When a client is undergoing chemotherapy, you can often see it in her nails. By carefully modifying your standard manicure procedure, you can take steps to prevent problems.
One thing not widely known about cancer treatments is that not only is the hair affected, but usually the nails are traumatized as well. Basically, the body is fighting for health, and the energy and resources needed to grow hair and nails are diverted to more necessary functions. Preventative care may reduce the trauma to the nails and help your clients recover more quickly.
Common nail symptoms for clients undergoing chemotherapy are as follows:
- Ridges running horizontally across the nail beds after every treatment, with thinning between each ridge
- Dryness, splitting, and peeling
- Lifting from the nail bed
- Loss of all connective tissue under the nail plate
- Loss of the nail plate and exposure of the sole horn
- Infection by opportunistic microbes, such as yeast, fungi, and bacteria
- If ignored, secondary infections can occur as these microbes enter the already immuno-compromised environment.
The Best Medicine Is Prevention When a client is undergoing chemotherapy, the first step is to get your client to ask her doctor the following question: “My nail technician wants to know if it’s OK for her to give me a gentle, sanitary manicure or pedicure?” This alerts the physician to the fact that you are aware of the situation and will take due care of the client, thus making it easier for her to say yes. If you’re given clearance, then set appointments when your client’s blood count is likely to be high. She’ll know when this is, and it will be healthier for her.
Next, work with your client by taking steps to prevent problems, rather than waiting to deal with them. Make the environment of fingernails and toenails as unfriendly to pathogens and as supportive to healing as possible. The key things are: light, bright, dry, and acidic pH.
- Light. No dark polishes (dermatophytes and other pathogens grow better in the dark).
- Bright. No opaque polishes. Use sheer or clear if anything at all.
- Dry. No enhancements or anything that will tend to seal in moisture.
- Acidic pH. The body’s normal pH for skin is 4.5 or so (with 7.0 being neutral) and so often drug therapies make the body more alkaline. You have to restore the acid balance to help the body fight off fungi, bacteria, etc.
With these ideas in mind, recommend that your client remove all nail coverings and go with a grooming service. This service can include all the usual work, with some exceptions:
- Gentle stroking (effleurage) massage to stimulate circulation is OK, but no deep tissue massage as there may be neuropathy and they won’t feel that you’re hurting them.
- No abrasion on the skin. Even with a callus, it’s better to simply hydrate it. They might feel fine if you try to reduce the callus during the service, but will feel pain the next day. > Trim nails very carefully and file them short with a well broken-in file. Virtually all the free edge should be eliminated (except in the corners, so you don’t end up with ingrowns). You don’t want to leave a free edge to trap moisture.
- Use lots of really good hydration and botanical oils. Consider using an antimicrobial product such as Poshé’s Antimicrobial Oil. It can be generously applied all over the fingers and toes and very lightly buffed into the nail plates with a soft sponge buffer, followed by a great hydrating lotion.
- No high-shine buffing.
- Advise your clients they can make a warm foot bath with some of their bath salts or something that smells good to them, but add one-half cup of apple cider vinegar to the water. This will lower the pH but not burn their skin. Once a week would be good, if they feel up to it.
- Leave nothing on the nail plates. But for the sake of your client’s health, it’s better to not have anything on the nails that will a) harbor germs or moisture to support germs and b) stress the fragile nail structure. If the client insists, recommend an antimicrobial clear coat with a very thin white French done with a striping brush at the very tip.
- Recommend the daily, at-home application of good botanical cuticle oil and a wide-spectrum antimicrobial such as Dr. G’s Clear Nail all over the fingers and toes.
Assure your clients that as the body heals, the nails will begin to grow and any imperfections will gradually work their way forward to the free edge. Just be very careful of the unprotected nail beds that are exposed when they lose nails. Generally it’ll be around six months from cuticle to tip for fingers and up to a year from cuticle to free edge for toes. Continue your “special needs” protocols and have patience.
Help for Cancer Patients and Techs
The Look Good…Feel Better organization is always looking for volunteers. Their website offers excellent information about working with cancer patients and will put you in touch with your local chapter to help answer your questions. For more information, go to www.lookgoodfeelbetter.org.