When a client exhibits redness, small blisters, swelling, separation of the nail plate from the nail bed, or tenderness of the nail bed and nail folds, this usually indicates contact dermatitis, a skin allergy to a product or ingredient.
Our guest columnist this month is Jeffrey Lauber, M.D., a practicing dermatologist and medical director of the Advanced Skin Treatment Center of Orange County in Newport Beach, Calif.
When a client exhibits redness, small blisters, swelling, separation of the nail plate from the nail bed, or tenderness of the nail bed and nail folds, this usually indicates contact dermatitis, a skin allergy to a product or ingredient. Contact dermatitis can be caused by nail products, but determining just which products have caused the reaction can be a challenge. For example, if a client exhibiting symptoms of contact dermatitis is wearing tips with acrylic overlay, she could be allergic to the nail glue, the acrylic liquid or the polish.
To determine exactly what product the client is allergic to, you can perform a “use test,” which is a simplified version of the patch test routinely performed by dermatologists. First, obtain all the products used on or around the client’s nail. This includes any products the client uses at home as well as those you use on her salon. Put a dab of product on a plastic bandage (use a separate bandage for each product) and allow it to air dry for 10 minutes. Then place the bandage on the inside of the arm, above the elbow, for 48 hours. If you test more than one product, keep a log of what products were tested and where the bandage was placed. If redness, blisters, or itching occurs under the bandage, you know the client is allergic to that brand of polish or glue.
A use test can help you narrow down the list of ingredients causing the reaction, but don’t assume that because a client is allergic to a particular brand of glue that she is allergic to all glues. To determine exactly what ingredient is causing the reaction, the client must see a dermatologist, who will perform a patch test. A patch test contains several hundred chemical compounds to determine the exact chemical identity of the allergen.
If the client’s dermatologist performs a patch test, make sure she gets the various product names under which the sensitizing agent is sold, methods of avoiding clinical exposure to the agent, and names of non-sensitizing substitutes. With this information, you can set about finding a suitable replacement.
For clients who want to keep their artificial nails, use replacement products that have been suggested by the client’s doctor. Keep in mind, though, that you can’t expect a dermatologist to be familiar with all the products available to the professional nail industry. You can ask your beauty products distributor for names of products he carries that don’t contain that ingredient, or you can call manufacturers directly and see if they offer alternatives. They should be happy to help you find a product that will work.
Once you’ve found a suitable replacement, apply the product to just one nail. If your client has no reaction after three or four days, you can probably safely perform the service on the other fingers. If acrylic or nail glue was determined to be the problem, it is important that the complete service be done on the test nail prior to doing all the nails. This is especially true if new or different adhesive substances are being tested.
Don’t fret if nail polish or nail treatments are found to be the problem. Polish is only an allergen in its wet state, so if adequate precautions are taken to dry the polish before it contacts the skin, there is no risk of causing contact dermatitis.
Use tests are safe and your practice of performing them ensures that clients are not exposed to products that will cause them an unpleasant or unhealthful reaction. The greater hazard is not patch testing clients who have allergy problems. Your failure to perform these quick and easy tests dooms some patients to repeated attacks of avoidable contact dermatitis.