n. a deformity in the nail bed that results in a concave indent of the nail plate, causing the outer nail to turn out; also called spoon nail.

What It Is
Spoon nails are a deformity in the shape of the nail bed, and consequently, in the nail plate. Usually the indented area of the nail will grow out over a number of months, but if a client has a persistent issue with spoon nails, it could be a sign of a larger, systemic problem. Dr. Parker Gennett, a podiatrist in Vestal, N.Y., suggests that clients who have spoon nails get a baseline exam from a doctor before enhancements are applied. If techs have a history with the client, they can often determine how to proceed without the advice of a doctor, Dr. Gennett says. However, if the client is new, and the nail plate doesn’t look clean and healthy, a baseline exam is sound advice to check for fungus, anemia, or a more serious systemic problem.

Spoon nails are exactly that — the nail distorts to a shape similar to a spoon. The nails are distorted because of a concave indent in the nail bed, onto which the nail plate is adhered. Some cases are so mild the nail appears to have only a soft wave in it. Other cases are severe, making the nail brittle and thin and causing it to split and crack inside the concavity. The splitting in the nail can extend to the end of the nail forcing the outside edges of the nail to turn upward. The skin surrounding a nail damaged by koilonychia is usually dry and cracked. Fungus can develop easily in the cracks and splits of the nail plate, and the fungus can cause yellow/greenish discoloration. The hyponychium may be thicker than normal.

Spoon nails can stem from a number of causes. They can be hereditary, in which case the nail(s) would appear clean and healthy — a normal nail, except for a small deformation in the contour. Picking, biting, and rubbing nails over a long period of time could result in spoon nails. Another cause is related to diet. Often associated with anemia, spoon nails function as an early warning sign that the body is lacking essential nutrients. When a long-standing client develops spoon nails but can’t remember a recent injury to the nail, she may have developed an iron deficiency.

Spoon nails can also be caused by trauma to the matrix. Seasoned techs will be able to identify this type of nail deformity: Only one nail will have concavity, the client can remember a painful experience involving that finger, and the abnormal shape originates at the cuticle and moves slowly but steadily to the free edge.

A final cause of spoon nails is a systemic problem, such as lung or heart problems, or cancer. Dr. Gennett says as a general rule “90% of all diseases will manifest in the nails at some point.” Consequently, nail techs need to know when to advise clients to seek professional help. “The key is change,” explains Dr. Gennett. “If the nail changes position by growing out, that’s good.” However, if techs notice a change in the color of the nail, they should suggest a visit to the doctor, says Dr. Gennett. A change in color could mean a fungus — or something much more serious, such as a growth under the nail, which could be malignant.

How to Treat Them
“Because nails grow so slowly, spoon nails could take six to nine months to correct,” says Dr. Gennett. If the cause is from anemia, the client will need to ask a pharmacist or doctor about an iron supplement to balance the low levels in her system. If a spoon nail is caused by trauma, it should grow out naturally to the free edge and be filed off. However, treatment can include emollients to soften the nail and the skin around the nail. This works well with toenails affected by spoon nails because a toenail won’t be covered with an enhancement. Topical cream could help make the thin, brittle nail and the surrounding area softer.

Dr. Gennett warns against applying an overlay on a toenail affected by koilonychia. The secondary stage of spoon nails is that the hyponychium thickens and the natural nail curves up. “Bacteria like this environment,” says Dr. Gennett. Any type of extension could catch and hold water. This is more likely to occur on the toes — and it often takes longer to spot — because toes are covered by shoes.

Considerations for Nail Techs
If you suspect a client has spoon nails, your best defense against potential problems is to ask questions. Find out how long the client has had the condition. If the nail is cracked or discolored, if you have no history with the client, and if the client has no knowledge of trauma to that finger, your best bet is to refer the client to a doctor before you add an enhancement. Spoon nails that are deeply cracked and split indicate permanent damage to the nail bed and will likely split the acrylic overlay, making the area a vacation spot for bacteria and fungus.

If the nail plate appears clean, with no splits or cuts, and if the client’s nail has been like that “as long as she can remember,” you should be safe applying an overlay. However, you do need to take a couple of precautions.

Prep the nail as you would normally, being especially careful to remove all the oils in the harder-to-reach contours of the spoon-shaped nail plate. Then, apply the bonding agent of your choice to all areas of the prepared nail. Be aware that if the adhesive misses any part of the indented nail, you could have lifting. Finally, during the application, firmly pat the product to fill in the depressed area and add more product as needed to complete the application. Remember, the product will be thicker where you’ve filled the indent. If koilonychia has occurred because of trauma, you will see the difference in product thickness when the nail grows out to the free edge. Don’t get nervous. Instead, be happy that you’ve helped make your client’s hands beautiful during the healing process.

— Michelle Pratt is a freelance writer and licensed nail tech based in Johnson City, N.Y.

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