A study to ascertain the potential inhalation hazard of toenail dust

Abstract

The use of the podiatric nail drill has become an acceptable way of reducing onychogryphotic nails in the clinical setting. The present study has demonstrated the presence of particles that are potentially dangerous to the human lung when they are contaminated with bacterial endotoxin (bacterial cell wall components that may cause an inflammatory response). Toenail dust collected from podiatric nail drills was examined for size, endotoxin content and the ability to stimulate release of IL-8 (IL- interleukins stimulate the release of other mediators in septic shock and inflammation) from macrophages and lung epithelial cells in vitro. The size distribution revealed a large number of particles that would deposit in the nose, airways and lung alveoli. Endotoxin was detected in extracts of nail particles and, interestingly, a component of these particles was able to stimulate substantial release of IL-8 from lung epithelial cells. Suspensions of toenail particles stimulated IL-8 release from monocyte-derived macrophages. Destruction of the endotoxin with the antibiotic polymyxin B still resulted in IL-8 release, suggesting that the particles themselves initiated the response and not necessarily the endotoxin. The authors conclude that podiatrists who routinely carry out nail reduction could be inhaling particles that could deposit throughout the respiratory tract, where they could contribute to inflammation by stimulating release of IL-8 from cells via the particles themselves and via endotoxin.