When a client comes to you for service with what looks like some type of skin disorder, how do you handle it? Does your salon have a sound policy regarding servicing clients with a skin disorder? Refusing to service a client and referring her to a physician is the surest way to either lose a client or gain her eternal loyalty. But there are certain skin conditions you will see in the course of your work that you should be able to identify.

While this article covers many skin disorders, it is impossible to cover all that you may see in the course of servicing clients. What this article will do is examine a broad spectrum of common disorders with environmental, fungal, viral, and unknown origins, and identify what the nail technician’s role is both in helping her client and protecting herself.

Many Skin Disorders Have Environmental Causes

Overexposure to the elements or any exposure to poisonous plants and insects can cause skin problems. Even water, in excess, is bad for skin. Different people have different reactions to common elements and compounds such as water, air, or nickel. Some are more sensitive than others; so while one person could wallow in a field of poison ivy for hours with no reaction, another would be hospitalized.

Hand eczema is a technical name for irritation of the skin and hands. It usually starts with red scaly patches on the back of the hands and in the webbed spaces between the fingers or on tire palms. Eczema can be caused by exposure to irritating substances such as household cleansers, chemicals, and even overexposure to water. In fact, it got the nickname “dishpan hands” because overexposure to water is such a common cause.

An allergic reaction to a substance can also manifest itself as eczema. When eczema is caused by an allergy, there may be small blisters on the skin, usually on the fingertips and the backs of the hands. Often the skin is very itchy or sore. If eczema is caused by a true allergy to a substance and not just a reaction to an irritating substance, every subsequent exposure to the allergen brings on a reaction that is worse than the one before it, says Doug Schoon, executive director of Chemical Awareness Training Service in Newport Beach, Calif.

Anyone can get hand eczema at any time, but it is most likely to occur in people who are genetically predisposed, those who have wet-work jobs such as nurses and hairstylists, electronics workers, those exposed to irritating or allergy-inducing substances, and those who are under stress.

Eczema is not contagious and you can help clients soothe its symptoms by recommending they wear gloves when working with water, avoid skin exposure to chemicals, and use a hydrating skin lotion on affected areas several times a day. Doctors usually treat eczema with a 1% hydrocortisone cream, which is a non-prescription drug found in most pharmacies.

Psoriasis, which is not contagious either, is more serious than eczema. Psoriasis is a chronic scaling disease that is usually caused by trauma to or irritation of the skin. A medical textbook, Practical Psoriasis Therapy, notes that psoriasis is common at the site of a scar, a burn, dermatitis (e.g. contact dermatitis, such as poison ivy), bites, a drug reaction, prickly heat, sun rashes, seborrheic dermatitis (flaky irritation of the scalp), ringworm, thumb sucking, a vaccine injection, herpes, shingles, and other infections of the skin.

The client with psoriasis can be affected on her elbows, knees, scalp, face, ears, and even nails. On the skin, psoriasis produces thick, white plaques or scales of skin. It looks like an extreme case of eczema, and, like eczema, is very itchy. Psoriasis can be very red and raw, or it can look like it was once raw but is now healing.

Aside from providing your suffering client with a good moisturizer, there is little you can do to help a client with psoriasis because treatment varies from patient to patient. For example, sunlight in moderation usually helps people with psoriasis, but it could be a mistake to recommend a few tanning sessions to your client with psoriasis because about 10% of psoriasis patients are adversely affected by any amount of sunlight. You can’t know if your client might be part of that 10%. A mistake of that sort could leave you open to a liability claim. Many times, topical steroids are used to treat the symptoms, but what you and your client can get over-the-counter is very different from what the doctor might prescribe.

Merely coming in for nail services can be therapeutic for psoriasis sufferers. Sometimes stress and anxiety can make psoriasis flare up, and a soothing manicure or luxurious pedicure could do wonders for their peace of mind.

If your client hasn’t already seen a dermatologist about her condition, suggest that she do so right away. There are a variety of treatments used by doctors to help psoriasis. Coal-tar derivatives in lotions or shampoos help to clear it up; plastic occlusion (wrapping) of the affected area helps lotion and ointment to penetrate the skin, and antihistamines and sedatives may be prescribed to relieve the itching and help the patient sleep.

Stasis dermatitis is an irritation of the skin that affects older people with poor blood circulation. It is commonly found in people with varicose veins, who are obese, diabetic, or who spend a lot of time on their feet, fane Martin-Wurwand, founder of the International Dermal Institute in Torrance. Calif., notes that stasis dermatitis, is characterized by broken capillaries and is itchy, irritated, and red. It is commonly found on the feet, ankles, bands, and wrists.

Although stasis dermatitis is not contagious, it does need some extra care during nail services. Stasis dermatitis can break down into lesions near and above the ankle. Howard Behrman advises in his book, Common Skin Disorder, that irritants should be avoided; pedicure service on people with stasis dermatitis then, should be as chemical-free as possible.

Keratosis pilaris affects mostly just the backs of the arms. It feels like a gritty material on the skin. Martin-Wurwand explains that keratosis pilaris is a build-up of skin cells around hair follicles, and that a loofah or dry brush along with an alpha hydroxy lotion will rid your client of the condition. It is not contagious.

What Do You Do When There Is Fungus Among Us?

Fungus affects skin differently than it affects nails. Skin-borne fungus is much easier to clear up than nail-borne fungus, says Dr. Jamie MacDougall, a Manhattan Beach, Calif.-based dermatologist. This is because antifungal preparations applied directly to the skin do not have an obstacle to penetrate (like the nail plate).

The most common skin-borne fungus is athlete’s foot, which is a fungal infection of the skin of the foot. The infection, also called tinea pedis, shows up as a rash, followed by cracks in the skin between the toes and a watery discharge, and it is very itchy. It is highly contagious and can be contracted by walking barefoot, particularly on moist floors such as those of bathrooms and swimming pools, where fungus lurks. The fungus can spread to other parts of the body.

During a pedicure service, if you suspect your client has athlete’s fool, you can continue the service, but it’s safest to wear gloves to prevent spreading the fungus, says MacDougall. There are some over-the-counter remedies to treat athlete’s foot, but if the skin is cracked and weeping, it is best for your client to see a doctor.

Ringworm is actually no kind of worm at all. It is a fungal infection of the skin or scalp. Ringworm is named for the red, usually circular eruption that spreads at the infection site. The infection usually causes burning and itching, and if it affects the scalp, may cause hair to fall out. Ringworm often occurs on moist areas of the body, such as the skin between the toes, the groin, and the armpits.

Ringworm can develop on the hands, and MacDougall says nail technicians shouldn’t service clients with ringworm until the infection is cleared. A nail technician should not attempt to treat ringworm. If a client has a small eruption, cover it loosely and completely with a gauze bandage. A medical professional will usually treat ringworm by keeping the infected area clean and dry and by applying various antifungal preparations.

Although much less common, tinea versicolor is a fungus of a yeast family that appears as dark or white spots or patches on the skin. Sometimes called “sun spots,” tinea versicolor leaves scaly round patches on the upper chest or back. When the skin is lighter than the rest of the skin, it looks as if the skin has lost its pigment. Typically it is discovered when the skin is exposed to light. The unaffected area will tan normally, but the areas where the fungus is growing either will not tan or will overtan; that’s how it gets the spotted look, Because it typically takes a sun tan to show up, tinea versicolor is seen most often in sunny locales.

Tinea versicolor is not contagious, but it needs treatment in early stages. Martin-Wurwand notes that sometimes doctors prescribe dandruff shampoo as a body wash to clear up the condition. “Those that contain selenium, such as Selsun Blue, work well, when used for a couple of week-she says. MacDougall notes that-tinea versicolor will usually only affect the upper torso unless it is left untreated. Untreated, it can spread to cover a large portion of the body and will require prescription medication to clear up.

All fungi that infect skin and nails are highly contagious. MacDougall says that maintaining thorough sanitation practices is a huge factor in preventing cross-contamination.

All fungi that infect skin and nails are highly contagious. MacDougall says that maintaining thorough sanitation practices is a huge factor in preventing cross-contamination.

Be Careful Yet Confident With Skin-Borne Viruses

Viruses are to blame for such skin ailments as herpes and warts. Although they aren’t fatal, herpes and warts can cause their victims considerable pain and embarrassment.

Herpes (which comes from the Greek word meaning “to creep”) simplex applies to several types of skin eruptions characterized by the formation of blisters. The blisters usually appear around the mouth and on the lips, near the nose, face, and ears, and in the mouth and pharynx.

Martin-Wurwand describes a condition known as herpetic whitlow, a relative of herpes simplex that affects the skin around the fingers and nails. (“Whitlow” is an old medical term that means “something affecting the end of the finger,” says MacDougall.) “Sometimes herpetic whitlow is mistaken for a nipper wound,” she says. The affected skin appears red and sore, and can be spread to the mouth, eyelids, and genitals. As with herpes simplex, there is no known cure, just relief.

MacDougall explains that herpetic whitlow looks like herpes found anywhere else on the body. Herpes simplex and herpetic whitlow can be transmitted through intact skin, and the virus is contagious from the first sensation of impending outbreak until the blisters form a crusty layer on their tops. He advises nail technicians to not work on affected fingers and to wear gloves while working on the rest.

Don’t confuse herpes blisters with eczema blisters. Herpes blisters are yellowish, look as though they have a clear-to-yellow liquid inside, and are painful; eczema blisters look like tapioca pudding under the skin and are itchy.

To help you distinguish herpetic whitlow from a non-herpetic wound, Martin-Wurwand suggests you ask your client where, she thinks she got the sore. If the client knows how she was wounded, it is highly unlikely it is herpetic. But, she says, if a suspicious lesion comes with no explanation and looks unusual, it’s best to send the client to a doctor for diagnosis and treatment.

People with lesions should not use a tanning bed, as light irritates herpes sores and causes them to flare up and become more painful.

Both types of herpes are considered very contagious, but only if you touch the actual blistered area. You can’t catch herpes by breathing the same air as someone who is infected. Therefore, wearing gloves and following strict sanitation practices make cross-contamination highly unlikely.

Warts are a fairly common occurrence but aren’t often thought of as a viral infection. When they occur around the nails (periungal warts), they are the dermatologist’s nightmare, according to MacDougall. Otherwise known as Verruca vulgaris, warts are benign tumors that are caused by a virus that stimulates rapid multiplication of skin cells. Most commonly found on the hands or the feet, warts are also contagious through direct contact.

Periungal warts are very difficult to get rid of and usually are spread by picking at other warts, says MacDougall.

Warts can sometimes be uncomfortable, particularly if they are on the bottom of the feet or between fingers or toes, but the embarrassment of the condition is usually greater than any discomfort they may cause. There are over-the-counter wart removers, such as Compound W, but the most reliable way to remove them is in the doctor’s office. A dermatologist will use liquid nitrogen to “burn” warts; they fall off several days after the treatment.

MacDougall says it is okay to work on hands with warts, but he recommends that you work on the affected finger after you have finished the other fingers. This should prevent you from spreading the virus to other fingers.

What Is That? Unknown But Not Overlooked

Modern science is baffled by some skin conditions that are sometimes important signs of underlying conditions. While a case of the hives may be a symptom of an allergy to cats (fairly easy to avoid), a little mole may be a sign of cancer. As a nail technician, you are in the unique position of seeing your clients on a much more frequent basis than most doctors see their patients. You also have the opportunity to be one of the first to notice certain physical changes in your clients.

Malignant melanoma is one of the least common but most deadly forms of skin cancer. It is thought to be triggered by long-term overexposure to ultraviolet light, usually from the sun. Typically it first shows up as a mole on a foot or ankle. Being that people don’t see the bottom of their feet very often, a pedicure service may be the first time anyone sees a new growth or a change; in an existing growth. Lynette Levy, an esthetician at Mimi Inc. nails and Skincare, says that when she notices suspicious growths, she tells the client that she has noticed “something,” that she isn’t sure what it is, and suggests the client have it examined by a doctor.

What You Know Can’t Hurt You

Through experience and time, you may have the opportunity to become familiar with some different skin conditions, but others you may only see once in your career. Some you may never want to see again. You should always suggest your client see a doctor if you are not sure what a particular skin condition is. Just make sure you have your client come back to you with instructions from her doctor as to what, if any modifications to her nail care regimen are necessary. Both of them will appreciate your caring and professional approach.

Taking Any Medications?

As is typical with the summer season, the quest for the perfect suntan is at its peak. Unfortunately, some people are on medication with a side effect known as photosensitivity. Photosensitivity is the condition where a drug causes the patient to have a more acute and severe reaction to ultraviolet light; in essence, the skin burns more quickly. Following is a list of drugs known to cause photosensitivity.

  • Accutane (used to treat acne)
  • Anti-cancer drugs
  • water pills
  • tranquilizers
  • antibiotics of the tetracycline family
  • lithium
  • anti-depressants
  • antihistamines
  • oral contraceptives
  • Retin-A
  • Anticonvulsants
  • some anti-diabetic medications
  • some high blood pressure medications
  • sulfonamides (these are usually prescribed for urinary tract infections)

If one suffers an inadvertent photosensitive reaction, it is usually treated by protecting the skin from light and avoiding the sensitizing substance when possible. The symptoms will most likely disappear within a week.

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