Nail & Skin Disorders

The Nail Doctor Live!

Salon owners and nail technicians from all over the world came to hear their favorite dermatologist discuss everything you need to know about nail disorders.

Salon owners and nail technicians from all over the world came to hear their favorite dermatologist discuss everything you need to know about nail disorders. The meeting hall was packed on November 2 when Dr. Richard K. Scher spoke at the Bill Graham Civic Auditorium in San Francisco during NAILS Show ’97.

Dr. Scher, who introduced himself as a member of the “Society for the Prevention of Cruelty to Cuticles,” managed to include both levity and gravity during a discussion and slide show presentation of nail disorders ranging from mild to severe. Following a short synopsis of the nail industry, the focus shifted to basic facts about the components and structure of the nail. Dr. Scher suggested the information he was about to cover represented what every nail technician wants to know about nail disorders, but is afraid to ask: The structure of the nail is not complex; however, there are a number of different sections that together form the nail unit. Each section is vital to maintaining a healthy fingernail. Damage or disease to any part of the nail unit can spell trouble.

Nail technicians should understand the importance of the cuticle (located at the proximal nail fold), the nail’s protective border. When the cuticle is filed too often or cut back too much, openings can form, allowing fungus and other particles to enter and reach the matrix, the most important part of the nail unit. The matrix produces cells that form the nail plate, similar to the cells found in a shaft of hair. The nail matrix is extremely delicate and is easily injured, damaged, and scarred. Trauma to this area can show up as a visible change in the nail plate or affect how it grows out.

Another important part of the nail unit is the nail bed. Its tip is located so close to the bone at the fingertip that a bone disorder can easily be mistaken for a nail disorder.

In a society where fingernails have become an important part of fashion and glamour, it is easy for people to forget that function is the fingernail’s foremost purpose. The fingernail has four basic functions, including touching (tactile sense), scratching, retrieving (picking things up), and protecting (offensive and defensive reactions).


Dr. Scher said although some allergic reactions appear across the board, most allergies occur on a case-by-case basis, depending on an individual’s personal biochemistry. Remember although your client may recover from a skin reaction to a particular product or ingredient, her allergy to it lasts a lifetime. The incidence of cosmetic allergies can be broken down as follows:

Skin care 56.3%

Nail Care 13.4%

Hair Care 5.9%

Deodorant 5.0%

Other 19.4%

The three most common allergy-causing chemicals found in nail products are formaldehyde, nickel, and acrylic. Formaldehyde can be found in adhesives, polish, and nail hardeners. Nail enamels that have been on the market for a long time often have metal mixing beads which contain a nickel compound. And, it is the liquid monomer component of the acrylic systems used by nail technicians that can cause allergies. Usually, problems begin after several months of repeated skin contact.

What to Look For

Dr. Scher reminded the nail technicians in the audience that their job was twofold. He said because your clients’ nails often reveal more about her than the polish color she likes best, it is important to become aware of certain signs of systemic illness. Here are some general points to help steer your client in the right direction.

Fungal and pseudomonas (bacterial) infections are the most common nail disorders occurring in the general population. Psoriasis of the nail, the next most common, often shows up on the skin as well. The psoriatic nail may not be able to protect the finger or toe, perceive fine touch or sensation, puck up small objects, or scratch. The changes in the nail that occur when psoriasis is present include separation of the nail plate from the nail bed and thickening of the nail bed. Psoriasis of the nail is often misdiagnosed as nail fungus.

Because the symptoms of these two disorders may be indistinguishable, it is absolutely essential that your client’s doctor perform the necessary tests for a correct diagnosis.

Lupus, a disorder characterized by inflammation of the skin, is most commonly found in women. A change in the cuticle is indicated by red, sometimes puffy nail folds, and the capillaries look more prominent than usual, even visible without magnification. Clients should seek prompt medical care.

Whitening of the nail plate over the lunula and the bottom portion of the nail due to fungus could be a sign of HIV.

White nail beds are commonly found in older clients or those with liver or kidney diseases. When you see clients where the bottom half of the nail is white and the other half is pick, about 50% of these people will have kidney disorders, and a lesser percentage will have liver problems. Although a white nail bed might be common is some individuals, usually a medical evaluation is recommended. If the nail becomes white all white, liver disease must be considered. On the other hand, pale nail beds can be a sign of low iron levels or anemia.

Blood under the nails gives a bright, cherry-red color to the nail beds and could be a sign of a heart patient who is taking aspirin or blood thinners. This type of coloration can also be a sign of carbon monoxide poisoning.

Dr. Scher concluded, “It is clear that nails are window to your client’s health. You have the opportunity and responsibility to be alert to early signs that may indicate significant medical disorders.”

Margy Reynolds, a nail technician and owner of Turning Heads is Crescent City, Calif., asked Dr. Scher about a white surface on toenails she thought might be fungus. “He gave me good advice and a sense of relief,” she says. “I sure wish I had a direct hot line to Dr. Scher’s office.”


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