Nail & Skin Disorders

The Lab Reports: Top Nail Experts Answer Your Questions

With the tremendous technological growth in the nail industry, nail technicians are better prepared for their jobs when they are armed with correct, up-to-date information. NAILS has assembled a panel of experts in the fields of chemistry, dermatology, podiatry, and genetics to answer readers’ questions as they relate to the chemicals, products, and techniques they use. Led by Richard K. Scher, M.D., the panel of experts will bring the latest, most accurate information to answer nail technicians’ direct questions bimonthly. In this debut column, meet the panelists and review these initial Lab Reports.

Nellie Brown, M,S., Western Regional Director, Chemical Hazard Information Program, Cornell University.  A biologist and chemist, Ms. Brown earned a master’s degree in a multidisciplinary program in natural sciences and applied science from the State University of New York College at Buffalo. Ms. Brown designs and teaches occupational safety and health courses for employers, labor unions, and the public. She is the author of numerous occupational health hazard manuals and MSDS companion sheets, available through the Chemical Hazard Information Program and the NYS Department of Health. She holds a New York State Grade II-A Wastewater Treatment Plant Operator’s license, is a certified lead inspector, and has been trained as an HIV Test Counselor. Ms. Brown was a speaker on workplace violence for a television special filmed by the BBC.

Karen Filkins, M.D., Director of Reproductive Genetics, West Penn Hospital (Pittsburgh, Pa.) - A board-certified clinical geneticist, obstetrician/gynecologist, and medical examiner, Dr. Filkins’ main area of expertise lies in genetics as it relates to pregnant women and their unborn babies. She is Clinical Associate Professor of Human Genetics at the University of Pittsburgh Graduate School of Public Health and serves as the Director of the Teratogen Information Service Pregnancy Safety Hotline at West Penn Hospital. Dr. Filkins has authored numerous books and papers, and also serves as scientific editor for an on-line reference of fetal anomalies.

Jamie L. MacDougall, M.D., Assistant Professor of Medicine and Dermatology, Los Angeles County/USC Medical Center - A graduate of the University of Southern California School of Medicine, Dr. MacDougall has practiced dermatology with distinction for the past eight years. He is an assistant professor of medicine and dermatology at the Los Angeles County/USC Medical Center, is on the staff at Centinela Hospital Medical Center, and is a fellow in the American Academy of Dermatology.

Godfrey Mix., D.P.M., Podiatrist, Sacramento, Calif. - Dr. Mix has been a podiatrist for 25 years. He is a member of the American Podiatric Medical Association, has served on the California Board of Podiatric Medicine, and is board-certified by the American Board of Podiatric Surgery. He is a regular contributor to NAILS Magazine.

Phoebe Rich, M.D., Clinical Assistant Professor of Dermatology, Oregon Health Sciences University - Dr. Rich founded the Nail Disorder Clinic at OHSU as well as her own private practice in Portland. She received her medical degree from OHSU. Dr. Rich has published work in the journal of Dermatologic Surgery and Oncology and the Journal of the American Academy of Dermatology.

Richard K. Scher, M.D., Professor of Dermatology, Columbia University Presbyterian Hospital, Head of the Section for Diagnosis and Treatment of Nail Disorders at Columbia University-Presbyterian Hospital -  Dr. Scher is an internationally known expert and pioneer in nail disease treatment and surgery. His textbook on nails is the premier work in this area. Dr. Scher has also published more than 200 articles on the subject and lectured extensively to both medical and lay groups. He writes a bimonthly column for NAILS Magazine.

Doug Schoon, Director, Research and Development, Creative Nail Design Systems (Vista, Calif.) - With more than 22 years’ experience as a research scientist, international lecturer, and author, Schoon is also the founder/executive director of Chemical Awareness Training Service. He is a chemical consultant to the American Beauty Association and is a member of the safety and standards committee of the Nail Manufacturers Council. Schoon holds a master’s degree in chemistry from the University of California at Irvine.

Sunil J. Sirdesai, Research and Development Director, OPI Products (N. Hollywood, Calif.) - An expert in the synthesis of novel monomers and polymers, Dr. Sirdesai has studied them in both academic and clinical settings. After receiving his Ph.D. from Rutgers University, Dr. Sirdesai studied at Marquette University and Polytechnic University. He has published and presented many papers to professional groups and academic journals.

 

Q. This past winter I thought I was having a problem with severe dry skin, but it showed up on only three of my fingers. The skin would get really dry and flaky, and then it would peel. I peeled so much my fingers were raw. The peeling continued through the spring, so I finally went to a dermatologist. After months of testing and hundreds of dollars in bills, the doctor told me it was an irritant reaction from constant contact with acrylic. He told me to use rubber gloves and liners to prevent contact with the chemicals. I have been doing this for months now and even with the protection, I have some really bad days with pain and irritation on these same fingers. How can it pass through that barrier? Could it be contact with dust particles in the air when I change gloves?

Dr. MacDougall: Allergic and irritant sensitivity reactions to acrylic monomers are a relatively common problem. Unfortunately, since these chemicals are powerful solvents that easily pass through rubber and skin, a single pair of gloves leaves your hands vulnerable. Additionally, since the acrylic monomer molecule readily penetrates damaged skin and produces an inflammation of the nerve endings in the fingers, the accompanying pain and altered sensation of exposed skin can last for several months after exposure to acrylic has stopped. It is not possible to desensitize yourself to acrylic once sensitization has occurred. Therefore, you must learn to handle and apply acrylic with a “no-touch” technique, using instruments only and wearing at least two pairs of gloves so that if one is contaminated, it can be discarded immediately.

Doug Schoon: After speaking with Sherri, the reasons for her continued problems became clear. Adverse skin reactions to enhancement products are caused by prolonged or repeated contact. If all contact is avoided, the symptoms should disappear. Gloves are a great way to prevent skin contact with UV gels or liquid monomers. However, dusts can also cause problems. Fresh nail filings contain trace amounts of unhardened UV gel or monomer. Eventually, an allergic reaction may develop. In this case, Sherri did not wear her gloves while she filed and shaped.

Since she was using a liquid and powder, bead consistency is also important to consider. If too wet of a bead consistency is used, the filings become enriched with monomer. This can worsen the problem if skin contact is not avoided. To prevent this problem, make sure you use a medium consistency. Using a consistency that is too wet, or touching the soft tissue with enhancement products causes most of the skin problems in our industry. To protect yourself and clients, both must be avoided. Nail technicians with sensitive skin should consider using non-powdered gloves made of nitrile, rather than powdered latex gloves.

Q. Exactly what does primer do to the nail plate, and is it harmful to double or triple-prime the nails at each fill?

Doug Schoon: Primers are like double-sided sticky tape. One half of a primer molecule is strongly attracted to the product, and the other hall is attracted to the natural nail surface. Primer molecules act like millions of tiny anchors or .suction cups to improve adhesion. It is a myth that primers eat or damage tile nail plate. They do neither. However, it is possible to use too much primer. Excess primer can run into the client’s soil tissue and cause painful burns. Also, over-priming can cause the nail plate to separate from the nail bed. If the nail plate is naturally thin or damaged by over-filing and heavy abrasives, primer can soak through to the bed. The result may be temporary burns or permanently scarred nail beds. Luckily, this is easily avoided by careful use. If you completely wipe the excess from the brush, it will contain enough primer for one entire hand. Too often, over-priming becomes a crutch to cover up faulty application techniques or improper nail prep. In the long run, over reliance on primer will cause more problems than it solves.

Q. I have a client who has had acrylic nails for two years with no problems until recently. A month ago, a couple of her own nails started lifting off the nail bed. Then were no signs of swelling, itching, soreness, or discoloration. Five months before that she broke out in a severe case of psoriasis all over her body. Could these two problems be connected?

Dr. MacDougall: Approximately 50% of people with psoriasis will develop changes in fingernails, and about 35% will develop changes in toenails.

The three main changes include:

1)      “pits,” which are tiny indentations in the nail plate

2)       brownish discolorations under die nail called oil spots

3)       onycholysis (separation of the nail plate from the nail bed), which is usually associated with a yellowish, crumbly material.

Dr. Rich: Although there are many causes of onycholysis, psoriasis is the most likely diagnosis in this case. Treatment of nail psoriasis consists of applying topical cortisone creams and lotions to the nails, and sometimes injection of cortisone into the nail fold. Progress is often slow because the nails take many months to grow out normally. Some psoriasis patients show a “Koebner reaction,” where any injury or irritation to the skin or nail can cause psoriasis to appear in the injured area.

Q. I recently had a client who let her acrylic nails grow out. She had worn acrylic for more than two years without any problems. Two months after the acrylic was finally gone, her nail plates started lifting off the nail beds. Almost all the nails looked like they had a fungal infection. What causes this?

Doug Schoon: The most common cause of nail plate detachment is physical damage or nail abuse. Over-filing with heavy abrasives or drills can damage the thin tissue that holds the nail plate to the bed. Wearing enhancements that are too long can cause these injuries, too. Over-filing or “roughing up” the nail plate probably accounts for most detachments. Improper removal is also a major reason. Drilling, grinding, and picking product from the nail plate can pry it away from the bed. Product should be removed only when necessary and with the utmost care. In this case, the nail technician did not remove the product, but instead allowed the client to grow the product oft. This creates a situation where the enhancement becomes seriously out of balance. Nail enhancements that are not properly maintained are much more likely to lead to plate detachment. To avoid this, nail technicians should take responsibility for ensuring regular maintenance and proper removal.

Once detachment occurs, it is very easy for a fungal or bacterial infection to start. While nails are reattaching to the nail bed, keep nails very short and avoid all heavy filing or other physical trauma to the damaged nail. Instruct the client to very gently clean the area and avoid further damage. If care is taken, most detached nail plates will grow out normally in 8-10 weeks.

Dr. Rich: The most common cause of onycholysis is injury to the hyponychium (the area under the free edge of the nail) and the nail bed. Women who wear acrylic nails, particularly if they keep the length longer than the tip of the finger, are prone to injury to the nail bed. The long nail acts as a lever that transmits force to the nail bed. When a minor impact occurs, such as opening the car door, the force is transmitted to the nail bed. These small injuries can cause onycholysis. It is impossible to say for sure what caused your client to have onycholysis, but it is possible that as her acrylic nails grew out, the tips where the acrylic was present allowed force to be transmitted to the area where no acrylic was present.

Keywords:   allergic reactions     fungal infections     onycholysis  

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