My nail ripped off in childhood. The surface is rough, wavy, and uneven. It seems more sensitive than my other nails. Is it more susceptible to nail fungus or disorders?

Due to the tearing of your nail during childhood, there may have been injury to the nail bed (the skin underneath the nail plate), the nail matrix (the growth center of the nail), or both. If there has been injury to either one of these structures and scar tissue resulted, then it may not be possible to get the nail back to its completely normal appearance. This would have to be determined by a dermatologic evaluation. As to whether the nail is more susceptible to fungus, abnormal nails may be more susceptible to infections, including fungus and even bacterial infections.

I have a 50-year-old male client who comes in for weekly manicures. For years, he’s had a bad habit of ripping his entire nail off his ring fingers, so now there is only a small layer of hard skin that occasionally bleeds. Both nails and fingers are swollen from the top knuckle down. He wants me to apply a thin layer of acrylic over the hardened skin. Will both nails eventually stop growing or will he get an internal infection?

It sounds to me that this client has traumatic infection of his fingers and possibly the nail units as well. I would definitely not apply acrylic over these areas. Not only could this cause allergic contact dermatitis, but it could also cause a primary irritant reaction from the acrylic and the nail technician could be held responsible for this. In regards to whether the nails will eventually stop growing, this depends on whether the trauma has scarred the nail matrix. If there is trauma and scarring of the nail matrix, then the nail may stop growing, disappear, or growin abnormally. It is not likely that there will be an internal infection, although infections of the fingers and hands can be very serious. Therefore, I think your client needs to be seen by a dermatologist and I would not perform any service on those two fingernails because it could make the situation worse.

To treat onycholysis, my coworker recommends soaking the nails in alcohol or clear iodine. She also does this for bacterial infections, which she calls water mold. Will this work for both conditions? Also, what is thymol and what does it do?

Onycholysis is a condition of the nails where the nail lifts and separates from the nail bed. It can be caused by many different disorders. If it is due to a mild fungus infection, such as candida or yeast fungus, a clear iodine may be helpful because iodine is mildly antifungal. However, it is not likely to work if the infection involves a signification portion of the nail or many nails. In addition, the onycholysis could be caused by something else, therefore, the iodine would have no effect. Allergy to nail cosmetics, thyroid disorders, psoriasis, and many other conditions may cause onycholysis as well. So it is important to determine what the cause of the onycholysis is in this particular client. In regard to soaking with alcohol, this probably is not going to be very beneficial because it is a weak antifungal and also a weak antibacterial. Secondly, alcohol is extremely dehydrating and will dry not only the skin, but the nails as well, so the client could also wind up with brittle nails.

Thymol is an agent that has been used for yeast infection of the nails in the past and it does have some benefits. It is usually dissolved in chloroform or another drying solvent. Thymol works to keep the skin underneath the lifted portion of the nail extremely dry. This has been effective in some patients who have onycholysis secondary to yeast or candida infection. However, since we do not know what the cause of the onycholysis is, whether the thymol would be effective is questionable.

I have a 67-year-old client who wears fiberglass or silk wraps. Just recently, the cuticle on her ring finger has pulled away from the nail bed all the way around and continues to do so. When her hands are in water, it seeps in under the cuticle area so she can never keep the area dry. Will her cuticle grow back? How can I repair it?

This is an early sign of paronychia or infection of the cuticle/proximal nail fold area. This can be a problem because with the space open, not only does water seep in under the cuticle area, but so do chemicals and soaps, as well as bacteria, fungus, and viruses. The cuticle will grow back once the paronychia has been treated with topical and/or systemic medication, depending upon whether it is bacterial or fungal paronychia. There is really no way that a nail technician can repair a cuticle that has pulled away from the nail bed. First the infection must clear up, then the cuticle will reattach so the space will close off again. The purpose of the cuticle is to keep that area, which is called as proximal nail groove, sealed off for protection against contaminants.