Dermatologic Best Practices for Manicures and Nail Care: A Systematic Review

Background Manicure and pedicure procedures are widely viewed as benign cosmetic practices, yet emerging evidence links them to various dermatologic complications, including dermatitis, infection, photodamage and, in rare cases, cutaneous malignancy. Understanding these risks is essential for clinicians counselling patients and for informing public health and regulatory efforts. Objectives To systematically review the dermatologic outcomes associated with exposure to nail cosmetic practices. Methods A comprehensive search of PubMed, Cochrane Library, Web of Science, Scopus and Embase was conducted through October 2025. Data were extracted on study type, exposure characteristics and clinical outcomes. Owing to heterogeneity in study design, exposures and reporting, findings were narratively synthesized. Quality appraisal emphasized study design, sample size, diagnostic confirmation and clarity of exposure assessment. Results Forty‐seven studies met inclusion criteria, spanning individual case reports to large outbreak investigations. Acrylate‐associated allergic contact dermatitis was the most frequently reported complication, with 2‐HEMA (2‐hydroxyethyl methacrylate) and ethylene glycol dimethacrylate identified as predominant sensitizers and additional allergens such as TREGDA (triethylene glycol diacrylate) and isobornyl acrylate increasingly recognized. Infectious outcomes included Mycobacterium fortuitum and Mycobacterium chelonae outbreaks linked to inadequately disinfected whirlpool footbaths, as well as bacterial and Candida infections associated with artificial nail enhancements, prolonged polish wear and traumatic manicure techniques. Reports of photodamage, squamous cell carcinoma (SCC) in situ and melanoma in situ localized to UV‐exposed dorsal hands among individuals with long‐term UV nail lamp use raised concerns about cumulative UVA exposure, although a causal association has not been definitively established. Across studies, evidence quality was low and limited by small sample sizes, inconsistent reporting and predominance of case‐based data. Conclusions Clinicians should counsel patients on allergen exposure, salon hygiene and UV protection, while regulatory efforts should prioritize standardized ingredient labelling and evidence‐based disinfection protocols. Greater clinical awareness and oversight are needed to ensure safety for both clients and nail technicians.