7.2 Skin Disorders and Diseases of Hands and Feet
Key Takeaways
- NIC Anatomy and Physiology items ask you to recognize signs, symptoms, and causes of skin disorders, diseases, and conditions — then decide service versus referral.
- Allergic contact dermatitis follows immune sensitization after repeated exposure; irritant contact dermatitis is a direct chemical or physical insult and can appear on first overexposure.
- Verrucae (warts) are contagious human papillomavirus lesions; herpes and herpetic whitlow are viral; tinea pedis and tinea manus are fungal — do not service those lesions.
- Spreading heat, swelling, pain, and redness with possible fever is a cellulitis-pattern emergency: stop the cosmetic service and send the client to urgent medical care.
- Hyperhidrosis, bromhidrosis, and anhidrosis are sweat-gland conditions; open sores, unidentified keratosis, and broken eczema or psoriasis plaques are refuse-or-refer findings.
The same NIC Anatomy and Physiology domain that tests healthy skin also asks you to recognize signs, symptoms, and cause of disorders, diseases, and conditions of the skin. For an Arkansas manicurist, that is not trivia. The Cosmetology Section expects you to analyze the client's skin during consultation, refuse a service that would spread infection, and stay inside cosmetic practice. Independent OpenExamPrep study for this license treats every lesion as a service decision: proceed on intact, non-contagious skin you can identify; modify when the skin is dry but closed; do not service when the finding is viral, fungal on the surface you would touch, open, spreading, or simply unknown.
You are not the client's physician. Naming a lesion in class so you can refuse it is different from announcing a medical diagnosis at the table. Chair-side language is "I cannot work on this area; please see a medical professional," not a disease lecture.
How exam items are built
Stems usually give you a sign (what you see), a symptom (what the client feels), and a cause class (virus, fungus, bacterium, chemical, immune, sweat-gland, pressure). Your job is to bind those three and then pick the professional action. A wart is not a callus because the cause is human papillomavirus (HPV), not friction alone. Cellulitis is not "swollen from sitting" because it is hot, spreading, and often systemic. Allergic primer rash is not the same as a first-day chemical burn from over-strong dehydrator.
When in doubt, protect the next client and the license. A missed fill is cheaper than a board complaint.
Contact dermatitis: irritant versus allergy
Contact dermatitis is inflammation where a product, metal, glove, or implement met the skin. NIC chemistry items will return to overexposure; this section is the skin picture.
Irritant contact dermatitis is a direct insult. A too-strong primer, liquid monomer flooding the eponychium, acetone sitting in a hangnail, or a file chewing living tissue can inflame skin on the first careless exposure. Signs: redness, burning, dryness, fissures exactly where the product or tool sat. Cause: concentration, time, and broken barrier — not an immune memory. Fix the practice: less primer, no flooding, no work on cracked skin.
Allergic contact dermatitis is delayed hypersensitivity after the immune system has been sensitized. A client may use the same acrylic system uneventfully for months, then develop itching, redness, vesicles, or eyelid rash from monomer, primer, latex, nickel, or a fragrance. The cause is an immune reaction, not "dirty dishes." You cannot allergy-test in a salon. Stop the suspected product, do not service open dermatitis, and refer. Switching brands without reading ingredients is not a cure if the allergen is still in the bottle.
Do not put enhancement product on inflamed periungual skin and hope the overlay "seals" it. You will seal in irritation and create a perfect wet chamber for microbes.
Psoriasis and eczema
Psoriasis is an immune-mediated condition, not contagious. Classic plaques are well-demarcated, reddish, with silvery scale. Palms and soles can show thick plates or pustules. Nails may pit or lift; nail diseases have their own chapter, but skin plaques on the hand or foot still block a service when they are cracked, bleeding, or pustular. Intact, dry, clearly chronic plaque that you can work around without opening skin is the only pattern many instructors treat as a possible proceed-with-caution. If you cannot tell plaque from fungus or from an infected fissure, refer.
Eczema (including atopic dermatitis and many "hand eczema" pictures) is inflamed, itchy, barrier-broken skin. It can look dry, red, weepy, or crusted. Cause is a mix of barrier failure, irritants, and immune activity — not a salon virus, but broken eczema is still an open door for infection and for product allergy. Do not soak, file, or monomer over fissures. Fragrance-heavy lotions and harsh dehydrators worsen it. Intact dry patches may tolerate a gentle, unscented protocol; wet, infected, or unidentified rash is a refuse.
Verruca, tinea, and herpes: do not service
Verruca (wart) is caused by human papillomavirus. On the sole, a plantar wart can be pushed inward by walking and mistaken for a corn. Distinguishing clues: rough or cauliflower surface, black dots (thrombosed capillaries), interruption of skin lines, tenderness on lateral pinch, and a history of spreading to other toes or to family members. Cause: virus. Action: do not service, do not file it into the dust that the next client will breathe, do not core it "like a corn," and refer. HPV does not care that you "only nicked it."
Tinea pedis (athlete's foot) is a dermatophyte fungus. Signs: itching, scaling, maceration between toes, sometimes vesicles on the instep, sometimes a moccasin-pattern dry sole. Cause: fungus plus moisture plus often shared floors or poorly disinfected basins. Action: do not service the affected skin. A "quick polish over it" still means your hands, files, and whirlpool met infectious scale. Send the client to medical care; disinfect as if the exposure happened — because it did if you already touched it.
Tinea manus is fungal infection of the hand, often a dry, scaly palm, often one hand, and often paired with tinea pedis (the classic "two feet, one hand" pattern). Do not service the involved skin. Do not assume it is only winter dryness.
Herpes on the hand is often herpetic whitlow: painful, clustered vesicles on a finger, caused by herpes simplex virus. Facial cold sores are the same virus family. Cause: virus, highly contagious, especially when vesicles are present. Action: do not service; refer. Implements that met a vesicle are a blood-and-body-fluid problem, not a "wipe with alcohol and keep going" problem.
Open sores and cellulitis
An open sore is any break: ulcer, fissure with raw dermis, draining blister, fresh wound, or unhealed bite. Cause varies (trauma, diabetes, poor circulation, infection). You do not have to name the cause to know the rule: do not service open skin. Pedicure basins, files, and nippers do not belong on an ulcer. Clients with diabetes or vascular disease can have ulcers that look "small" and become limb-threatening; that is medical care.
Cellulitis is a bacterial infection of the dermis and subcutaneous tissue. Signs: spreading redness, heat, swelling, pain, shiny tight skin, red streaks toward lymph nodes, and often fever or feeling ill. Cause: bacteria entering through a break (hangnail, fissure, insect bite, ulcer). Action: this is urgent medical, not a soak-and-massage problem. Do not put the limb in a pedicure basin. Do not "work the swelling out" with petrissage. Stop, document that you refused, and urge same-day medical evaluation. On an exam item, fever plus spreading hot redness is not hyperhidrosis and not a harmless bruise.
Sweat-gland conditions and keratosis
Hyperhidrosis is excessive sweating. Palms drip on the consultation card; soles soak socks. Cause: overactive eccrine glands (sometimes inherited, sometimes triggered by heat or anxiety). Intact skin can often still be serviced if you dry the plate, use appropriate prep, and do not ignore maceration that has already become tinea. Hyperhidrosis is not, by itself, an infection.
Bromhidrosis is foul odor from sweat interacting with bacteria, retained shoe moisture, or decaying keratin. Cause: bacterial breakdown of sweat or debris, not "poor character." If the skin is intact and not obviously infected, you may service with thorough cleanse, client education about dry shoes and socks, and ruthless disinfection of basins. If you also see macerated web spaces or open fissures, treat those as tinea or open sores and refuse the affected areas.
Anhidrosis is little or no sweat. Cause may be local nerve or gland damage or a systemic problem. The exam point is that skin that cannot sweat also cannot cool itself well. Localized dry, intact skin may still receive gentle cosmetic care; a client who reports heat illness, neurologic disease, or a sudden total stop of sweating needs medical evaluation, not a "just add lotion" brush-off.
Keratosis means thickened keratin. In the salon the everyday form is keratoma/callus. Other keratoses (stuck-on seborrheic plaques, gritty sun-related actinic keratosis) are not callus-file targets. Actinic lesions are medical because they can be precancerous. If a "callus" is irregular, changing, pigmented, ulcerated, or on a sun-exposed dorsal hand rather than a pressure point, refer. Do not pick, slice, or acid-burn unidentified keratosis.
Service versus refuse at a glance
| Finding | Typical cause | Signs and symptoms | Service decision |
|---|---|---|---|
| Irritant contact dermatitis | Direct chemical or physical insult | Burn, dryness, redness where product sat, often soon after overexposure | Do not service broken or weeping skin; correct product use |
| Allergic contact dermatitis | Immune sensitization after repeated exposure | Itch, redness, vesicles, sometimes delayed by weeks | Stop the allergen; no service on open dermatitis; refer |
| Psoriasis plaques | Immune-mediated; not contagious | Silvery scale, well-defined plaques; possible nail pitting | No service if cracked, bleeding, or pustular; refer if unidentified |
| Eczema | Barrier failure and inflammation | Dry, itchy, red, possibly weepy skin | Refuse open or infected areas; avoid harsh products |
| Verruca / wart | Human papillomavirus | Rough papule, black dots, interrupted skin lines, spreading | Do not service; refer |
| Tinea pedis | Dermatophyte fungus | Itch, scale, macerated toe webs, sometimes vesicles | Do not service affected skin |
| Tinea manus | Dermatophyte fungus | Dry scaly palm, often one hand, often with foot fungus | Do not service affected skin |
| Herpes / whitlow | Herpes simplex virus | Painful clustered vesicles on a finger or nearby skin | Do not service; refer |
| Open sores | Trauma, vascular disease, infection, and others | Break in skin, drainage, crust, ulcer | Do not service |
| Cellulitis pattern | Bacterial infection of dermis and subcutis | Spreading heat, redness, swelling, pain, possible fever | Urgent medical referral; no salon service |
| Hyperhidrosis | Excess eccrine sweat | Dripping palms or soles | Possible if skin intact; dry the plate; watch for tinea |
| Bromhidrosis | Bacterial action on sweat or moisture | Odor | Possible if no infection; educate and disinfect |
| Anhidrosis | Reduced or absent sweat | Abnormal dryness; heat-risk if widespread | Gentle care only on intact skin; medical review if systemic |
| Pressure keratosis (callus) | Repeated friction | Broad thick keratin on a pressure point | Cosmetic reduction only if intact and clearly not a wart |
| Unidentified or actinic keratosis | Variable; sun damage possible | Irregular, changing, or non-pressure scale | Refer; do not file as callus |
Little Rock chair-side example
A walk-in wants a gel pedicure. The fourth-toe web is white, itchy, and peeling; the heel has intact even callus; the shin shows a hot, expanding red patch and the client feels feverish. You have three different decisions on one person: refuse the web (tinea pattern), you may address intact heel callus only if you are not going to share tools from the infected web (in practice, do not start a service that requires you to handle infectious scale), and stop everything for the shin — that is a cellulitis-pattern medical problem, not a massage add-on. Exam items love this kind of mixed picture. They are testing whether you can refuse the dangerous finding even when part of the foot "looks like a normal callus."
Traps
Do not file a plantar wart as a corn. Do not call allergic primer rash a fungal infection just because it itches. Do not massage a hot swollen leg. Do not service herpes vesicles because "it is only one finger." Do not treat open psoriasis or eczema as a chance to demonstrate extra cuticle work. Confirm the current NIC wording on disorders, diseases, and conditions of the skin in the bulletin your Arkansas provider posts.
A client develops itching vesicles around the nail folds after months of uneventful acrylic fills with the same primer. Another client’s eponychium burns the same day a technician floods it with dehydrator. The delayed, after-repeated-exposure reaction is which condition?
You see a rough, cauliflower-like papule on a toe with tiny black dots. The client says it has been spreading to the next toe. The safest professional action is which of the following?
A client’s lower leg is hot, swollen, and shiny with spreading redness, and they feel feverish. What should the nail technician do?