What is it? Koilonychia, or spoon nails, is a condition where the nail bed is flat or concave and dips or waves are visible on the surface of the nail. The dips and waves are actually in the nail bed — but since the natural nail is attached to the bed, the abnormality affects the nails. In mild cases of koilonychia, nails appear to have a wavy texture. In more severe cases, the nails have a spoon-like indentation in the middle, and the center of the indentation will be deep enough to hold a few drops of water. Often the nail is split vertically down the center. At times, the sides of the nails flare out, the skin under the nail can become very dry, cracked, or split, and the hyponychium can thicken.

How do you get it? The causes of spoon nails vary. The condition can be hereditary. When this is the case, multiple nails will be affected with some sort of concave dip. The indent will grow out, but the new nail will have the same indentations. Sometimes spoon nails are due to a client continually picking, biting, or rubbing her nails. When that is the case, only the nails the client has damaged will show signs of koilonychia. Severe trauma to the matrix of the nail can also cause koilonychia. In this case, only one nail will be damaged, and the client will be able to remember an isolated incident when it happened. Anemia can also cause spoon nails. Rarely, koilonychia is the result of a systemic problem, such as lung or heart problems or even cancer.

How is it treated? Doctors will evaluate the nail and get a patient’s history to determine the cause of the disorder. The doctor may opt for no treatment, knowing the deformed nail will grow out; she may recommend an iron supplement, or she may order more tests to determine if there is a deeper cause. Treatment can also include an emollient that softens the nail and the surrounding skin to prevent splitting and cracking.

What can a tech do? Once a doctor has determined there is no risk involved in enhancements, techs can apply an overlay to even out and correct the concave nail. Be sure to prep the area that is indented carefully — it’s easy to miss a spot on an uneven nail. During the application step, press firmly on the concave area, filling in the small dips completely.

What else? Be aware that when koilonychia is in the advanced stages, it is possible for bacteria to get lodged in the split nail or in the open, cracked skin. Sometimes trapped bacteria or fungus will turn the area yellow or green. Do not apply product over any compromised skin or over a spoon nail that is cracked in the middle, regardless of whether any discoloration is evident. Water can easily get trapped and bacteria can grow, even with careful preparation.


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