Chapter 10 Nail Disorders and Diseases

“Change and growth take place when a person has risked himself and dares to become involved with experimenting with his own life.” – Herbert Otto

Objectives List and describe the various disorders and irregularities of the nails. Recognize diseases of the nails that should not be treated in the salon. LEARNING MOTIVATION (WHY?) Nail disorders and diseases are certainly not the most glamorous portion of your training in cosmetology, but learning about them could be one of the most critical. More infections are spread through the nails and hands than any other area of the body. You actually have a greater chance of contracting a nail disease from a client than head lice or a skin disease. Therefore, careful analysis of the client’s hands and nails is crucial to both your safety and that of your other clients. In addition, contracting a nail infection will prevent you from working for an extended period of time, which will cost you money. A normal, healthy nail is firm and flexible and should be shiny and slightly pink in color, with more yellow tones in some races. Its surface should be smooth and unspotted, without any pits or splits. Certain health problems in the body can show up in the nails as visible disorders or poor nail growth. Today's lesson, which covers disorders of the nail, is relevant to your future success and well-being.

Nail Disorders Nail disorders are caused by injury or disease. Disorders must be referred to a physician. Only cosmetic problems can be treated by a licensed cosmetologist or nail technician. NAIL DISORDERS A nail disorder is a condition caused by injury or disease. A cosmetologist should recognize normal and abnormal nail conditions, and understand what to do in case of an abnormality. There are two actions a cosmetologist can take: Tell the client that there might be a disorder and refer him or her to a physician, if necessary. Cosmetically improve certain nail plate conditions if the problem is cosmetic and not a medical condition or disorder. It is your professional responsibility and a requirement of your license to know which option to choose. A client whose nail or skin is infected, inflamed, broken, or swollen should not receive services. Instead, the client should be referred to a physician if you determine that is the appropriate recommendation, based on the client’s condition and your training.

Nail Disorders (continued) Bruised nails Eggshell nails Beau’s lines NAIL DISORDER: A condition caused by injury to the nail or disease or imbalance in the body. As a professional, you must recognize those conditions you can treat and those that must be referred to a physician. (HINT: If the area to be worked on is inflamed, infected, broken, or swollen, it should be referred to a physician.) NOTE: Refer students to Table 10–1 to follow along as you review nail disorders. BRUISED NAILS: Caused by a blood clot forming under the nail plate resulting in a dark purplish spot, usually due to injury. Treat gently; avoid pressure. EGGSHELL NAILS: Have a noticeably thin, white nail plate and are more flexible than normal. Nail separates from nail bed and curves at free edge. Caused by improper diet, internal disease, medication, or nervous disorders. Be very careful and gentle, as these nails are fragile and can break easily. Use the fine side of an emery board to file; do not use a metal pusher. BEAU'S LINES: Also known as furrows or depressions; run across the width of the nail. Result from illness or injury to the nail cells in or near the matrix; can be caused by pregnancy or stress. Lengthwise ridges can be caused by psoriasis, poor circulation, and frostbite. Use great care when manicuring; avoid using a metal pusher; use plastic pusher or cotton-tipped orangewood stick. If redness, pain, swelling, or pus are present, refer to a physician.

Nail Disorders (continued) Hangnail Leukonychia HANGNAIL OR AGNAIL: A condition in which the living skin splits around the nail. Sometimes caused by skin dryness or cutting the living tissue; can be helped by hot oil manicures. Hangnails can become infected; if redness, pain, swelling, or pus are present, refer to a physician. LEUKONYCHIA (WHITE SPOTS): Whitish discoloration of nails, usually caused by injury to base of nail or nail matrix; they eventually grow off.

Nail Disorders (continued) Melanonychia Discolored nail Onychophagy Onychorrhexis MELANONYCHIA: Indicated by darkening of nails; may be seen as a black band under or within the nail plate, extending from base to free edge. Caused by a localized area of increased pigment cells (melanocytes) with the matrix bed. DISCOLORED NAIL: Turns a variety of colors as a result of surface staining; a systemic disorder; poor blood circulation; foods; dyes; smoking; or biological, medical, or even pharmaceutical reasons. ONYCHOPHAGY (BITTEN NAILS): Caused by an acquired nervous habit, which can often be overcome with frequent manicures and care of the hardened cuticle. ONYCHORRHEXIS: Split or brittle nails with lengthwise ridges. Caused by injury to matrix, excessive use of cuticle solvents, harsh cleaning agents, polish removers, aggressive filing, or heredity. Nail services can be performed only if nail is not split and exposing nail bed. Correct with conditioning treatments such as hot oil manicures and eliminating cause.

Nail Disorders (continued) Plicatured nail Nail pterygium Ridges PLICATURED (FOLDED) NAIL: Highly curved nail plate; often caused by injury to the matrix, but may be inherited. Often leads to ingrown nails. NAIL PTERYGIUM: Abnormal damage to the eponychium or hyponychium that occurs when skin is stretched by the nail plate. Caused by serious injury, such as burns, or an adverse nail reaction. Cuticle and pterygium are not interchangeable terms. Do NOT push extension of skin back with an instrument, as this may cause injury and worsen the condition. Instead, gently massage cuticle creams and conditioners into affected area; oil manicures may also be helpful. RIDGES: Ridges running vertically down the length of the natural nail plate are caused by uneven growth of the nails, usually the result of age. Unless the ridges become very deep and weaken the nail plate, they are perfectly normal. When manicuring a client with this condition, carefully buff the nail plate to minimize the appearance of ridges. Be careful not to overly thin the nail plate, which could lead to nail plate weakness and additional damage. Ridge filler is less damaging to the natural nail plate and can be used with colored polish to give a smooth appearance while keeping the nail plate strong and healthy.

Nail Disorders (continued) Splinter hemorrhages Increased curvature nails Pincer nails Trumpet nails SPLINTER HEMORRHAGES: Caused by physical trauma or injury to the nail bed that damages the capillaries and allows small amounts of blood flow. INCREASED CURVATURE NAILS: Nail plates with a deep or sharp curvature at the free edge due to greater curvature of the matrix. Two forms of dramatically increased curvature nails: Pincer nails Trumpet nails ACTIVITY: Conduct a term pronunciation activity. Ask students to properly pronounce one term. After you have confirmed the proper pronunciation, have the entire class pronounce each term.

Nail Fungi Parasites that may cause infections on the hands and feet Highly contagious Grows where it is warm, dark, and moist Avoided by proper cleaning and disinfection NAIL INFECTIONS Fungi (singular fungus) are parasites, which under some circumstances may cause infections of the feet and hands. Nail fungi are of concern to the nail salon because they are contagious and can be transmitted through unsanitary implements. Fungi can spread from nail to nail on the client’s feet, but it is much less likely that these pathogens will cause fingernail infections. Fungi infections prefer to grow in conditions where the skin is warm, moist, and dark, that is, on feet inside shoes. It is extremely unlikely that a cosmetologist could become infected from a client, but it is possible to transmit fungal infections from one client’s foot or toe to another client. With proper cleaning and disinfection practices, the transmission of fungal infections can be easily avoided. Clients with suspected nail fungal infection must be referred to a physician.

It Is Not Mold! Discolorations of the nail are not mold. They are a bacterial infection caused by Pseudomonas aeruginosa. In the past, discolorations (especially those between the nail plate and artificial enhancements) were incorrectly referred to as molds. However, discolorations are actually caused by Pseudomonas aeruginosa, a bacteria that can grow out of control and cause infection under certain conditions.

Nail Infections Indicated by redness, pain, swelling, pus, and inflammation Causes: contaminated implements Other indications: yellow, green, brown, or black spots Avoid infection: cleansing and disinfection NAIL INFECTIONS: Indicated by redness, pain, swelling, pus, inflammation. Should not be treated in the salon, but referred to a physician. CAUSES OF INFECTION: Nail infections are caused by contaminated implements. They are NOT caused by moisture trapped between an unsanitized natural nail and artificial enhancements. OTHER INDICATIONS OF INFECTION: Initially yellow-green spots, which in advanced stages change to brown and black. AVOIDING INFECTION: Don’t take shortcuts or omit cleaning and disinfection procedures. Don’t perform services if client is suspected of having an infection. Completely disinfect all metal and reusable implements, wash linens or replace with disposable towels and thoroughly clean table surface before and after procedures.

Nail Diseases Onychosis: any deformity or disease of the nails Onychia Onychocryptosis NAIL DISEASES ONYCHOSIS: Any deformity or disease of the nails. ONYCHIA: An inflammation of the nail matrix with formation of pus and shedding of the nail. Can be caused by a skin opening that allows entry of bacteria, fungi, or foreign materials, or by improperly disinfected nail implements. ONYCHOCRYPTOSIS (INGROWN NAILS): Affects both fingers and toes. Nail grows into the sides of the tissue around it; with toenails, poorly fitted shoes or walking can press the soft tissues against the nail margin. If area is infected, refer to a physician.

Nail Diseases (continued) Onycholysis Onychomadesis Nail psoriasis ONYCHOLYSIS: The lifting of the nail plate from the bed without shedding, usually beginning at the free edge and continuing toward the lunula. It is usually the result of physical injury, trauma, or allergic reaction of nail bed. Less often, it is related to a health disorder. Often occurs when natural nail is filed too aggressively or artificial nails are improperly removed. ONYCHOMADESIS: The separation and falling off of a nail from the nail bed. Occurs on both fingernails and toenails. Can be caused by a localized infection, minor injuries to matrix bed, or severe systemic illness. Can also be caused by chemotherapy or cancer X-ray treatments. Do not apply enhancements if this condition is present. If no infection is present, basic manicure and pedicure services can be provided. NAIL PSORIASIS: Often causes tiny pits or severe roughness on the surface of the nail plate. They appear both randomly and in evenly spaced rows. Can cause the nail plate to look like it has been filed with coarse abrasive or cause a ragged free edge. Can also affect the nail bed, causing yellowish to reddish spots under the nail plate (called salmon patches).

Nail Diseases (continued) Paronychia Pyogenic granuloma PARONYCHIA: A bacterial inflammation of the tissues surrounding the nail. Pus and swelling are usually present. Individuals who work with their hands in water are more susceptible, as hands become dried and chapped. To prevent, use moisturizing lotions. PYOGENIC GRANULOMA: Severe inflammation of the nail in which a lump of red tissue grows up from the nail bed to the nail plate.

Nail Diseases (continued) Tinea pedis Onychomycosis TINEA PEDIS: The medical term for fungal infections of the feet; also known as athlete’s foot. In acute conditions, deep, itchy, colorless vesicles (blisters) appear. They spread over the sole and between the toes, perhaps involving the nail fold and infecting the nail. Can become chronic. ONYCHOMYCOSIS: A common form is whitish patches that can be scraped off the surface of the nail. Another form is long, yellowish streaks within the nail plate that invade the free edge and spread toward the root. A third form causes the free edge to crumble and may even affect the entire plate; can spread toward matrix. ACTIVITY: Conduct a term pronunciation activity. Ask students to properly pronounce one term. After you have confirmed the proper pronunciation, have the entire class pronounce each term.  

Summary and Review What conditions do fungal organisms favor for growth? Name two common causes of onycholysis. In what situation should a nail service not be performed? What is Pseudomonas aeruginosa and why is it important to the nail technician? SUMMARY AND REVIEW Well-manicured nails, whether natural or artificially applied, have always been recognized as an indication of good grooming. It’s important to also remember that nails originate in the epidermal layer of the skin and that, like hair, their condition is dependent upon the individual’s overall health. Nails contain the chemical substance called keratin and can be cut without pain. You cannot apply any topical product that will cause nails to grow, but a balanced diet filled with the daily required vitamins and nutrients will help produce healthy, disorder-free nails. Remember that your creativity in providing quality nail services must be grounded in a thorough knowledge and awareness of the structure and physiology of the nails. Working on unhealthy nails can be dangerous to both you and your clients. Learning to identify those conditions that must be referred to a physician is critical to the safety of both. 1. What conditions do fungal organisms favor for growth? Answer: Dark, warm, and moist conditions.   2. Name two common causes of onycholysis. Answer: Injury and allergic reactions. 3. In what situation should a nail service not be performed? Answer: A client whose nail or skin is infected, inflamed, broken, or swollen should not receive services. Instead, based on the condition, the client should be referred to a physician, if you feel that is an appropriate recommendation. 4. What is Pseudomonas aeruginosa and why is it important to the nail technician? Answer: It is a naturally occurring bacteria on the skin that can grow out of control and cause an infection under certain conditions, especially lack of oxygen. Nail fungus is of concern in the salon because it is contagious and can be transmitted from one client to another through unsanitary implements and working conditions.

Summary and Review (continued) Name at least eight nail disorders and describe their appearance. What is the most effective way to avoid transferring infections among your clients? If a client develops a nail infection, can nail technicians offer treatment advice for these conditions? Can beauty professionals treat an ingrown toenail if there is no sign of pus or discharge? 5. Name at least eight nail disorders and describe their appearance. Answer: Bruised nails: dark purplish spots under nail plate. Ridged nails: vertical ridges down length of nail plate Eggshell nails: thin, white nail plate that is more flexible than normal. Beau’s lines: visible depressions running across width of nail plate Hangnail: living skin splits around the nail Leukonychia: white spots on the nail Melanonychia: darkening of fingernails and toenails Onychophagy: bitten nails Onychorrhexis: split or brittle nails that have a series of lengthwise ridges   6. What is the most effective way to avoid transferring infections among your clients? Answer: Practicing strict sanitation and disinfection procedures during every nail service with every client. 7. If a client develops a nail infection, can nail technicians offer treatment advice for these conditions? Answer: No, they can only recommend to the client that he or she see a physician; they cannot perform services on the client until the condition has been successfully treated. 8. Can beauty professionals treat an ingrown toenail if there is no sign of pus or discharge? Answer: No, an ingrown toenail is a medical condition that can only be treated by a qualified medical professional.

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