Being a nail technician is not just about applying the perfect coat of polish or knowing the latest Essie shades for the season. Nail technicians are also responsible for protecting the health of their clients and themselves. Maintaining top health standards in order to prevent the spread of infectious disease is accomplished by adhering to strict sanitation and disinfection guidelines, reading product Safety Data Sheets, and by being able to recognize the appearance of skin and nail infections. Having a clear understanding of the clinical presentation of infections of the skin and nails is crucial for the health and safety of both clients and nail technicians. The following is a summary of several infectious entities that every salon worker should be able to recognize and that will no doubt walk through your salon door at some point.

If you suspect that a client or a fellow salon worker has one of these infections, it is imperative to recommend that they see a physician for treatment. Knowledge is power and knowing what to look out for is vital for the health of everyone involved.


Warts are verrucous papules that frequently have a “cauliflower-like” appearance and tend to occur on the hands, feet, and around the nails. Warts are caused by the human papilloma virus (HPV), are contagious, and can spread from contact. Warts can be very difficult to treat.


Onychomycosis means fungal infection of the nail. Nail fungus can be caused by dermatophytes (fungus), yeast, or non-dermatophyte molds. Multiple factors predispose a person to fungal infections of the nail including increasing age, diabetes, suppressed immunity, excessive sweating (hyperhidrosis), poor circulation, and nail dystrophy (irregular growing nails). Additionally, nail fungus can be acquired from fungal infections at other areas of the body. For example, tinea pedis (athlete’s foot) can spread to the toenail, especially if the nail is damaged or lifted. Although onychomycosis can occur on either the fingernails or toenails, it is much more common on the toenails. Onychomycosis on the hands tends to occur in two scenarios: 1) when the feet are significantly affected and the individual frequently touches his or her feet; or 2) in people who may have a compromised immune system. Onychomycosis on only the fingernails is unusual and a dermatologist should evaluate any suspected case because it is possible that the diagnosis is onycholysis (nail separation). Onychomycosis is the most common infection you will see in the salon and it happens to be the most common nail disorder in adults. Even though the appearance can be highly variable, most nail technicians are able to recognize onychomycosis. Often the nail appears discolored and can be yellow, white, brown, thickened and/or crumbly. There is significant debris under the nail and the surrounding nail folds, and the cuticle may be redder than usual.

Staph Folliculitis

Staph folliculitis is an infection of the hair follicle that is usually caused when the bacteria Staphylococcus aureus enter an opening in the skin. This can occur anywhere on the body where there are hair follicles. Red and pus filled pimple-like bumps appear and the surrounding skin can become red and tender. This type of infection is extremely contagious. A bacterial culture should be performed and antibiotic therapy is imperative.


Pseudomonas is a bacteria known as “the greenies” in many salons because it produces a pigment, pyocyanin, that imparts a green color to nails when the organism makes its habitat on the nail plate. Most nail technicians are aware of pseudomonas, but many don’t know that it is caused by bacteria and needs to be effectively treated.

Photo courtesy of James Heilman, M.D.

Photo courtesy of James Heilman, M.D.

Herpetic Whitlow

Herpetic whitlow is an infection of the hand and usually the tip of the finger caused by a herpes virus. The digit appears red and swollen, and is usually significantly tender. There may be fluid-filled blisters and the infection is contagious.

Tinea Pedis

Tinea pedis, also known as “athlete’s foot,” is a fungal infection of the skin of the foot. The sole of the foot can be red and scaly, or alternatively you may observe a macerated [soft and whitish], wet, and cracked appearance between the toes in the toe web spaces. It is most commonly in the third and fourth toe web spaces.

Dr. Dana Stern

Dr. Dana Stern

Dermatologists treat skin, hair, and nails. I am a board-certified dermatologist and I specialize in the treatment of nail disorders including nail infections, inflammatory diseases of the nail, cosmetic issues related to the nail, cancers of the nail, sports-related nail injuries, and nail surgery.

Most of my consultations are from other dermatologists, physicians, or patients who have read about me and I also see patients referred from nail salons. I view my relationship with nail technicians as a partnership in that we are all trying to do what is best for our patients and clients. I am always happy to collaborate and to offer my expertise, and the relationship is reciprocal, as I enjoy learning from nail technicians as well.


You can contact Dr. Stern with your questions via Facebook or Twitter (@DrDanaStern). Visit her website at

Read previous “day in the life” articles by Dr. Stern at


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