Nail & Skin Disorders

The Nail Doctors: Twice the Advice

This month's edition of the Nail Doctor is so jam-packed, we brought on two doctors to answer your pressing questions. 

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.

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