Q: What's happening to cause my acrylic clients' peeling under the free edge? A few clients of mine who wear acrylics arc experiencing peeling of the natural nails from underneath the free edge. When the nail peels, water gets trapped and bacteria grows. How can I stop the natural nail from peeling? Why does this happen?
A: Peeling of the nail plate, referred to as onychoschizia, may occur from a variety of causes. By far the most common cause is dehydration, or loss of moisture. It may be seen in people who have dry skin (some refer to this as "dry skin of the nails") or in patients who have eczema. Overuse of soap and water, too-frequent washing, and frequent contact with detergents may also precipitate this problem. In addition, the nail plate becomes drier with age so that in the elderly, peeling is more common. When the nail plate is in this condition, it is more brittle, cracks easily, and frays at the edges. Dermatologists often refer to this as the brittle nail syndrome. Artificial nails, whether sculptured nails or nail wraps that utilize adhesives, also have a tendency to cause peeling in some people. Those individuals, who are susceptible, which might include your clients, are probably prone to dry skin and nails.
There is no foolproof means of preventing the nails from peeling. However, if you buff the nail plate slightly to smooth the surface prior to applying acrylic, peeling is less likely to happen. It also helps to keep the nails well-moisturized when the acrylics are removed. Sometimes vitamin supplementation with biotin, a vitamin found in eggs, is also beneficial.
Q: I have two clients who have a similar condition on their natural nails that I have not been able to remedy. On several nails (but not all), there are large white patches that never go away. They do not grow out with the nail, so it seems they must result from something in the nail bed.
When I first remove the polish from the nails, the white patches tend to disappear, but as the natural nail remains exposed to the air for a few minutes, they return. If I apply oil immediately or give a paraffin treatment, the patches tend not to look white, although they can still faintly be seen. But when I prepare the nails for new polish, the nails become dry and white again and the polish tends to peel off more easily. Light buffing of the nail surface does not seem to change the whiteness, which also makes me think this is something in the nail bed and not on the nail plate.
I have been using a base coal for dry nails on both clients after trying all the other base coats we normally use, but the condition persists. Both clients are concerned because they do not feel comfortable without polish since the white areas are so prominent. Can you help us with a diagnosis and a suggestion for clearing up this condition?
A: White nails, known as leuconychia, may occur, as you imply, in two forms. First, the problem may be in the nail bed, where the spots tend to remain stationary, or in the nail plate, where they tend to grow out, just as you have stated.
From your description, I am inclined to think it is the nail plate that is affected. I say this because you mention that an oil or paraffin treatment helps diminish the spots' appearance; then the white spots return and the nails become "dry and white" again. These changes would not occur if the nail bed were affected, but certainly can if it is the nail plate that is affected.
My perception from your description is that your clients' nails are undergoing a drying-out process and that is what is causing the white spots. As you say, the whiteness disappears briefly when you remove the polish, but returns again when the nails are exposed to air. This is an excellent description of dryness. I recommend frequent moisturizing and periodic rest periods from wearing nail polish. In addition, formaldehyde-free enamels and acetone-free removers are also often beneficial.
Q: A few of my clients have developed a thin, ⅟4-inch-long brown line under a nail at one time or another. It starts in the middle of the nail and eventually grows out. The line appears whether they wear natural or artificial nails.
I can usually gently work out the line with a cotton-tipped orangewood stick when it grows a bit past the free edge. One of my clients suggested that it’s a hair that somehow works its way through the body and exits through the nail. I’m not worried about it, but I would like to know what it is.
A: The thin dark line could be cause by a number of conditions, none of which is cause for alarm. The symptoms you describe don’t indicate an infection or a tumor. I don’t believe the line represents the same disorder in all people. Some are undoubtedly splinter hemorrhages, which are tiny lines of clotted blood under the nail. Splinter hemorrhages, usually caused by injury to the nail, appear as ⅟4-inch-long, pencil-thin brown or black lines located near the middle of the nail.
A traumatized capillary in the nail bed causes blood to “pool” under the nail plate and bed, resulting in a splinter hemorrhage. The blood usually attaches to the underside of the nail plate and grows out with it. Because of the anatomical relationship between the nail plate and underlying nail bed, these small hemorrhages appear as longitudinal lines.
Lines in the nail plate can be caused by foreign bodies that have lodged under the nail plate. Depending on the client’s hobbies and occupation, it could be almost anything — dirt, hair, paint, or even a small piece of wire. If the object is tiny and the client is wearing nail polish at the time the object becomes lodged under her nail, the line won’t be visible until she removes the polish—making it appear to have developed suddenly. The object will eventually work itself out, or it might need a little prodding from the nail technician.
In response to your client’s hypothesis, a strand of hair cannot work itself out of the body through the nail. Hair is manufactured only by hair follicles, which are not found in the nail unit, and hair cannot be carried in the bloodstream. Even if a hair did somehow get into the bloodstream, it is impossible for the hair to work its way through the blood vessels and then exit the body via the nail. However, hairs frequently do become lodged under the nail.
Q: I have a client who has been coming to me for two years. She wears silk wraps on her natural nails. For the past two months, she has developed a rash on her middle and ring fingers on both hands the day after she gets her nails done. The affected fingertips turn red, and pinhead blisters develop under the skin on the side of the nails. You can feel the blisters, but you can barely see them. They don’t itch, nor do they visibly blister. The blisters never have pus. After a few days, they start drying up and the skin cracks. The client is on different medications; when it first happened she was on antibiotics and prednisone. She also takes aspirin. This client is in her 50s and may be on hormones. I believe she is going through the change of life. We have tried switching soap and the nail brush; I have even tried not using activator, but her fingertips still break out.
A: From your description, it sounds like you client is developing dermatitis (inflammation of the skin) around the nails. I cannot explain why it only affect the middle and ring fingers of both hands, but your client may be having a reaction to one of the products being used on the nails.
There are two types of reactions that occur. The first is called a primary irritant reaction, where the client’s skin is simply being irritated by some aggravating process that develops into an eczema-like change in the skin. The second possibility is that your client is actually allergic to one of the products. This situation is less likely because an allergy would probably affect all the fingers.
There are other causes that fit your description, such as overactivity of the sweat glands of the fingers, which produces a rash called dyshidrosis. This, too, seems less likely because your client’s condition always occurs a few days after the silk wraps are applied.
It might be advisable for your client to see her dermatologist so that a definite diagnosis can be made. If the cause of the problem is understood, the condition itself can be treated and may even prove preventable. This kind of rash is not associated with medications and is not the type of dermatitis associated with menopause. It might help to use a protective moisturizer on the skin before applying the wraps.
--Richard K. Scher, M.D. and Paul Kechijian, M.D.
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