Nail & Skin Disorders

Servicing Clients with Autoimmune Disorders

Knowing what to do with special needs clients before they walk through the door will make both you and the client more comfortable and the service more meaningful.

An autoimmune disorder — such as arthritis, lupus, or multiple sclerosis — affects various parts of one’s body, such as bones, muscles, nerves, skin. Some conditions greatly hamper one’s mobility. Others are life-threatening. Nail care for clients with autoimmune disorders, just as for clients with circulatory diseases, requires extreme patience and gentleness. Sometimes the client’s physical condition can affect her nail care needs.

Your first step in ascertaining appropriate care for a client with an autoimmune disorder is to find out about specific nail conditions and prescribed medications.

Cosmetologist Chris Bingham (Wall, N.J.) stresses the importance of knowing what medications clients may be taking. She has seen so many clients on certain medications that she says she can tell what a client suffers from by her hair texture. By observing the hair’s elasticity and the way it accepts shampoo, Bingham says she can tell who is—or should be — on med­ication for high blood pressure. Over the years she simply made the connection between the people she knew were on medication and the hair condition they had in common.


William Wickwire, M.D., a dermatologist (Redondo Beach, Calif.), realizes the difficulty technicians may face when deciding if they only need to improve a client’s bad nails or if a condition merits a referral to a doctor. “People s weak nails are often due to too much nail manipulation,” says Wickwire, rather than a medical condition.

Any sudden change in a long-term client’s nail condition that cannot be attributed to factors such as a change in product should prompt a technician to send the client to a dermatologist. “For example, if the nails are suddenly brittle, a dermatologist might pinpoint the problem to a thyroid disorder,” says Wickwire. “There is a condition called Hashimotos, where antibodies attack the thyroid. It causes crumbling, splitting, thinning, and occasionally spoon-shaped nails. But if the disorder is diagnosed, the overall disorder and the nails will get better.”

If the client has complained about other health problems or lack of energy, the technician should stress that though she doesn’t mean to alarm the client, an outside factor may be contributing to both problems and a doctor might be able to solve them.


The most familiar autoimmune disorder is arthritis, an inflammation of the joints from infectious or metabolic causes. Although an arthritis sufferers nails aren’t necessarily any different from those of typical clients, an arthritic client often needs extra gentle service.

Stephen R. Doms, M.D., a dermatologist (Minneapolis, Minn.), says that it is more comfortable for an arthritic client to hold her palm upward for a manicure, with fingers pulled in as if making a fist. Although he realizes that this presents a very different orientation for the nail technician, Doms says that he has adjusted by moving his chair next to, rather than across from, his patients.

This change in position prevents stress on the joint, making clients more comfortable. It’s even better when the elbow is slightly bent with the hand resting on the table for support.

Sabrina Stahn, owner of Sabrina Salon of Nails (Minnetonka, Minn.), has a client in her mid-40s who is suffering from rheumatoid arthritis. She frequents the salon every three weeks for fills. Though Stahn hasn’t noticed any differences in her nails, her client’s wrists are very swollen. “I try to hold her hand or arm with a firm gentleness,” describes Stahn. “Most clients will say something if they’re in pain. I’m real cautious anyway, but I try to take added precautions when I work with her.”

Hashimotos Disease crumbling, splitting, thinning, spoon-shaped
Arthritis deformed nails
Lupus thick nail folds, rough cuticles, deformed nails, abnormally red or blue skin, black spots, hypopigmentation (lightening)
Raynaud’s Syndrome white or blue fingers, split nails, longitudinal bands of pigmentation, fluorescent nails under UV light
Alopecia crumbling, spoon-shaped, spotty or red lunula, pitting, thickening, discoloration, separation of nails at distal plate, debris under nail bed, deformed nail

Doms wouldn’t rule out any type of nail service for people with arthritis. However, he adds that a person’s nails may become deformed as they match the shape of the underlying bone, which is affected by the disease. The nails should not become painful, and technicians may file or add extensions to give the nails a normal shape and make them more attractive.


Lupus affects a body’s connective tissues. People with lupus often have excessively thick or rough nail folds and cuticles, says Wickwire. Their vascular system is also affected, and they may have abnormally red or blue skin from capillary inflammation.

Lupus patients may also suffer from Raynaud’s Syndrome, or spasms in the fingers’ blood vessels caused by temperature drops. Simply walking outside into cold air can trigger the spasms, and even turn fingers white or blue. Wickwire says that there is no danger in doing heat treatments like paraffin dips or hot oil manicures as long as the client’s circulatory system isn’t impaired.

Nancy Pebbles, owner of Nails at Last (Modesto, Calif.), has a client with lupus. “She always gets fungus under one or two nails,” says Pebbles. “Not that this can’t happen to others, but she seems more susceptible to it because she takes a lot of antibiotics.”

Doms questions whether antibiotics make a person susceptible to fungus-related problems. “Lupus patients use cortisone-type medications to try to control their body’s severe inflammatory response, to help their body not beat itself up,” he says. “These [cortisone] medications can make patients more susceptible to fungus and bacterial infections.” In other words, Pebbles’ patient may be taking a lot of antibiotics for other conditions, but they are not adding to her fungus problems.

Wickwire adds that a client’s medication may split the nails, form longitudinal bands of pigmentation, or make them appear fluorescent under UV lights. Doms says that nails may develop tiny black spots from small hemorrhages caused by a medications effect on the way blood circulates. A client may also have hypopigmentation, or lightening of the nails. Doms suggests applying lots of base coat or nail strengtheners to weak nails, and polish to hide hemorrhages or pigment bands. “You’re only worried about the cosmetic questions here,” he explains. “It’s not like a fungus. We’re not treating a disease process, just a side effect of a disease or its medication.”

A lupus patient’s nail may become deformed and painful if not enough blood and oxygen are reaching the nail bed. The small arteries suffer from vasospasms, or constrictions. “It’s like stepping on a garden hose and stopping the flow of water,” describes Doms. “The small nerves cry out for blood. Technicians should use extra care and caution while servicing these clients. They shouldn’t perform any service that may cut a client, because they may form an ulcer that doesn’t heal.”


Simply put, people with alopecia areata develop an allergy to their own hair. Their defense mechanisms attack an enzyme produced by the hair follicles, which leads to hair loss. Some people have spontaneous regrowth or periods of hair loss alternating with hair growth, while others suffer permanent damage. Peggy Knight developed alopecia areata at age 14, and by age 24 had lost all her hair. She explains that stress can trigger the alopecia if a person is predisposed to it, but that, contrary to popular belief, stress doesn’t cause the disorder. Knight formed Peggy Knight International (Ross, Calif.), a company that specializes in women’s hair loss, whether from alopecia, burns, cancer, or other ailments. Knight says that alopecia patients’ nails often look like they have pinholes in them.

Wickwire describes these pinholes as similar to “hailstones hitting car windows.” Not all alopecia sufferers have nail problems, though it’s common for their nails to crumble, become spoon shaped, or for the lunula to become spotty or red. Doms says that people in whom alopecia is a secondary disorder to another condition (psoriasis, for example) have nail problems associated with their alopecia. If alopecia is the primary condition, a patient’s condition is usually limited to hair loss.

Doms says that the nails of patients with alopecia may show signs of stippling (horizontal ridges), banding (vertical ridges), pitting, fraying, and thickening, the latter resembling a fungal infection. As in a client with arthritis, the bone and nail may change shape. A client may have debris under the nail bed, but Doms warns against trying to remove it. ‘There may be separation of the nail at the distal plate. I wouldn’t poke around under the nail for fear of loosening it further. You don’t want to lose the entire nail.”

Holly Oyler (Louisville, Ky.) has had alopecia universalis, or complete hair loss, for 18 years, though from the age of 4 she would lose clumps of hair from her scalp. Her nails are never strong enough to go without an acrylic coating. “They’re very transparent and cushiony,” she says. “If I don’t have acrylics, my fingertips are very sore. It’s like there are no nails there. I needed acrylics before they became big in the nail industry. When I first started covering my nails I used dental porcelain.

“I wear my nails long. I can get away with it because I own a fashion company. I have to go for a fill every 10 to 14 days, or I get a fungus. I use an antifungal cuticle oil every night, and if there are any signs of cracking or lifting, I go in and have them checked. And I don’t let people use cuticle nippers.”


A progressive weakening or paralysis of the musculature caused by areas of hardened tissue in the brain or spine, multiple sclerosis (M.S.) doesn’t have a predictable effect on nails, according to Wickwire. For nearly a year, Vicki Sutton, owner of Your Nail Pros (Lilmet, Ga.), has had a client with M.S. When the client first came to Sutton she wore her nails natural, but has since started wearing an overlay and polish because her nails were deteriorating.

Sutton explains, “Product seems to adhere well, but I’m not sure if it’s connected. I keep her nails at a wearable length. But the disease is taking its toll. I help her into her seat and try to make her comfortable. Sometimes she waits for a half hour or more after her service is done before leaving the salon.”

Bingham, who has M.S., used to wear a fiberglass base for strength and found that her nails lasted a long time until she suddenly became ill. Suddenly, her nails became brittle and “shattered like glass.” She says they dehydrated in a matter of 12 hours.

Bingham’s nail beds are so thin that even buffing can cause burns. And, unlike Sutton’s client, Bingham has trouble with products because they take so long to dry on her nails.

Bingham’s nails continue to worsen, peeling and shred- ding away. “They’ll rip on a piece of paper,” she explains. “It’s impossible to wear any kind of extension. Normally you’d file a natural nail from the edge to the center, not saw the file back and forth.

“In fact, it’s one of my pet peeves to see technicians who are too used to doing acrylics saw back and forth on a natural nail. However, that’s the only way I can file my nails now. If I file from the edge to the center, they just bend. That’s with polish on — which gives you an idea of how weak they are.”

Though Bingham’s nail problems seem to coincide with the weakening of her general health, Wickwire and Doms both feel that M.S. does not cause specific nail changes. “Their condition may be from medication or a reaction to chemicals,” says Wickwire. “People develop allergies over a long period of time. Allergies are a cum- mulative reaction to a substance. People don’t want to think that they might have an allergy to something they’ve been using for a long time. Also, because M.S. is an autoimmune disorder, the condition itself can wreak havoc on a person’s susceptibility to foreign substances. Finally, because of the person’s overall weakness from M.S., her nails may suffer more trauma from being banged about.”


It’s difficult to know how to service clients with autoimmune disorders because their nails can change quickly. Bingham says that both client and technician should be willing to work together to create and maintain beautiful nails. You should realize that these “special needs” clients may need additional time for service every week, and that you may need to account for more frequent repairs. You will also have to decide whether you want to charge for this additional time and service.

The client should be willing to come in for touch-ups more often. A technician who is aware that certain medical conditions may cause problems with a client’s nails can discuss this issue with a client before any trouble happens so they both know what the other person expects.

Most important, remember that beauty may be as important, if not more so, to these clients than to your regular customers. Sometimes a nice set of nails can make them feel better about their physical ailments. Bingham says, “How we look affects how we feel. My nails are very important to me because when I have nails with a free edge my hands are gorgeous. When my nails are ugly I behave differently. I want to stick my hands in my pockets.”

Arthritis, lupus, alopecia areata, and multiple sclerosis by no means cover all autoimmune disorders; they are simply some of the more common varieties. Keep in mind that because these disorders tend to impair these clients beyond their nail needs, you are, in many cases, servicing handicapped clients. Cater to them, but don’t baby them. Make them as comfortable as possible. Learn as much as you can about their particular ailment. Be gentle as you service them and find a good balance between what they hope to do with their nails and what is physically possible for them at that given time. You will gain their trust, confidence, and continued patronage.

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