Q: The nails on the pinky and middle fingers on my client’s hand are thickened and growing almost straight up. The client used to bite her nails and has only been wearing acrylics for a few months. She doesn’t want to remove the acrylics to see if the condition goes away. Do you know what’s causing this?

A: Your client’s nail biting habit may have permanently injured the nails; if so, nothing can be done to return the injured nails to normal. However, since only two of the nails are growing abnormally, it appears that something local is altering their growth. My “educated” guess is that inflammation of the nail matrix or nail bed is causing the nails to thicken and push up. The inflammation could be the result of bacterial, yeast, or fungal infection. Although your client probably needs to see a dermatologist, you might try removing the acrylics from her nails and clipping the two thickened and malformed nails as short as possible. Keep the nails clipped short and free of applications for about three months to allow them time to heal. If your client is unwilling to try this approach or if her nails fail to get better within three months, refer her to a dermatologist. I can assure you the nails will not get better if the acrylics are not removed.

Q: Is it a fungal infection or not? 

A few clients at out salon have been diagnosed by their doctor as having fungal infections of the nail. (The nails are white and crumbly.) Some of the doctors say the condition is not contagious and that it’s OK to apply acrylic nails. The other doctors say it is contagious. Who is right? If it is contagious, what disinfection procedures do you recommend to prevent passing the fungal infection to other clients?

A: The question raises several important issues. First, crumbly nails are often caused by a fungal infection, but the diagnosis should be confirmed through tests performed by a dermatologist. Did the doctor culture the infected nails to establish the diagnosis?

When a fungal infection is present in the nails, it is best to leave the nail free of applicatons. Covering the nail with acrylics or nail enamel creates a warm, damp, protected environment in which fungi flourish. Routine use of these products is not recommended in clients with fungal infections. You can, however, cover the nail for brief periods of time to camouflage the client’s problem so that she looks her best for a special event, such as a wedding or an evening out.

The question of whether a fungal infection can be passed from client to client in the salon is interesting. Fungal infections of the nail are rare. Fungi that cause most nail infections are not passed directly from person to person. In addition, most individuals are not susceptible to fungal infections; it is exceptional for individuals who live together to infect one another. In fact, many individuals purposefully exposed to fungi for research purposes do not develop persistent infections. It is unlikely, therefore, that clients will develop fungal infections as a direct result of having professional nail services. Clients with a fungal infection in the nail should not have their nails polished because enamel applications may worsen their infection.

Nail technicians should disinfect their instruments after each service and use a clean and disinfected set of instruments for each client. Although the risk of spreading infection – fungal, bacterial, or viral – is low, it is not hygienic to use the same instruments on different clients without first disinfecting the instruments. Dry heat, liquid disinfectants, or autoclave sterilization are satisfactory disinfection methods.

Q: Can fungal infections be passed from client to client? 

I read with interest your article in the October 1993 issue on the possible dangers of acetone. Although the polish remover we use in our salon is acetone-free, we use acetone to soak off nails that are cracked or broken. The finger tips soak in acetone for up to five minutes at a time. After reading your article, I am extremely concerned about the possible hazards to the health of my clients and nail technicians.

A: There is no health hazard to your clients or technicians from soaking the nail in acetone for five minutes. However, it is essential that you ensure that the salon is well-ventilated and that no one smokes or lights a match when acetone is being used because it is extremely flammable. It might interest you to know that I inhaled all types of chemicals regularly for one year when I took organic chemistry in college, and I suffered no ill effects.

Soaking the fingertips in acetone to remove applications does temporarily damage the nail and surrounding skin by removing moisture and natural oils. The injury is not permanent; the skin will return to normal within a day or two after a moisturizer is applied.

The underlying nail takes longer to heal. Removing the application tears and fragments the nail surface, making it rough. Acetone dehydrates the nail plate and makes it brittle. Occasionally, healing will not occur and a new nail will have to grow, which can take three to six months.

None of these effects are a health hazard and they are not likely to cause permanent injury to the client’s nails (which will always regenerate). Assuming the client understands beforehand the potential effects, she can make the choice to wear acrylics.

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