Science & Medicine Panelists:

David L. Dyer, Ph.D., Debra Marr-Leisy, Ph.D., Phoebe Rich, M.D., Ivar E. Roth, D.P.M. Doug Schoon, Sunil J Sirdesai, Johanna Youner, D.P.M.

This Month’s Nail Technician Experts:

Angie Gross is a nail tech at Soge Hair and Body Care in Atlanta.

Lynnette Madden is owner of Salon 29 at Main in East Greenville, Pa.

I have a client with fan-shaped nails that are also very flat. We have tried all types of artificial nail treatments. Everything will be fine until the second or third fill (She loves beautiful nails and has even tried getting fills every eight days.) She has also tried hard to grow her own natural nails, but nothing seems to work for her. Please help.

Angle Gross: First, know that these are the most difficult type of nails to work with. So is she lifting? Cracking? Coming off? If she lifts at the cuticle, proper nail prep is a must. Make sure the cuticles are pushed back and the entire nail — especially around the cuticle edge — is well etched. If she is lifting from the free edge, you must remove the lifted area and replace it with new acrylic. Don’t try to make the nail follow the shape of the acrylic. Acrylic will grow straight out with very little flexing, but the natural nail will twist and turn (and dip down and up) especially once it leaves the nail bed.

If the nails are coming off, make sure there is no dust left on them and a bonding agent is used before applying the tip and before applying the primer. Next, I would suggest using a full well tip and a gel glue to accommodate the flat nail, making sure there are no air pockets under the tip. Also make sure the tip is as wide as the nail’s free edge. Concentrate your tip, blending to the center of the well that overlaps the nail (leaving the area closest to the cuticle the thickest). This enables the C-curve of the tip well to “flex” to the nail instead of squeezing its way off the nail bed. I’m a big advocate of acidless primers, but in this situation I’d use an acid primer. It is especially important to make the free edge no more than half the length of the nail bed. The longer the free edge, the more pressure the stress area will take on. When applying the acrylic, having a good arch is important for added strength.

If the nail is cracking in the stress area, cut into the acrylic where it is cracked to allow the acrylic to get into the crack instead of just laying on it. Also when filling in, add a ball to each side of the nail (parallel to the cuticle) sweeping it toward the center of the nail.

Lynnette Madden: You have not said if you are using tips or sculpting, but I would assume that you are using tips. Try to sculpt her nails and see if you find a difference. You may also want to keep her natural nails under the enhancement shorter by using your electric file or a round file under the nails. You cannot force or change the shape of these nails. Her nails are most likely pulling away from the product and lifting. Keeping her nails shorter and preventing them from growing out might help you.

In the November 2002 issue you mentioned that scaly skin can be caused by something called two foot/one hand syndrome. I believe that I have just that. (It’s awful) What do I do?

Dr. Rich: Two foot/one hand disease is caused by a dermatophyte fungus. In this condition, both feet and one palm have a scaly, dry appearance and test positive for fungus when scrapings of the flaky skin are tested. Often there is fungus in the toenails and fingernails of the affected hand. Treating with an antifungal medication (oral works best but topical helps too) clears the skin of the palms and soles. There is a fairly high recurrence rate of this fungal condition, so long-term preventative treatment with a topical antifungal cream is helpful. There are many other common skin conditions that mimic this fungal skin problem. Eczema can cause scaling and flaking of the palms and soles and is not related to fungus. Psoriasis can also cause similar symptoms of scaling, peeling, and thickening of the palms and soles. It is important to get the proper diagnosis of the problem so that appropriate treatment is used.

I have a client who has been working on her feet for 36 years and is now developing painful calluses. How can I ease her pain? What’s best for calluses like these?

Dr. Youner: Calluses are built to protect your feet from friction. Certain skin types callus more easily and quickly — Mediterranean skin types and women of color. (I have found that African-American women can easily build a callus that is 1/2- inch deep in just two months!)

If they are deep and painful, the calluses should first be shaved by a podiatrist. Once this has been pared down, daily use of a uric acid cream (Carmol 20 over-the-counter or Carmol 40 in prescription strength) or lactic acid preparation (AmLactin over- the-counter or Lac-Hydrin by prescription) in the morning and at night will remove skin and help prevent build-up. Sometimes in a very high arched foot, an arch support with a soft extension can be custom-fabricated to your foot They are expensive ($400 in my office), but a necessity for certain people. If it is not prohibited in your area, I see no problem with an experienced, competent pedicurist using a credo blade to reduce built-up callus. A fresh blade should be used each time. Check with your state board for local regulations.

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