One of my clients was wearing acrylics and after awhile her thumbnail started to lift from the nail bed. I removed the acrylics and clipped the nail as short as I could. There was no improvement in her nail, so she went to the doctor, who told her to soak it in vinegar twice a day. When that didn’t work, he gave her some cream to apply, but that isn’t helping. Now the side of her finger is very sensitive. Can you please advise me on what to do?


Dr.Rich: The lifting of your client’s thumbnails is called onycholysis (separation of the nail plate from the nail bed). In someone wearing acrylic nails, the most common cause of onycholysis is trauma to the nail. The acrylic nail is harder and stronger than the natural nail and resistant to breaking. Therefore any force that is exerted on to the nail is transmitted to the weakest part of the nail bed and the nail is separated from its attachment in the nail bed. Once the separation has occurred, the space beneath the nail plate becomes a breeding ground for yeast and bacteria. Keeping the nail short is a good idea, as is using a topical antifungal medication for any yeast that might be present.


Rarely does an allergic reaction to the acrylic cause onycholysis, but if your client experiences itching of the nail folds and persistent rash following fills, it could be that she is allergic to a component of the acrylic product. It may not be necessary to remove the acrylic. If she can keep the nail very short, stay out of water as much as possible, and continue using an antifungal cream, the nail will often reattach over time. This reattachment is dependent on regrowth of the nail and may take many months to occur. Vinegar soaks are helpful when the bacteria pseudomonas (seen as a greenish black discoloration under the nail plate) is present.


Dr. MacDougall: White vinegar soaks are commonly used as an inexpensive antibacterial agent and are often helpful when treating pseudomonas infections. The doctor must have been trying to clear such an infection. If the side of her finger has become sensitive, especially if it is also becoming swollen, then the finger has probably developed paronychia, which is an inflammation or infection of the paronychium. These types of infections are either bacterial (which tend to be painful), yeast-induced (which tend to be less painful), or mixed, in which case both types of organisms are present. At this point the doctor would probably choose to treat with oral antibiotics and topical or oral anti-yeast medications to clear the infection.


In the past, I have used pure acetone as my polish remover. It works faster, smells better, and is more cost effective than other removers. I recently started a new job, and when I suggested using pure acetone, everyone reacted very negatively. Do you have any research on the subject?


Sunil Sirdesai: Pure acetone is a strong solvent and it does work faster, but chances are you are also removing a thin layer of acrylic nail along with the nail polish. This is the reason acrylic nails feel tacky when you use pure acetone to remove polish. You might have to buff or refile lightly to even the surface of the acrylic nail before reapplying nail polish.


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