I have a client whose nails throb during a manicure, even when she gives herself one at home. She says the throbbing doesn’t stop until after polish is applied to her nails, and that this happens every time. Her nails appear healthy. What could be causing this?

The only explanation I can think of is if there was over-vigorous manipulation in the cuticle/proximal nail fold area, resulting in injury to the nearby nail matrix. Also, over-vigorous cleaning using nail implements underneath the nail plate and injuring the nail bed can cause the nails to throb. I do not understand why it would stop when nail polish is applied because polish does not have any particular effect on throbbing of the nails. Another possibility may be a circulation problem. Certainly if the condition continues, your client should see a dermatologist. Nails may also throb if there is an infection, but the description of your client’s nails as appearing healthy would make this a rather unlikely explanation.

I have a client who has a tumor under her thumbnail. She had the same problem several years ago on her other thumb and when the tumor was removed, she also lost the nail. Should my client see a doctor who is familiar with nail problems?

The cause of nail tumors is unknown, but I would consult a dermatologist to find out more about the nature of the nail tumor and why is it occurring. Most nail tumors are benign, but nevertheless, this condition requires immediate evaluation by a dermatologist. Some of these growths may have to be removed, and many dermatologists and dermatological surgeons are capable of removing these lesions. The location of the tumor usually determines whether the nail is lost or the client ends up with an abnormal nail. In general, if the tumor is located in the nail bed, it is possible to get a normal nail after surgery. If the tumor is located in the nail matrix (the nail growth center), then there is a much greater likelihood of having an absent or abnormal nail after surgery is performed.

One of my clients wants me to do her 10-year-old daughter’s nails, but I think she is too young. Does the nail have a different composition when we are younger? Should I not put acrylic nails on young people?

I see no problem applying nail polish on someone this young, but I would certainly avoid any mechanical manipulations with metal or wooden implements in the cuticle/proximal nail fold area. This is where the nail matrix is located and mechanical manipulations at that site could injure the nail matrix and subsequently injure the nail. The composition of the nails in young people is the same as in adults, except that in children the water content of the nails is higher, causing them to be softer and more flexible; therefore, their nails are less brittle and dry and much less likely to break, split, peel, and fray at the edges. I would not recommend applying acrylic nails on young people because it may cause an allergic reaction, although it is not likely that it would cause a fungal infection if the acrylic was kept on for only a few days. Removing acrylic nails from a child can be traumatic, so I would recommend against applying them.

I have a new client who is an elderly woman with severe rheumatoid arthritis. She has three nails that are loose along the sidewalls. To her knowledge, these nails have not suffered any trauma, and other than being white where they are not attached, they do not look discolored. She said this happened to one of her nails several years ago and it finally reattached on its own. Her nails are very dry and brittle. Could this be due to her arthritis medication? How should I service this client?

Patients with rheumatoid arthritis may have abnormal nails if the arthritis affects the tips of the fingers. This is because the distal interphalangeal joint, which is the joint located nearest the cuticle, is also very close to the nail matrix; therefore, arthritis and inflammation in that location could affect the nail matrix and produce an abnormality of the nails. However, what you are describing sounds like onycholysis, where the nail plate lifts from the nail bed (the skin underneath the nail plate). This may be due to many causes, including fungus, allergy to nail cosmetics, psoriasis, and other conditions as well. Therefore, your patient should be seen by a dermatologist who will take samples of the nail to determine the cause of lifting. Yes, it is possible for some medications to cause the nail to lift; however, since only three nails are affected that likelihood is considerably reduced. In terms of the nails being dry and brittle, this is not unusual in elderly clients, so moisturizing the nails will help a great deal. You can best serve this client by referring her to a dermatologist.