Q. What is the best way to handle clients’ nail-related health problems? I think you should refer them to a dermatologist while other technicians I know prefer to give out home remedies.

A. What you do on yourself, a family member, or a friend outside the shop is different than what you want to do in your shop. You can open a pustule or dig out a splinter, but true first aid is not appropriate in your professional workplace.

I firmly believe that the cheapest and best way to do anything is to see an expert and do it right the first time. But even I cannot cure all nail problems. However, I try to be honest with the patient about what can be expected.

It is important to learn to recognize when a situation is dangerous, serious, or progressive and to refer a client to a doctor, who is the expert. For example, I may know how to treat a particular surgical condition, but I also know that some treatments will cause a permanent deformity no matter who treats it—me or a specialist. But I will refer the patient in that situation to a hand surgeon so she knows that I am giving her the very best possible care. She will continue to be my patient for other skin or nail conditions, knowing that I will give her the best care available or refer her to someone who can.

You should do the same with your clients. By sending clients who exhibit serious or progressive nail conditions to a dermatologist, they too have the best chance of having the disorder treated properly and cured. And it should strengthen their faith in you for having the understanding to know when you’re out of your league.

It is wise for nail technicians to have a working relationship with a doctor to whom they can refer clients with conditions that need medical attention. Doctors are not competitors of nail technicians because we have a different purpose in treating nails. A dermatologist treats nail diseases; a nail technician beautifies the nail. By developing a referral relationship with a dermatologist, you can refer medical problems to him, and he can refer cosmetic conditions to you.

  1. I know a technician who cures fungus by soaking the fingers in bleach. Another “cures” weak nails by soaking them in white iodide. I’m afraid to try these things, but I’ve been told that if you send clients to doctors you scare them off. How do I handle this?
  2. As for home remedies, there are many mild nail problems that get better and can even spontaneously heal on their own. If someone uses a home remedy and the condition clears, she’ll often assume it’s a result of the home remedy rather than the natural healing process.

As for your question on fungus, I believe fungus infections are incorrectly identified about 100 times more often than their true incidence. Unfortunately, general physicians aren’t any more accurate diagnosing true fungus than most nail technicians. And since the condition isn’t fungus, and it tends to heal on its own, technicians begin to believe that a fungus infection is easy to cure.

If you think that dermatologists or multibillion dollar drug companies haven’t considered marketing these types of home remedies already, you’re wrong. When I started researching nails 33 years ago, white iodide and bleach were commonly used. Bleach, properly diluted with one part bleach and 20 parts water, was the major treatment of wounds in World War I, and iodide was said to cure fungus.

It takes a much lower concentration of bleach to kill bacteria than it does to kill fungus, which is why the bleach cure seems to work. While one part bleach in 20 parts water kills bacteria, the concentration of bleach that is required to kill fungus would burn the skin and destroy the nail.

White iodide has been used on just about every nail problem imaginable. I’ve never tried white iodide on weak nails, though. I did try iodide on many other nail conditions, but I have never found it to work better than allowing nails to heal on their own, in their own good time.

While these home remedies are not very effective, the only harm you could do with the specific treatments you mention is to delay effective treatment for the client by someone with medical expertise.

  1. I recommend a 3% tolnaftate solution to clients for fungus and mold. If the condition is severe, I refer the client to a physician. Is 3% tolnaftate strong enough to treat the condition if it’s not severe? Can I add other things to the solution like bleach or vinegar, or will that disturb the tolnaftate?
  2. Tolnaftate is an antifungal medication that clears some skin conditions such as athlete’s foot and jock itch. It has not been shown, however, to be effective on fungal infections of the nail. The Physician’s Desk Reference for Non-prescription Drugs states, “Tinactin [the trade name for a common tolnaftate product] is not effective on nail or scalp infections.” This statement comes from Schering-Plough, the maker of Tinactin, which is the original and most widely sold version of tolnaftate. I do not know of a single scientific article or even a single dermatologist who believes tolnaftate works on nails, whether it’s a 3% or even 20% solution.

But, again, the problem here is that the condition you’re calling a fungus isn’t a fungus at all. It is most likely an injury caused by trauma or a pseudomonas infection. You can’t talk about curing fungus without first doing a diagnostic culture that shows it really is fungus. Many of these so-called “fungus infections” will clear on their own without treatment, thereby feeding the myth that these treatments are effective.

Adding other ingredients to enhance medication is not legal if the FDA has not approved such use. You wouldn’t, for example, give a client an unapproved substance to take by mouth, would you? Never add anything to a solution without prior controlled studies and safety monitoring.

  1. My artificial nails have started lifting or falling off just one week after a fill instead of lasting two or three weeks. After several occurrences, I removed all of the product and found my natural nails were lifting off the nail bed and some had touches of green near the lifted area. What is this and how is it treated? Can artificial nails be worn again after the treatment? How can I tell when it’s completely cured? Can anything be done to prevent the problem in the future?
  2. The separation of the nail plate from the nail bed could be caused by a product allergy, or it could be caused by any number of factors. Having your hands in water a lot may contribute to the nail separation. Remove the product and wait for the condition to clear, then test for an allergy by wearing product on one nail.

Green discoloration is due most frequently to pseudomonas bacteria, which will grow in any pocket of wetness. I suspect that water got between the artificial nail and the natural nail and created the environment for the green-causing pseudomonas.

If pseudomonas occurs just between the nail and the artificial nail, simply expose the green area to air and it should clear quickly. You could also clean the area with alcohol or spray it with polysporin just to be sure.

However, the green discoloration will persist even after the pseudomonas is gone. You can scrape or file off the green stain. Remember that the presence of green doesn’t mean the infection is still present. I feel it is safe to reapply an artificial nail after even a short period of drying out, as long as you’re sure there is no moisture or a crevice that could hold moisture when you re-apply product. If there is a wet pocket around the cuticle or under the nail, dry it first. If there is an infection, such as paronychia, refer the patient to a doctor for treatment.

  1. Are the UV lights used to bond gel to the nail harmful to nails or skin? The nails are exposed to this light at close range for, at most, three or four minutes per week.
  2. All UV light does some amount of damage to skin, even UV-A light, the kind used in tanning parlors. You are asking if the damage is significant. To determine the safety, a scientist would have to know the wavelength and amount of energy output. Then he would have to adjust his formula for the thickness of the skin around the nail.

All UV light emits radiation, which shows its damage long after the exposure. If people wrinkled while at the beach they would stop sunning themselves. But the skin is like a photographic film — it remembers all radiation. I guarantee you that the sunburn or suntan you have now will add to your wrinkles in 20 to 30 years.

It is worth asking the UV-A bulb manufacturer about safety, but I don’t feel any great alarm. If it is marketed as a cosmetic device it is probably safe. If it is just a UV source not specifically made for human use I would be more concerned. If you are really concerned, ask the manufacturer for information and test results on the lights strength and safety. If the light was not made (or wasn’t safe) for human use, most manufacturers would be quick to let you know that they will not accept any responsibility for health problems.

If all manufacturer identification has been removed, I would not use the device. A product could be safe even if the manufacturer denies that the product is intended for human use, but I would want someone else to assume legal liability.

  1. The nail on one of my male client’s large toes is thickened and has evenly spaced vertical blue lines running the length of the nail — from the base to the free edge. The nail thickening starts beneath the toenail and the material seems soft. The client is a runner but does not have athlete’s foot. What is this condition, and is there a treatment for it?
  2. The skin thickens in response to injury. Thickening is the skin’s way of protecting itself. However, at some sites of repeated trauma, a callus will form. Your patient is probably developing an equivalent of a callus under the nail. His running puts more pressure on this particular toe and the blue streaks are likely to be hemorrhages in the nail bed due to repeated trauma that is transmitted back to a superficial blood vessel. This trauma is similar to the black dots most basketball players have on their heels from torn blood vessels caused by the trauma of sudden stops.

You probably won’t get this client to change his stride, but keep his toenails as short as is comfortable and suggest he use a pumice stone, sloughing lotion, or callus-reducing foot file to remove excess skin.

Have him use leather softener on his athletic shoes (if they are leather) and then apply pressure from the inside with something such as a wooden spoon handle to stretch the leather in this one area. This helps spread the impact over the other toes. With some of the newer non-leather shoes, he can buy shoes that are a half-size larger and then place material in the toe so that the force of impact is transmitted to the other toes, sparing the large toe.

  1. A new client complained about itching around her fingers weeks after I applied tips with an acrylic overlay. No redness, pus, or swelling were present. I referred her to a dermatologist and suggested an anti-itch ointment until her appointment. I was afraid that soaking off the nails would further irritate her fingers. What could this have been? Should I have removed the product?
  2. If a client has a true allergy it will never show up on the very first exposure unless she was previously exposed to an identical or similar substance. Allergies can show up anywhere from four days to many years after the initial exposure. Several weeks often pass before an allergic reaction occurs. This case strongly suggests an allergic reaction.

You are wise to ask about removal because the material can soften as it is removed and may more easily penetrate the nail. I do recommend removing the application, but you must wipe away the material quickly. There might still be a flare-up of symptoms, but I would want the product removed as soon as possible.

You can patch test a person for allergies before applying product to ascertain if the reaction was an allergic reaction. Do this by applying the suspected material to a bandage, letting it dry, and applying it to the thin skin on the inner arm. As soon as it starts itching, remove it. If there is no reaction after two days, some other part of the process may be causing the reaction. I often tell patients how to self-patch-test.

A client with an allergic reaction doesn’t need to see a doctor unless there is marked discomfort or swelling. Cool water soaks of the area would make this patient more comfortable.

Whenever you are in doubt about performing any procedure, go slowly. If, for example, you fear removing product will worsen the condition, take the product off one finger the first day. If there is an improvement or no flare-up, remove the rest of the product. Allergic contact dermatitis always subsides in two to three weeks once exposure to the irritant stops. It very rarely causes any permanent defect.

If you decide to use another product on this client after she has recovered, try it on just one finger for four or five days before proceeding. The test nail doesn’t have to be long. Do a test finger first for any client who has had a reaction to other nail products.

If there is no reaction after five days, go ahead and apply a full set. Ask the client to call you if she has any reaction (although you should call her after a week to be sure she’s not having any problems).

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