03/15/2018    Bryan C. Markinson, DPM

RE: How do you grind mycotic nails? (Estelle Albright, DPM)

I have done some study on aerosolization of nail
particles from grinding of nails and presented it
at the 2012 Meeting of the Council for Nail
Disorders. Consider the following from a Great
Britain study of 101 podiatrists
Workplace Exposure to Bioaerosols in Podiatry
Clinics
Coggins, et al., Ann. Occup. Hyg., pp1-8 on
behalf of British Occupational Hygienic Society:

32% of podiatrists reported respiratory condition
73.3% used gloves
4.6% used respiratory mask
16.8% used protective apron
15.8% used eye protection
15.8% used room ventilation system
47.5% used nail drills with exhaust system
11% used nail drills with water spray dust
suppression
All control measures were not used at all times

1) Respirable aerosols (80%) of the dust
contained yeasts and
molds (65%) and fungi (87%)
2) 3 grams nail dust generated per day
3) Nail dust included bacteria (staph), fungi,
yeasts and molds,
endotoxin.
4) No significant difference in the
concentrations depending on
time of day collected
5) No correlation between number of patients
treated, number
of nails treated, time of drill use and total
fungal
concentrations.

And continuing from other sources:

1) Studies in UK reveal 4x the prevalence of
asthma
amongst podiatrists (Millar 2000)
2) Podiatrists have high prevalence of
precipitating
antibodies to T. Rubrum (Abramson)
3) Shape of toenail dust allow it to be airborne
for
long periods. Read this one twice if you think
masks and extractors are fullproof
4) Osteopathic literature reports x-ray evidence
of
lung nodules in podiatrists

And anecdotally I have heard of incidences of
fatal deep fungal lung infections that have
become activated
due to medical treatment of other conditions,
such as chemotherapy for lymphoma that cures the
lymphoma but immunosupresses enough to let the
fungal infection (previously dormant) kill the
patient.

I have not grinded a nail in over 25 years. I
believe it is an affirmed workplace hazard. While
masks and dust extractors greatly reduce the
burden, particles that escape the suction can
stay afloat for over 30 minutes. Over a lifetime
of practice day in and day out, cumulative
exposure is great and not grinding nails is much
safer.

Also, exposure by itself resulting in deep fungal
infections is not the only hazard. Immune
response to nail dust may result in respiratory
effects, skin sensitivities, eye inflammation,
etc. (while not being considered as the true
cause.)

I recommend that podiatrists seriously re-
consider the necessity of grinding nails.

Bryan C. Markinson, DPM, NY, NY

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