> CHEMOTHERAPY/RADIATION-RELATED NAIL CHANGES: Cancer treatments and drugs can cause brittle, grooved, or sensitive nails. The most common nail change is hyperpigmentation or skin darkening under the nail. Other changes include horizontal depressions of the nail plate called Beau’s lines, white horizontal discoloration involving the entire nail plate called Mee’s lines, and white horizontal discoloration involving only part of the nail called leukonychia. Onycholysis, where the nail separates or loosens from the nail bed, and onychodystrophy, a malformation of the nail, can also occur. Once the cancer treatment has ceased and the nails grow out, they should return to normal. Trim, file, and clean the nails as long as they haven’t lifted off the nail bed — lifted nails can become a site for bacteria to enter — but avoid artificial nails for a few months until the natural nails have returned to normal. Acrylic nails especially can trap bacteria in the space between the acrylic and the natural nail.
> CHEMO-INDUCED PERIPHERAL NEUROPATHY: Ask your client if she is experiencing any numbness, burning, or tingling in the feet or legs, as this may indicate she has suffered damage to peripheral nerves as a result of chemotherapy. Just as a diabetic suffering from peripheral neuropathy must be treated with extra care, a cancer patient must be monitored for symptoms, as chemo-induced peripheral neuropathy could leave her vulnerable to burns from
friction or water that’s too hot, or the inability to feel pain from nicks or cuts.
> HAND-FOOT SYNDROME: Several types of chemotherapy drugs can cause a condition called hand-foot syndrome, also known as palmar-plantar erythrodysesthesia. According to Mórag Currin, founder of Touch for Cancer Online, the soles of the feet can become red, tender, dry, and even peel, as a result of exposure to heat and friction. This condition can resemble severe sunburn and is sometimes accompanied by numbness or tingling sensations. Be sure to use a highly emollient product and massage gently to avoid too much friction and heat that could exacerbate the condition.
> BLEEDING/INFECTIONS: Always ask your client if she has approval from her doctor to receive nail services before proceeding. A March 2013 Houston Chronicle story quotes Dr. Philip Salem of Salem Oncology Centre in the Texas Medical Center: “When platelet counts drop below a certain level, the patient becomes very prone to bleeding, sometimes to a level where you cannot allow pedicures at all,” Salem says. “The decision of doing something as seemingly simple as a pedicure has to be done jointly with a doctor to ensure the patient’s safety.”
Additionally, people undergoing chemotherapy and other cancer treatments are more prone to all types of bacterial, fungal, and viral infections. Because of your client’s compromised immune system, take extra precautions to prevent
infection. Always wear gloves, and never nip or cut cuticles. Instead, push cuticles back and file nails gently. Reassure your client that all of your implements are sanitized, disinfected, and/or single-use.
THE CANCER PATIENT’S RX
Here are some things to keep in mind when performing nail services on a cancer patient:
> Chemotherapy and radiation may cause your client to become hyper-sensitive to certain products and aromas. Avoid products with alpha-hydroxy or beta-hydroxy acids, and use three-free nail products. Encourage your client to keep her nails simple and natural while she is going through treatment. “Your client’s medical practitioners may require that her nails are not polished,” says Andrew Flanagan, a nail tech at The Spa Magnolia in Victoria, B.C., Canada, who specializes in aesthetic services for oncology patients. “Practitioners need to monitor the nail bed, so a nice nail buffing may be all that you can do.”
> Treat your client with extra care and compassion. Remember that your service can be a wonderful respite from medical treatments. “Patients spend a lot of their time in hospitals and clinics with doctors or nurses who are always focused on their illness,” says Flanagan. “Salon outings for cancer patients can be a very social event. Often, cancer patients love to have the opportunity to talk about anything except their illness — and some of them are not shy! Before every service, take a minute to gather yourself and be ready for the unexpected; you will feel very rewarded in the end.”
Read more about providing nail services to cancer patients here.
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