Nail & Skin Disorders

Servicing Clients With Special Medical Needs

Clients with diabetes or circulatory disorders can be safely serviced by using gentle techniques.

While some people love to describe, in detail, their medical problems, most people will share such personal information reluctantly, and only with close friends, family members, or their doctor. Rarely will a new client sit down at your table and list her medical history for you. But some clients have medical conditions you do need to be aware of. For example, clients with circulatory disorders or diabetes need especially gentle service. Before you can work on a special-needs client, you need to know how to question her about potentially sensitive conditions. This is the first article in a three-part series about servicing clients with special medical needs.

Blocked Pathways

A client who has poor circulation has veins or arteries that are somehow obstructed, either by debris, constriction, or hardening, or as a result of another disease such as diabetes.

When circulation is impaired or weak, oxygen-rich blood cannot get from the heart to the body’s tissues. The hands and feet are often the most seriously affected because they are farthest from the heart. People with poor circulation have hands and feet that are often cold to the touch, but these clients suffer from many other problems as well. Impaired circulation can cause numbness; tingling; ulcerations (pockets of infection under the skin); muscle fatigue; skin discoloration on the arms and legs; sharp or shooting pains in the arms and legs; slow- or non-healing wounds; chronic scaling of the skin; scaly, itchy, or dry skin; chronic infections; and neuropathy (loss of sensation).

The nails can be a good indicator that a person has poor circulation. You sometimes can tell a client has poor circulation by applying pressure to the nail bed. The nail bed should go white when pressure is applied and turn pink as soon as the pressure is removed. If it remains white or is very slow to turn pink, circulation is probably poor. The nail bed is rich with capillaries. If oxygenated blood is not able to reach the capillaries, you might also see slower nail growth and white nail beds.

What’s the Risk?

Clients with these conditions are more likely to get infections in cuts because there’s less blood flowing to the tissues to help the healing process.

Diabetics are especially vulnerable to infections because their ability to heal quickly is poor, combined with their poor circulation. Diabetic clients are more susceptible to mold, yeast, and bacterial infections on and around the nail, and they are three times more likely than healthy clients to get paronychia, says Orville J. Stone, M.D., a dermatologist in Huntington Beach, Calif. However, he says, “Diabetics generally take such good care of themselves that they have fewer health problems overall.”

Screen Your Clients

You can safely service clients with circulatory disorders if you know about the condition beforehand and modify your techniques. There are many ways to ask clients about the health conditions that will affect their service without seeming nosy. “At the client’s first visit I ask if there is anything I need to know about her,” says Holly Martineau, owner of Nail Elegance by Holly in Tacoma, Wash. “I tell her that it’s not because I’m nosy, but because I need to know about certain health problems that might mean making changes in how I work on her.”

Most new clients at With Love B’Anne Salon in Phoenix, Ariz., volunteer information to technicians about their health problems at the first appointment, says nail department supervisor Nilsene Privette. That way, technicians can make service recommendations based on the client’s responses about lifestyle and health.

An easy way to handle this situation is to have all new clients fill out a questionnaire, or you can include questions on your client information card and have them fill out the card. Madelyn McNeil, owner of Nail Pazazz in Houston, Texas, puts relevant medical information on her client cards. Recording medical information on the client card guarantees that all necessary information is available to any technician, and the client isn’t asked all the same questions if someone other than her regular technician sees her.

Modified Services

You can do most salon services on clients with circulatory disorders with some simple technique modification. Chris Young, a nail technician at Hey Jude’s Nail and Hair Salon in Baltimore, Md., has been maintaining acrylic nails on a 23-year-old diabetic client for three years.

“Regular two-week fills are a must to reduce the chance of getting mold. If a nail breaks or there is lifting I have the client come in immediately because the nails need to stay sealed,” Young says.

Fungus and mold are much harder to treat on a diabetic, so educating the client about the importance of maintenance (and having her call as soon as she notices a cracked or lifting nail) is essential.

Young, who has arthritis herself, recommends using only clear acrylic or gel on clients with circulatory disorders. “Doctors like to see the nail beds to check circulation,” says Young. “I have arthritis and go to the doctor every three months, and I have to take my polish off because he wants to check my circulation. Even something as subtle as a blush powder could give the doctor a false reading.”

McNeil, who has many clients with circulatory disorders, says she pushes back cuticles on them instead of nipping. She encourages clients to use cuticle cream regularly to keep cuticles from drying and splitting, which can lead to hangnails. Carshonn Shimer, owner of Fingerprints in Deerfield, Fla., wraps the tip of her cuticle pusher in cotton to prevent tearing or cutting the skin.

The care you take to avoid cutting the client is your most important precaution, says Privette. Some clients with circulatory disorders may take blood thinning medication, which makes them bruise more easily and bleed longer when they are cut. Privette advises against using nippers on these clients and recommends using well-worn files so there’s less chance of nicking or causing an abrasion.

Nip only the hanging or torn skin on hangnails without catching any surrounding skin, says Privette. Get rid of the surrounding dry skin with cuticle solvent and a pumice stone.


Some technicians refuse to perform pedicures on clients with circulatory disorders or diabetes because they fear causing an infection. Although the procedure must be done with extreme care, pedicures can be very beneficial for these clients.

Edward Young, Jr., M.D., a dermatologist in Sherman Oaks, Calif., recommends doing minimal work on diabetics’ feet because they are prone to ulcerations, which are pockets of infection concealed under the skin, most often under a callus or nail. Ulcerations are serious infections that can spread or rupture. Unless the client is a severe diabetic, Dr. Young says limited foot maintenance is acceptable.

Before doing a pedicure on a diabetic, Annie Fiecoat, a nail technician at Fancy Fingers N’ Toes in Tucson, Ariz., examines the feet for discoloration, peeling, or swelling. Instead of using a foot file, she uses a fine stone to lightly scrub away excess dead skin. Never use cutting implements on a diabetic’s feet because the risk of serious infection is so great. Technicians can cut toenails, says Privette, but should never go into the corners of the nail, even if the client is perfectly healthy.

Because regular maintenance |is so important, McNeil encourages these clients to come more frequently and even gives them a reduced service price as an incentive if they do. “We don’t reduce calluses as much as we normally would, but if they have a regular schedule you don’t face that anyway.” With regular maintenance, she says, these clients’ feet stay healthy and callus-free.

Paraffin Dips

Whether or not you should do paraffin dips on clients with circulatory disorders depends on whom you talk to. Some doctors say a paraffin dip is fine, while others advise against it. Likewise, some nail technicians do it without any problems, while others refuse to consider it.

One reason some doctors object to paraffin dips is that these clients may suffer from a loss of sensation, which makes them unable to gauge the paraffin’s temperature. Also, reminds Dr. Young, blood is part of the body’s natural “air-conditioning” system, dispersing heat throughout the body. With poor circulation, blood does not move in or out of the “hot spot” efficiently, so the heat remains concentrated on the wax-encased hand or foot and can cause a burn.

On the other hand, Dr. Stone says the warmth can help stimulate circulation and is beneficial for these clients except in very serious cases. To determine if you should do a paraffin dip, press a finger to the client’s skin. If the skin stays white for a long period of time before turning pink again, he advises against doing the dip.

At With Love B’Anne, technicians apply warm lotion or oil and wrap feet in plastic wrap instead of doing paraffin dips. They cover the foot with a bootie and let the client relax.


Clients with circulatory disorders will always enjoy a light massage, but avoid too much manipulation of either the hands or feet. Says Young, “Gentle massage is probably fine and might even be beneficial. It might stimulate circulation. But don’t be vigorous because you don’t want to damage functioning blood vessels.”

Too much stimulation can also cause the client to feel lightheaded, as Shimer discovered. “I have had clients become dizzy from activating the circulation too much. I had one woman pass out right in the pedi-chair. It was a combination of the heat and the over- manipulation,” she says.

Stay away from European massages and reflexology and stick to light stimulation of the arms and legs on these clients. Stop the service immediately if the client complains of dizziness or lightheadedness.


At first, waxing may seem a great add-on service for these clients because it removes hair without the need to use a razor. However, Jane Martin, The Dermal Group’s education director, recommends against giving waxing services to clients with circulatory problems.

“Waxing involves heat and pressure — two things you really don’t want to apply to these people,” says Martin. Hair removal opens the pores, and, in some cases, causes blood spotting, she explains, which gives germs a portal of entry into the body, inviting infection.

Nor do you want to wax over varicose veins, says Martin. “The pressure and friction needed to apply and remove the muslin isn’t good over varicose veins because you can cause a blood clot to detach from the walls of the varicose vein and circulate to the brain or heart,” she says.

Accidents Do Happen

If you do nick a client, stop the service and tend to the cut immediately. Apply an antiseptic or over- the-counter antibiotic to the cut and cover with a bandage. If the cut bleeds, apply pressure until the bleeding stops. Warn the client to keep the wound clean and dry and watch for signs of redness and swelling. If the wound becomes infected, the client should see her doctor immediately.

Most of your diabetic or circulatory disorder clients know exactly how to handle the situation. If the client doesn’t, call her physician, tell the doctor what happened, and ask how to handle it,” says Privette. “Most doctors will be happy to help over the phone.”

Servicing a client with special needs can be as rewarding for the technician as for the client. Your most important tools are a gentle touch and a caring atmosphere. By making clients with special needs look good, you give them the self-esteem to feel good as well.

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