When I see someone present with recurrent minor infections like this, I take a look at the whole picture. I do have the advantage of having access to patient medical records, but as a licensed professional you are able to question the general health of your client. Since this client is 50 years old, there is most likely another co-condition underlying the recurrent infections. I would first ask her gently if she is a diabetic, or has been told by a physician that she is in a pre-diabetic state. Second, I would ask her if she has taken any immunosuppressant (chemo) drug therapy recently or currently. If the answer to either of these questions is yes, then I would refer her to her physician. Third, I would ask her if there is anything in her health history that would shed light on this situation. If the answer is no, then I would advise a regime of careful hand-washing with a soft nail brush and gentle castile soap. Her preference for short polished nails is a plus, as she would not be a good candidate for enhancements. Careful adherence to a hand-washing routine should keep her nails clean and prevent recurrent infections. If she still continues to have a painful, purulent (pus filled) cuticle area, then I would refer her to her physician, as you have done all you could within the scope of our profession.
— Grace Almleaf, MNT, is a podiatry assistant in Jamestown, N.Y.