood of an event occurring). The aim should be to reduce these, as ill-health can adversely affect the quality of life, the ability to work in a chosen industry, insurance costs and litigation claims. Health surveillance should be carried out when a workplace hazard is minimised rather than eliminated
Staff should be encouraged to report any signs of skin problems and all reasonable steps should be taken to resolve the problem and prevent recurrences. Follow the manufacturerâs recommendations for the personal protective equipment (PPE) needed for hands and eyes during mixing, application and washing out of hairdressing chemicals. Gloves can be inconvenient to use due to the lack of sensation/dexterity required to cut hair, apply foils and so forth. They are not popular with clients as they snag and pull on the hair.
It is inevitable that hairdressing clients will be directly exposed to the same irritants and allergens as the hairdresser or barber. If the client has had skin problems or has reacted to hair products in the past, it is advisable to patch test the chemical prior to use. Most Material Safety Data Sheets for products used on the hair or skin recommend that a patch test be performed 48 hours in advance of application. If any sign of inflammation is present after 24 to 48 hours, the treatment should not proceed. The client should be advised to seek the advice of their medical practitioner.
Cosmetic products and tools are a favorable environment for the multiplication of microbes, which contribute to and cause the spread of viral, fungal, and bacterial infections. Numerous factors contribute to this problem. First, the ingredients of most beauty products, such as organic and inorganic compounds, moisturizers, basic minerals, and growth factors, provide an environment conducive to the multiplication of microbes.
Several literature reports document the existence of a variety of microorganisms isolated from beauty tools used in salons such as nail care tools, sharpeners, sponges, combs, makeup brushes, hair stretchers, rollers, and hairpins. Researchers collected samples from clippers, clipper steps, combs, and brushes from 40 different beauty salons in Taraba State, Nigeria, in 2020. All samples contained pathogenic bacteria, including species of Staphylococcus, Bacillus, and Streptococcus. In addition to bacteria, pathogenic fungi in the following genera were also found: Aspergillus, Trichophyton, Malassezia, Mucor, and Microsporum. The highest microbial content in this study was measured on clippers, as these tools received the lowest level of sterilization practice among all of the tested tools.
In 2019, at the University of Al-Qadisiyah, College of Biotechnology in Iraq, six bacterial species were isolated from combs, brushes, rollers, hairpins, scissors, razors, dryers, and laundry tools from beauty salons in the campus. Based on the molecular and biochemical characteristics of the isolated bacteria, they were identified as S. aureus, which was the most dominant species in all samples, S. epidermidis, Streptococcus spp., Micrococcus spp., Enterococcus spp., and Enterobacter spp.
In the same year at the university, bacteria and fungi were isolated on nutrient agar and potato dextrose agar from combs and brushes used in public beauty salons in three campuses in Nigeria. The bacterial isolates were identified as Staphylococcus aureus, and species of Bacillus, Micrococcus, Serratia, Citrobacter, Proteus, and Shigella, and fungi such as Aspergillus flavus, Penicillium spp., Trichophyton spp., and Microsporum spp.
It can be concluded from this study that beauty salons can be considered a hazard when the hygiene standard is far from the expected, especially when it is combined with high moisture and dust content. Another study investigated the microbial content in a beauty blender when it was not cleaned at all or when it was dropped on the floor and reused without cleaning. The results revealed the presence of both S. aureus and E. coli.
In 2018, hair samples were collected from salon tools from ten different salons within the Benin metropolis, Edo State, Nigeria. All samples were inoculated on nutrient agar. The bacterial isolates obtained from salon tools included E. coli, Proteus vulgaris, Streptococcus viridian, and Corynebacterium sp.
In Kamyaran city, Iran, in the summer of 2015, bacteria and fungi were isolated from hair dressings used in beauty salons using a variety of selective microbial media. The contaminating microorganisms were identified as Staphylococcus aureus, S. epidermis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and species of Bacillus, Micrococcus, Enterococcus, and Enterobacter, and the fungal species Aspergillus flavus, A. fumigates, Alternaria spp., Cladosporium spp., Geotrichum candidum, Rhizopus nigricans, R. stolonifer, and Penicillium spp.
In Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria, samples from combs, brushes, and hairdryers were collected from two hairdressing salons inside the campus to investigate the role of salons in spreading diseases. The samples were inoculated on nutrient agar, MacConkey agar, and mannitol agar and showed the presence of bacterial species in the genera Streptococcus and Micrococcus, as well as Staphylococcus aureus, and a few species of fungi in the genera Aspergillus, Mucor, and Rhizopus.
The same theory, the role of salons in spreading diseases, was tested by Enemuor and colleague at Kogi State University, Anyigba. They collected samples from combs, brushes, hair stretchers, rollers, and hairpins from six hairdressing salons. The samples were then cultured on a variety of selective and general media, revealing the presence of five bacterial and six possible pathogenic fungal species. The dominant bacterial species across all six salons was S. aureus, followed by S. epidermidis.
In another interesting study by Baqer et al (2014), sponges and mascara were tested to evaluate microbial contamination. The results revealed the existence of normal flora, such as S. epidermidis, and the dominance of S. aureus and other Enterobacteriaceae family members including E. coli, Shigella, and P. aeruginosa. Each of these species is known for their ability to cause nosocomial infections in health centers and the community.
In 2015, fungal species were detected in hair brush samples from beauty salons in Jatinangor, Indonesia, using two different culture media, Sabouraud agar with chloramphenicol and Sabouraud agar with chloramphenicol and cycloheximide. The majority of fungi in this study was saprophytic fungi, including species in the following genera: Aspergillus, Fonsecaea, Penicillium, Cephalosporium, Mucor, Rhodotorula, Gliocaldium, Phialophora, Rhizopus, and the species Mycelia sterilia. The existing fungi were highly affected by the salon practice used in washing brushes. When required care was neglected, examination revealed the presence of a small percentage of dermatophyte species. When brushes were cleaned once a week with a common detergent, Candida spp. were detected, and when the brushes were never washed, Trichophyton spp. and Malassezia spp.
In 2012, Naz isolated and detected numerous human pathogens from 100 samples of beauty salon tools including blusher brushes, face sponges, and wax. The samples were inoculated on mannitol salt agar, cetrimide agar for bacterial detection, and potato dextrose agar for fungal tests. Most of the wax samples, all brushes, and beauty sponges were contaminated with S. aureus.
Most of the research on assessing the role of salon tools in the spread of diseases found that these tools either were never stylized or were not cleaned between customers.
In addition to all of the studies investigating pathogenic microorganisms contaminating cosmetic tools, the literature is replete with reports on the isolation of microbes from cosmetic products in beauty salons, including lipstick, mascara, eye shadow, foundation, blusher, eyeliner, facial creams, and hand and body lotions.
In one study in 2018 at the University of Raparin, Iraq, over 120 moistened cotton swab samples were collected from ten different hair and beauty salons to define the presence of microorganisms in lipstick, eyeliner, mascara, and foundation. The study found more bacterial growth than fungal growth. The bacterial species included Staphylococcus spp., Streptococcus spp., and Enterococcus spp. Similar microbes were found in studies conducted in the same year at Benghazi University, Libya. That study analyzed microbial contamination of 25 facial cosmetics including samples of kohl, eyeliners, and lipsticks. Bacterial and fungal contaminants, such as Staphylococcus aureus and Candida albicans, respectively, were found.
More cosmetic products have investigated earlier in ten beauty salons in different regions of Tabriz city, Iran. Scientists collected 52 samples from skin and eye cosmetics, such as cream, mascara, powder, and eyeliner from All samples were inoculated on cetrimide agar, Levine eosin methylene blue agar, Baird Parker agar, and Sabouraud dextrose chloramphenicol agar. All cosmetics were found to be contaminated with bacteria, fungi, and yeast, and the most dominant species were associated with the following genera: Streptococcus, Pseudomonas, Bacillus, Staphylococcus, Acinetobacter, Salmonella, Klebsiella, Citrobacter, Rhodotorul, and Candida, as well as E. coli. Among all of the samples used in this study, the powder had the highest contamination level, which might be due to exposure to air and the frequent use of the same powder pad.
The number of people who use and share a cosmetic product greatly affects the microbial contamination rate. In a study by Skowron et al, samples including cream, lotion, and face and hair masks were divided into three groups. The first group of products were used by one person, the second group was used by a group of people, and the last group of products was expired and utilized by public. The microbial content in personally used products was much lower than that of publicly used products, and the expired products exhibited the highest microbial contamination. The majority of microorganisms detected in this study were considered microflora and few pathogenic organisms were detected, such as P. aeruginosa and C. albicans.
Although many microbes detected in cosmetic products are not necessarily pathogenic, they may still pose a risk when considering the overall microbiome. It has been shown that organisms in the normal flora can threaten human life when they transfer from one person to another, which is common in salons.
It was found that the higher the moisture percentage in the beauty product, the higher the microbial count. A review of several studies clearly showed that more bacterial species, especially Gram-negative bacteria, were isolated from cosmetic products in beauty salons. Some microbes isolated from cosmetic products and tools are considered as significant threats to public health. S. aureus, P. aeruginosa and K. pneumoniae are ubiquitous in the environment, and are related to nosocomial infections, causing severe infections in plants, humans, and other animals. Bacteria related to nosocomial infection microbes are rarely and poorly controlled by antibiotics.
In addition to infections acquired from hospitals, food-borne diseases are another issue caused by microbes found on salon instruments and products. The most common food-borne microorganisms, such as E. coli, Bacillus sp., Salmonella sp., and Yersinia sp. are widely found in salons. Both Bacillus cereus and E. coli can cause food poisoning, as they are agents that secrete toxins into food, triggering gastrointestinal illness. Salmonella spp.
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