Nail & Skin Disorders

Lab Reports


i have been using a gel product on a client for several years. A few months ago she started complaining that her cuticles were sore after her appointments. I attempted to be even more careful in my filing, especially near the cuticle area. However, the problem has gotten worse. Her cuticles appear dry with some swelling. She does not complain of any soreness on the nail bed, but her natural nails are lifting from the nail plate. The hyponychium appears dry and flaky and some parts of the free edge appear wihite, like a fungus.


I have instructed my client to see a dermatologist, but she refuses because she is afraid she will be told to remove the enhancements. What should I do?


Dr. Rich: Your client has had an allergic reaction to the gel product. This is rare but I have seen it in my practice several times. Generally the reaction looks scaly and flaky around the nail folds and hyponychium. It is usually worse for a few days after the product is applied. The solution to the problem is simple: Switch your client to acrylic nails or to silk or fiberglass wraps. These products are different enough from gels that people who have an allergy to one product usually can use the others without any problems. The only time this would not work is if the client is allergic to the cyanocrylate glue used in wraps and tips.


You can test your client to see if she is allergic by applying the gel to a Band-Aid and after it is cured having your client apply the Band-Aid to her inner arm. If she develops an itchy rash there after 24 hours then she is allergic to the gel product. You could test to see if she’s allergic to the glue in the same way.


Dr.MacDougall: Without actually seeing your client it would not be possible to render a diagnosis, but the presence of a dry, flaky hyponychium with some parts of the free edge appearing “white like a fungus” should alert you to the possibility of an uncommon form of nail infection referred to as superficial white onychomycosis. This is usually caused by the same organisms that cause athlete’s foot. In some people, they are unable to completely penetrate the nail plate, so they cause infections on the surface of the nail plate instead. She could try using any of the over-the-counter antifungal solutions, which should be brushed on with an old toothbrush twice daily. This mechanically debrides the affected area and helps deliver medicine onto the surface of the nail where the fungus resides.


Other possible causes are allergic reactions, drug reactions, psoriasis, and lichen planus as well as other rarer disorders. Her fear of what a physician might tell her is a poor excuse to avoid seeking medical attention. As one of my medical school professors once said, “Denial cures everything … eventually.”


I’m a nail student. My aunt’s nails peel and split. I have used Nail Envy nail hardener but within a couple of days her nails begin to peel and split again. She’s a kinder-garten teacher so her hands are in water a little more than the average person’s, but they don’t improve during the summer when she isn’t at school. I checked to see if her lotion has sodium hydroxide in it, and it doesn’t. She uses nail polish remover less than once a week. Could there be formaldehyde in the nail hardener or polishes? What can I do?


Sunil Sirdesai: I don’t think the lotion is affecting the nails. Nail Envy does contain formaldehyde. It is not uncommon to have formaldehyde in nail hardeners as it is the component responsible for hardening the nails. We have noticed that a small percentage of people get peeling and splitting when they use formaldehyde. In most cases, this problem is solved by switching to a formaldehyde-free formula.


Rich: Your aunt has brittle nail syndrome. The typical brittle nail is thin, peeling or splitting sometimes with longitudinal ridges that can chip at the free edge. It is not known for certain exactly what causes this condition but an important factor is dehydration of the nail plate. Brittle nails are exacerbated by frequent exposure to detergents, soapy water, and solvents. Anemia (iron poor blood) can be a rare cause of brittle nails. There is often a familial tendency to have thin, fragile nails.


Treatment should be aimed at moisturizing the nails. You are correct to check for ingredients in lotions and nail cosmetics that might worsen the problem. It is doubtful that there is free formaldehyde in her polish. (Toluene sulfonamide formaldehyde resin is a common ingredient in polish but this chemical does not contain formaldehyde.) The main problem with free formaldehyde is primarily an allergic reaction and your aunt has different symptoms. Have your aunt use a heavy moisturizer on her nails every time she washes her hands. Nail Polish is OK if she does not over-use polish remover. She may also want to try a vitamin called Biotin that can be purchased at the health food store or pharmacy. It will take at least four months to see progress.


I was on my way to being a successful nail tech when one day the three fingers that I hold my client’s fingers with and the three fingers on my other hand that I hold my brush with broke out really bad.


My fingers swelled up and got blotchy white spots and they itched terribly. I had deep cuts all over the tips of my fingers.


I know I am allergic to the monomer I was using. As soon as I stopped working, it took about a month to heal. I have tried using gloves but that doesn’t help. I want to know if there is a monomer that is made for sensitive skin. I haven’t always had this problem and I’m thinking it’s something in the monomer I’m using now. What can I do?


Dough Schoon: 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 will last for life. This is why it is so important to work safely and always avoid skin contact with all monomers, gels, and resins. Any of these can cause adverse skin reactions if used incorrectly. Once a technician allows herself to become overexposed to this degree, her options are limited.


It is important to understand, nail technicians don’t become allergic to monomer or gels or any other product – they become allergic to a specific ingredient. A good dermatologist can help identify the ingredient(s) by patch testing. This is the only sure way to determine what is causing the allergies. Once you know the actual cause of the allergy, you can find products that do not contain that ingredient. However, if the technician continues to use sloppy techniques that cause overexposure of the skin, eventually, she will probably become allergic to another ingredient. Remember, all adverse skin reactions are completely avoidable, but skin contact must be avoided and products must be used correctly.


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