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 white, 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.”