Nail & Skin Disorders

Nails Under The Microscope - Understanding Nail Anatomy & Disorders

Nail technicians should know as much about the inside of the nail as the outside. Here’s an anatomy lesson on the onychium. Pay attention – there’s going to be a test at the end.

Warts around the nails (periungual) and under the nails (subungual) are often seen in children. Unlike nail psoriasis and onychomycosis, peri- and subungual warts occur more often in this age group than in adults. Since viruses cause warts, they can be transmitted from one person to another. It is wise for nail technicians to be aware that that if they are performing procedures using implements on teenagers or children with warts (verrucae) of the nails, not thoroughly disinfecting their implements could spread the disease to other clients. Clients with periungual and subungual warts should be strongly advised to see their dermatologist for medical treatment. Removing warts usually involves some form of surgery, such as burning them off (electrocoagulation) or freezing the off with liquid nitrogen. Your client can use a topically applied wart remover, but they seem to be less effective for treating warts around the nails. Your client can try one before opting for the surgical solution to her wart problem.

Another problem encountered in children are dark bands of the nail extending from the cuticle outward to the nail tip. These bands are usually of more concern in adults than in children. Nonetheless, when seeing such bands, nail technicians should advise the client to seek medical attention. Most of these bands in children are birthmarks. They are like having a mole (nevus) of the matrix, and they may, under some circumstances, require a biopsy or removal. In adults, they are more worrisome because in rare cases they could be a manifestation of a melanoma, a more serious form of skin cancer.

One of the conditions that requires differentiation would be a bruise under the nail (subungual hematoma). Often the patient may not remember an injury that caused the discoloration and thus it is essential for a physician to prove the color is due to blood (from a bruise) and not a possible melanoma. When in doubt, refer the client to her doctor.

A variety of hereditary conditions that affect the nails may signify other more serious health problems, and the nail technician may be in a position to be the first to recognize these conditions and perform a valuable service in recommending medical evaluation.

Some examples include the nail-patella (kneecap) syndrome. With this condition, the nails are abnormal and have triangle-shaped moons. The patient may have no kneecaps and is susceptible to kidney disease.

Another such condition is yellow nail syndrome, where the nails are yellow and have no cuticles. These patients often have swollen ankles as well as lung disease (specifically emphysema, which children do get, but only rarely) and chronic sinus conditions.

A hereditary disorder called dyskeratosis congentia produces very small, thin, and deformed nails and is associated with a seriously low blood count. Again, an astute nail technician will often be the first one to notice some of these abnormalities, and she may be the only one to recognize their significance.

Diabetic children and adolescents are particularly prone to infections around the nails, known as paronychia. With paronychia, the cuticle skin is red, swollen, and somewhat tender. The most common cause is the yeast fungus called candida; nail technicians should not perform any mechanical manipulations around the cuticles, including cutting, trimming, or pushing back the cuticles. Such procedures will make the infection worse and could spread it further, not only in the infected person but to others as well. Again, treatment by a dermatologist is critical; it may include topical and oral medications.

It may be said that the nail technician has a unique opportunity to be a real heroine when young clients come to her salon for services. Although children and adolescent have somewhat different nail problems than adults, they still have much in common. Since the younger age groups are frequenting nail salons more and more often, a heightened awareness among nail technicians can only serve to prove further that they are true professionals with important responsibilities.

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