Nail & Skin Disorders

Frequently Asked Questions: The Nail Doctor

Your questions answered! What causes fungus, what to do about brittle nails, and more.

Flipping through the last five years’ worth of The Nail Doctor column, you would notice that the same questions pop up time and time again. These are common questions because they are common problems, so we decided to put together a useful guide to the most frequently asked questions (FAQ) concerning nail health, The following 13 FAQ will be permanently posted on our website. Keep checking back, as we will be adding to that list on a regular basis.

What causes fungal infections and how should I treat them?

Nail technicians can’t actually treat a fungal infection, but they should be able to recognize some of the signs of this problem. The green spots frequently seen on clients with extensions are more often pseudomonas and frequently are confused for fungus. (See the next question.) Fungus organisms love to infest wide, open spaces. Keeping nails trimmed short will help prevent this, thus reducing trauma and creating less area for the fungus to invade. Keep in mind that fungal infections occur more often in toenails than in fingernails due to the moist environment in shoes. There are topical and oral medications available for treating nail fungus, which should be discussed with a dermatologist. The yeast fungus, Candida, thrives in open spaces beneath the nail plate and is often the culprit in this situation. If the infection persists, antifungal therapy should be administered by a dermatologist.

What are green nails and how do I treat them?

The most common bacterial infection of the nails is due to pseudomonas, and is sometimes referred to as “green nails” because of the greenish-colored nail plate. Pseudomonas is generally caused from air pockets under the nail plate that allow moisture to get in and the green pigment-producing organism thrives in the moist environment This is usually accompanied by onycholysis (lifting nail), so a dermatologist should intervene. You can advise the client to soak her nail in vinegar or a 5% household bleach solution several times a day for about four days. It will usually take several months for the green stain to grow out.

I have a client with brittle nails. What causes this and what should I do about it?

When the nail plate becomes dehydrated, the results can be peeling and splitting nails, which fray at the edges. As a consequence, the nails may break and become more fragile, and can easily catch on clothing. It may also be harder for clients with brittle nails to pick up small objects or button a shirt. This condition also causes polish to chip and peel, although it is still a good idea for the client to wear polish to help protect the nail plate from further dehydration. Use and suggest a non-acetone polish remover, which is also less drying. Treatments with formaldehyde can be drying when used regularly Heating brittle nails is relatively simple. First, remind the client to wear gloves when using cleaning agents and detergents. Have her avoid trauma to the nail, and not use her nails as tools. Also, recommend clients use a hand moisturizer daily, which will also help moisturize nails. When working on clients with this condition you should avoid excessive mechanical manipulation in the cuticle area. Vigorously pushing back the cuticles with a metal implement, or cutting them, injures the nail matrix (the nail growth center) and causes the nail to weaken.

What effect does cold weather have on the nails?

Cold weather can wreak havoc on your client’s hands and nails. Special care must be taken during the winter months to combat the nail-related problems associated with this time of year. Some of the nail conditions you are likely to see include brittle nail syndrome, bacterial infections, and Raynaud’s Phenomenon. (For information on brittle nail syndrome, fungal infections, and bacterial infections, please see the individual questions.) One consequence of cold weather is decreased circulation to the fingers and toes, which can result in Raynaud’s Phenomenon. It may cause fingers to become discolored, alternating from red to white to blue and is often painful. Wearing gloves is recommended for people who have this condition because gloves keep the fingers warmer, thus improving blood flow to the nail area. If the symptoms become severe, do not improve, or continue to get worse, then your client should see a dermatologist.

Is wearing artificial nails safe?

In and of themselves, and when applied properly, acrylic nails are safe. What contributes to the “danger” to clients is repeated exposure to the chemicals on the skin. Most of the chemicals used to create artificial nails are acrylic-based. Certainly they would be dangerous if ingested, but it is not likely that any significant amount of the products can go through the nails into the bloodstream. The danger is when products are applied improperly. Extension products that do not fully cure or harden, whether acrylics or gels, can cause an allergic reaction. Another concern is when the products come in repeated contact with the skin. It is important, as a nail technician, to prevent products from touching the client’s skin. Do not be overly alarmed, though, if some product touches the skin; it is only through repeated exposure that the harm is done. And while there are no components in the products used to create artificial nails that cause bacterial and fungal infections of the nails, you must make sure that your clients care for their nails so they do not develop these types of problems.

My client’s nails are constantly lifting away from the nail bed. What causes this? How can it be treated?

Onycholysis (separation of the nail plate from the nail bed) is a condition with many different causes. The more common causes include fungal infection (particularly the yeast fungus Candida), psoriasis, trauma, or perhaps sensitivity to certain nail products. Usually, nails will not reattach on their own unless the causative factor is eliminated. Sometimes cutting back the nails and removing the lifted portion and then treating the nail bed or skin underneath can be helpful, but it is difficult to know which treatment is correct unless the patient is evaluated med­ically (by a dermatologist) with proper tests that point to a specific diagnosis. Once the diagnosis is made and the client is treated for the disorder, it usually takes anywhere between 3-6 months for the nails to reattach, depending upon the extent of the lifting. Sometimes the nails never reattach. If the; cause of the lifting is allowed to continue affecting the nail, it can eventually create a scar in the nail bed and the nails won’t be able to reattach. Scar tissue typically accumulates over a very long period of time.

What is the best way to treat a client with scarring of the proximal nail fold region?

Scarring of the proximal nail fold region involving the matrix (nail growth center) is referred to as pterygium (not to be confused with the common cuticle overgrowth that is often incorrectly referred to as pterygium). This disorder is actually an overgrowth of the proximal nail fold onto the nail bed. By definition, pterygium forms if there is scar tissue in the nail matrix. Since the nail matrix at that particular site cannot manufacture nail plate, the proximal nail fold skin grows out with the skin of the nail bed, giving rise to the triangular formation known as pterygium. A number of skin and nail disorders may cause pterygium to form. There are two approaches to treat pterygium. The first is used if the pterygium is permanent due to scarring, but the primary disease is now inactive. Under some circumstances, these clients maybe helped by surgical reconstruction with the removal of the pterygium and the scar tissue in the matrix, which results in a nail more cosmetically acceptable than it was before. In patients whose pterygium formation is still in an active stage, then the treatment would be directed at the primary disorder. Once the disorder is brought under control, further scarring will not occur and pterygium can be reduced or even prevented.

What causes grooved nails and how can I treat them?

Nails may be grooved in two directions: from side to side or from the cuticle outward (Do not confuse these with normal ridges that often appear in older clients.) When the grooves are from the cuticle outward, they are called longitudinal grooves of the nail, and these are most commonly caused by a cyst, or a little growth in the skin next to the proximal nail fold. To treat this type of cyst, called a myxoma, a doctor typically performs some form of surgery. When the grooves are from side to side, which is by far much more common, they are referred to as Beau’s lines. The most common cause of this disorder is a yeast infection of the skin around the cuticle. This infection injures the nail matrix and because of this type of injury, the matrix cannot produce a smooth nail but instead produces a grooved one. An infected cuticle is referred to as chronic paronychia, and is most commonly caused by the yeast fungus Candida. If your client is in good health and not on any medications, a doctor must first provide a diagnosis and treatment. If it is a common yeast infection, then it can be treated with antifungal creams or pills.

When can I work on bruised nails?

When a nail is injured, it can assume a number of different appearances. The most common, of course, would be a discoloration of the nail plate due to bleeding under or around the nail. This condition is referred to as a subungual hematoma, or hemorrhage in the nail plate (similar to a bruise on the skin). When this occurs, the blood accumulates under the nail and it usually causes the nail plate to separate from the nail bed. In addition, the accumulation of blood underneath the nail plate can create pressure and pain. To relieve the pressure, a doctor will cut back the nail plate with a nail nipper to release the accumulated blood. This now leaves the nail bed exposed, and the client will have to wear a bandage for a few days. The new nail will grow rapidly when the separated nail plate is cut away. Once the discolored, bruised, or infected nail has been properly diagnosed by a doctor and treated, it is then safe to work on that client, provided there is no sign of infection, bleeding, pain, or allergy to acrylic. A tip may be applied to the remaining nail plate if the client has no sensitivities to the products (not recommended for clients with chronic lifting). There is no harm in applying nail pol­ish. Clients may actually appreciate the camouflage.

What is psoriasis?

Psoriasis is a condition that most frequently manifests itself on the skin. When the nails are involved, the function of the nail unit becomes impaired. The psoriatic nail may not be able to protect the finger or toe, perceive fine touch or sensation, pick up small objects, or scratch. The most common misdiagnosis of psoriasis of the nail is fungal infection. In fact, the signs and symptoms of nail psoriasis and onchomycosis (nail fungus) can be indistinguishable. It is absolutely essential that your client’s doctor perform the necessary tests in order to arrive at a correct diagnosis. (It is not a nail technician’s responsibility to “diagnose” any nail condition.) The changes in the nail that occur when psoriasis is present include onycholysis (separation of the nail from the nail bed) and subungual hyperkeratosis (thickening of the nail bed). Other signs of psoriasis include splinter haemorrhages, reddish-brown discoloration of the nail bed, and white spots on the nail plate. It should be made clear that psoriasis of the nail is a serious and often disabling condition. It should be accurately diagnosed by a physician who will perform the necessary tests (including a KOH wet mount, culture, and possibly a nail biopsy) before starting treatment. After confirming that nail psoriasis is present, an appropriate and safe routine should be. Clients with nail psoriasis should not wear acrylics because the acrylic can sometimes aggravate the condition.

I have a client who recently began having an allergic reaction after her salon visits. What could be causing this?

Allergic reactions are caused by prolonged and repeated contact to a specific ingredient in a product. Once a person becomes allergic to something, the allergy can last for life. That is why it is so important to avoid skin contact with all monomers, gels, and resins. Any of these can cause skin reactions if used incorrectly or if they come in repeated and prolonged contact with the skin. A good dermatologist can help identify the ingredient(s) that are causing the allergies by patch testing. Once you know the actual cause of the allergy, you can find products that do not contain that ingredient. Remember, all adverse skin reactions are not completely avoidable, but skin contact must be avoided and products must be used correctly.

My client often has white spots on her nails. What causes this?

White spots on the nail is perhaps the most common nail disorder and axe called leukonychia, which literally means “whiteness of the nails.” There are many types of nail whiteness, some of which indicate serious illness; fortunately, by far the most common cause of white spots on the nail is minor injury to the nail matrix. Caused by trauma or minor injury to the nail matrix, these spots will grow out from the matrix with the nail plate and eventually disappear. Nail technicians should be aware that this type of leukonychia could be caused by over-vigorous pushing back of the cuticles with a metal or wooden instrument Always soften the cuticles first with a lotion or warm water before pushing them back, and never use anything but gentle pressure. However, should the condition persist or its cause be inexplicable, recommend that the client have the disorder evaluated by a dermatologist.

Does gelatin strengthen weak nails?

Over the decades, people have always looked for an easy way to strengthen the natural nail plate. Nails are made of protein called keratin, and a deficiency of protein can show up as soft, fragile, or brittle nails. Since gelatin is a form of protein, the logic is that the protein would help strengthen nails. It has never been proven in a controlled and scientific fashion that gelatin does anything to strengthen nails. Nails also contain no calcium so there is no rationale for taking calcium to strengthen nails. Several studies have been done with the vitamin biotin that showed some usefulness in making nails stronger.

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