Monkeypox Concerns in the Salon, Spa or Massage Establishment

by Selena Belisle, CE Institute LLC

Contagious disease is something that everyone should consider when working in a close, person-to-person, service occupation. This includes estheticians, nail technicians, cosmetologists, massage therapists and all staff in a spa or salon setting.

Today, we have a new contagious disease threat with monkeypox.  Monkeypox was first detected as a rare viral disease in Africa in 1958; however, transmission of the virus was thought to only occur with infected animals. Unfortunately, we now know that person-to-person transmission is possible, and this progression with increasing prevalence threatens us today.

The WHO (World Health Organization) labelled monkeypox as a Global Health Emergency on July 23, 2022.  In the United States, monkeypox infections are on the rise with a few thousand cases detected in 46 states (at the time of when this article was printed). Health experts state that monkeypox will not become a worldwide pandemic.  Monkeypox is still a very rare disease; however, it is important to learn about new and increasing contagious threats with monkeypox being our newest.

Monkeypox Transmission

The CDC (Centers for Disease Control and Prevention) states person-to-person transmission of monkeypox primarily occurs through direct contact with body fluids, respiratory secretions during prolonged face-to-face contact and touching parts of the body with monkeypox sores.

In 2018, a few individuals were infected when handling an infected individual’s bed sheets.  That means anyone who changes a treatment table or handles linens which are in direct contact with an infected individual could be exposed at your establishment.

Monkeypox can also be transmitted with infected animals, pregnant women passing the virus to their unborn baby and sexual contact; however, we will only focus this article on what seems to be relevant for salon or spa workers. There is a lot more one could learn about monkeypox beyond what we will share here.

Monkeypox Rash: Blister-like Sores

Monkeypox sores might appear as blister, bump, whitehead, acne, milia, an ingrown hair, sebaceous cyst and other benign possibilities. Past monkeypox pictures usually depict an individual covered in blisters. 

With today’s person-to-person transmission, an infected individual may only exhibit a few random sores.  With less sores, infected individuals might dismiss their illness as something other than monkeypox. The CDC states^[1] that monkeypox sores and symptoms could be confused or misdiagnosed as chickenpox, smallpox, syphilis, herpes, chancroid, and varicella zoster which causes shingles.

Monkeypox sores usually progress through the following stages before eventually subsiding: macules, papules, vesicles, pustules, and eventual scabs. Those who have been infected with monkeypox have described their sores as being very painful.

Monkeypox Signs and Symptoms

Monkeypox symptoms can last from 2 to 4 weeks. Infected individuals can experience a different combination of symptoms. Some could have one or two symptoms while others might experience all of these symptoms and more. The CDC reports^[2] monkeypox symptoms include:

• Fever
• Headache
• Muscle aches
• Backache
• Swollen lymph nodes
• Chills
• Exhaustion
• A rash that can look like pimples or blisters

If you have a client exhibiting a new skin sore or rash with any of these symptoms, you should reconsider providing service until the client obtains a medical diagnosis for their illness. 

How Does Monkeypox Affect a Spa or Salon Worker

There are three areas of concern for spa and salon service providers with monkeypox:

1. Prolonged person-to-person contact is reported to transmit the monkeypox virus through respiratory secretions. Coughing and sneezing respiratory droplets is likely the largest airborne risk of all.
2. Most spa and salon services involve touching the client. According to WHO, monkeypox sores are found on face in 95% of cases, and the palms of the hands and soles of the feet in 75% of cases^[3]. These bodily areas are where the greatest amount of spa and salon services are provided, and monkeypox is reported to be transmitted by touching an infected individual’s sore(s).
3. Touching linens or towels that have come into contact with an infected individual has also been reported to transmit the monkeypox virus. That means even if you did not provide the service, if you touch an infected individual’s clothing, towels or linens, you have been exposed.

How Can I Protect Myself from Monkeypox at Work?

• Work on in-tact, whole skin only. If you see a sore on the skin, ask the client about it. Are they aware of their sore?  Did they already receive a diagnosis for it?  What is their medical diagnosis? Some clients will know if they have a sebaceous cyst, eczema or some other skin disruption.  However, if a client is unaware of their sore, it is best to avoid the area and acceptable to request the client to seek proper medical attention or diagnosis prior to providing service(s).

• Always wear gloves when working intra-orally or around mucous membranes given monkeypox is reported to be transmitted through bodily fluids.

• Wearing a facial masking similar to what has been practiced with COVID-19 may help prevent monkeypox transmission through respiratory secretions.  Using a higher level of protection mask such as a N-95 will provide better filtration for contagious virus than a cloth or other lesser disposable masks.

• Wear a facial mask and gloves when cleaning a treatment area or handling dirty sheets and towels. Be sure to keep the mask over your mouth and nose for the best possible protection.

• Open all available windows and doors when working, cleaning or generally occupying any work area. Keep your workspace well ventilated.

• Follow general service contraindications at all times.

General Service Contraindications

• Service should not be provided when a client has a fever.  Fever is a regular sign of infection, and that infection could be a contagious disease.

• New undiagnosed swelling is a local service contraindication. Service should not be provided to an area where swelling is present.

• Undiagnosed flu-like symptoms are a service contraindication.  Flus and colds are also a contagious viral disease.  If your client shows for service with excessive coughing, sneezing, sore throat or other flue like symptoms, service should be denied even when fever is not present. It is not worth risking exposure to contagious disease because this could be passed onto other clients, coworkers, friends and family, in addition to acquiring the disease yourself.

• New undiagnosed pain is also a service contraindication.  An individual may seek a spa or salon service to help them feel better or take their mind off their pain.  But we would never want someone with a blood clot, kidney stone obstruction or other type of serious illness in our treatment space while they should be in the emergency room. Unfortunately, there is a growing aversion to seek medical care; however, utilizing appropriate medical care is still an important process to being and staying well.

What to do if You Think You’ve Been Exposed

Wash your hands and contact your doctor immediately to discuss your potential exposure. Self-isolate until you receive instructions from your doctor. Your doctor will determine any potential treatment and how long you should self-isolate.

Do not allow anyone in the workspace where potential contamination has occurred, until proper precautions are taken to sanitize the area.

• Here is the National Institute for Occupational Safety and Health website with personal protection equipment (PPE) information: https://www.cdc.gov/niosh/ppe/. 
• Here is information from the CDC of how to clean and disinfect a facility every day, and when someone is sick: https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

If you are diagnosed with monkeypox, assist professionals with contact tracing to notify other potentially exposed individuals in your circle.

The Takeaway

To date, we do not have any reported cases of monkeypox transmission from providing spa or salon services. Monkeypox has affected less than a fraction of one percent of the US population. However, according to the information provided by the CDC, monkeypox cases are on the rise, and transmission could be possible in spa or salon services when there is close prolonged contact with an infected individual.

Spa and salon service providers are generally required to complete basic certification training to obtain licensure in their respective fields. Educational certification usually includes training in pathologies and services contraindications.  Following basic service contraindications and learning about new threats at the workplace can help a practitioner avoid contagious disease. You can obtain more information about monkeypox from the CDC’s website:  https://www.cdc.gov/poxvirus/monkeypox/index.html

^[1] https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html#anchor_1653687460218

^[2] https://www.cdc.gov/poxvirus/monkeypox/symptoms.html

^[3] https://www.who.int/news-room/fact-sheets/detail/monkeypox

Here is our published Monkeypox update in Massage Magazine: