Q  If a client has what appears to be a fungal infection on her toenail, is it okay to polish bottle and brush on someone else without spreading the infection?

Dr. Mix: The probability of infecting a client with fungus from another client by using the same polish is quite remote. The chemicals in nail polish do not support fungal growth; in fact, the solvents in the polish should destroy any fungus in the bottle. If there were any fungal spores present in the polish from the previous client, they would be imbedded in the polish when it dries, so the spores couldn’t grow anyway.

 However, whether you should polish is a good question for another reason. Some doctors recommend against applying polish over any fungal nail. As far as toenails are concerned, I do not see that the application of polish is bad in most cases of mild to moderate fungal infections. In these instances, I do not believe harm will come to the client because you covered the fungus with polish. To be absolutely reassured, you could sell the client the bottle of polish for her personal use; that would leave no question about cross-contamination. In cases of severe fungal infections, it is common for the nail to lyse (become free) from the nail bed, and a secondary infection may occur. Do not apply polish on a client with an infection until she has been evaluated by a podiatrist.

 In order to know whether applying polish is safe, you have to be able to correctly identify a fungal infection.  I have known of many nail professionals who have mistaken a bacterial infection for a nail “fungus”. You must be absolutely positive what you are dealing with is actually a fungus. A green discoloration of the nail plate or underlying tissues usually indicates a bacterial infection (most likely a pseudomonas species), and seldom does it indicate a fungus. Yellow discoloration may or may not be a fungus. If there is any question as to whether what you are seeing is a fungus or a bacterial infection, refer the client to the proper medical specialist for an evaluation. Never apply polish over a bacterial infection of the nail, whether it be a toenail or a fingernail. To seal a bacterial infection under the nail plate will only cause it to become worse.

 It’s always important to practice good sanitation and disinfection in the salon, but it is even more important when you are working on a client with a fungal infection of the nail. Have her wash her hands or feet with a disinfectant soap before the service and again just before you apply polish. It is also good practice to use a disinfectant spray on the nails after the wash. The spray will be a more concentrated disinfectant and will complete the preparation necessary before applying polish. After polishing a suspected fungal nail, wipe off the polish brush and clean it in some polish thinner before recapping and storing the bottle. This is an extra measure of security.

 Q  Because of chronic ingrown toenails, a client of mine has no nail on either large toe. How can I give her an attractive pedicure without just painting the nail bed? Is there a way to create a toenail for her, even though there is no nail to attach it to?

 Dr. Mix: I have spoken with nail technicians who attach a tip to the nail bed with a pharmaceutical-grade adhesive, which is different from the type of industrial-grade adhesive typically used by nail technicians. Pharmaceutical-grade adhesive is made to come into contact with the skin without irritating it. Keep the tip short so it does not extend beyond the end of the toe. This will keep it from catching on hosiery or from being torn loose. You will need to use a tip that does not have much side-to-side arch nor should it have much of a curve from front to back since toenails are relatively flat. Use a tip made of a flexible material so it can be easily adjusted to the flatter surface of the toe.

You will need to warn the client that the nail will probably only stay in place a few days, as body oils and the wear and tear of walking will cause it to loosen and fall off. You can sell her some adhesive so she can re-glue the nail herself. It is my opinion that the nail should only be used while wearing open-toed shoes or sandals, when desirable cosmetic appearance on special occasions is required. I am sure other nail technicians have addressed this problem in a variety of ways, and I’d be interested in hearing technical details because I’m sure there are plenty of clients in this situation.

 Q  I have a natural nail manicure client who has been wearing polish for years. Now, when she takes off her polish, her nails ache so badly she has to put polish back on to relieve the pain. Why is this? Will she have to wear polish forever to avoid pain?

 Dr. MacDougall: The only possible medical explanation for this complaint is that she might be allergic to one of the components in the nail polish remover. Your client might want to try “use testing” the polish remover on her inner upper arm to see if a similar reaction occurs. Perhaps the “pain” is merely the discomfort associated with removing the layer of protection and using remover, which can cause nail beds to feel cool and uncomfortable. If the pain persists, I would wonder if your client has some underlying psychological condition that may need further evaluation.

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