5.4 Skin Diseases & Disorders, Skin and Nail Analysis & Contraindications to Nail Enhancements
Key Takeaways
Skin and nail analysis means inspecting the skin, nail folds, nail plate and free edge before every service, then choosing a service that suits what you find.
Colorado Rule 1.7(E) bars services on a client with a communicable disease or a contagious condition involving visible swelling, eruption, redness, bruising, a rash or an open wound, unless a physician, PA or advanced practice nurse gives written authorization.
Contagious skin conditions at the nail table include tinea (ringworm and athlete's foot), warts, impetigo and scabies; psoriasis and eczema are not contagious but may still rule out a service when the skin is broken or inflamed.
Enhancement services are contraindicated over onycholysis, infection, inflammation, broken skin, a known allergy to the product chemistry, or a nail plate too damaged to support the overlay.
Skin lesions are described by type: macules (flat spots), papules (small raised bumps), vesicles (small fluid-filled blisters), pustules (pus-filled) and fissures (cracks).
Analysis Before Every Service
PSI's Domain 2 groups three skills: skin and nail structure, skin and nail analysis, and selection of appropriate services based on the condition of skin and nails. Analysis is the bridge between the anatomy in Chapter 4 and the services in Chapters 6 and 7. Do it before every service, not only the first:
- Wash and sanitize your hands; have the client sanitize theirs (Colorado requires client hand sanitizer at every nail station).
- Look at the skin of the hands or feet: color, dryness, cracks, calluses, lesions, rashes, swelling, bruising, warts, cuts.
- Look at the nail folds (eponychium, lateral folds, hyponychium): redness, swelling, pus, hangnails, overgrown or adherent tissue.
- Look at the nail plate: color, thickness, ridges, pits, spots, lifting from the bed, splitting, curvature, existing product and lifting.
- Ask about pain, numbness, recent injuries, medical conditions, medications and past reactions (Section 5.3).
- Decide: proceed, proceed with modifications, or decline and refer.
Describing Skin Lesions
| Lesion | Description | Example at the nail table |
|---|---|---|
| Macule | Flat, discolored spot | Freckle, age spot |
| Papule | Small, solid raised bump | Wart, early insect bite |
| Vesicle | Small blister with clear fluid | Allergic contact dermatitis around the cuticles |
| Bulla | Large blister | Friction blister on the heel |
| Pustule | Raised lesion filled with pus | Infected hangnail, impetigo |
| Wheal | Itchy, swollen lesion that fades within hours | Hives |
| Fissure | Crack in the skin, can reach the dermis | Cracked heels, chapped knuckles |
| Scale | Flakes of dead skin | Psoriasis, dry skin |
| Crust | Dried serum, blood or pus | Healing scrape, impetigo |
| Ulcer | Open lesion with tissue loss | Diabetic foot ulcer: refer, never treat |
Skin Diseases and Disorders of the Hands and Feet
| Condition | Key signs | Contagious? | Nail service decision |
|---|---|---|---|
| Tinea pedis (athlete's foot) | Itching, scaling, peeling or cracking, often between the toes | Yes (fungal) | Decline the pedicure; refer |
| Tinea manus (ringworm of the hand) | Ring-shaped, scaly, itchy patch | Yes (fungal) | Decline service on the affected area; refer |
| Verruca (wart) | Rough, raised papule; plantar warts are flattened on the sole | Yes (viral, HPV) | Do not file, buff or cut over it; decline if extensive |
| Impetigo | Honey-colored crusts, oozing sores | Yes (bacterial) | Decline; refer |
| Scabies | Intense itching, burrows, often between the fingers | Yes (mite) | Decline; refer |
| Cellulitis | Spreading red, warm, painful swelling | It is an infection | Decline; refer promptly |
| Eczema (atopic dermatitis) | Dry, itchy, red patches; can weep or crack | No | Proceed only on intact skin; avoid irritating products |
| Psoriasis | Red plaques with silvery scale; nail pitting, oil-drop spots | No | Gentle services on intact skin; avoid trauma, which can trigger new plaques |
| Contact dermatitis | Redness, itching or blisters where a substance touched | No | Identify and avoid the trigger; refer if severe |
| Calluses and corns | Thickened skin over pressure points; a corn has a central core | No | Smooth calluses gently; never cut; refer painful corns |
| Hyperhidrosis | Excessive sweating of the palms or soles | No | Affects product adhesion; dehydrate carefully |
| Fissures and chapping | Cracks in dry skin | No | Moisturize; avoid harsh products on open cracks |
Colorado's Communicable-Disease Rule
Rule 1.7(E) states that a licensee must not perform a service on a client with a communicable disease or contagious condition involving visible swelling, eruption, redness, bruising, a rash or an open wound or sore where services would be performed. The service may go ahead only after the client provides written authorization from a licensed physician, physician assistant or advanced practice nurse. Three points are easy to miss:
- The rule turns on visible signs, not a diagnosis. If a condition with swelling, eruption, redness, bruising, a rash or an open sore may be contagious, treat it as covered.
- A client's verbal assurance ("my doctor said it's fine") is not enough; Colorado requires written authorization.
- You still do not diagnose. Describe what you see, decline the affected area and recommend medical evaluation.
Choosing Services Based on Condition
| Finding | Service choice |
|---|---|
| Thin, flexible, peeling nails | Gentle filing with fine abrasives, a protective treatment or light overlay; avoid heavy buffing |
| Ridges (onychorrhexis) | Ridge-filling base; do not buff the ridges flat |
| Bitten nails with intact skin | Manicures, possibly tips or overlays to discourage biting |
| Dry, cracked cuticles | Conditioning manicure, oil, paraffin on intact skin |
| Heavy heel callus | Gradual smoothing with softener and file; never cut |
| Sweaty palms | Extra dehydration; product chemistry suited to oily nails |
| Thick, discolored, crumbling toenail | Suspect fungal infection; decline and refer |
Contraindications to Nail Enhancement Services
PSI lists "contraindications to nail enhancement services" as a separate topic from manicure and pedicure contraindications. Before applying tips, liquid-and-powder, gels, wraps or dip systems, check for:
- Infection or inflammation of the nail or surrounding skin: paronychia, pus, swelling, heat or pain.
- Onycholysis (plate separated from the bed). An overlay hides the separation, traps moisture and invites Pseudomonas or fungal growth.
- Suspected fungal infection of the plate.
- Broken skin, cuts or open wounds at the nail folds.
- Known allergy or prior reaction to methacrylates, gels or adhesives. Do not apply the same chemistry again.
- A plate too damaged or thin to support an enhancement, such as after trauma or aggressive removal; build it back with natural-nail care first.
- Green or dark discoloration under existing product. Remove the product and do not reapply until the nail is healthy (Section 5.1).
- Medical conditions that change the risk, such as diabetes, circulatory disorders or chemotherapy. Consult the client and their physician as needed, and choose gentler services.
When a contraindication exists, you can alter the service by switching to a natural-nail manicure, skipping the affected nail or choosing a different product system. You can also decline and refer. Document the decision on the client record either way.
Scenario
A client wants a full set of liquid-and-powder enhancements. Analysis shows two fingernails lifting from the bed at the free edge with no pain, and a scaly, itchy ring-shaped patch on the back of the same hand. The lifting nails are onycholysis, a contraindication to enhancements on those nails. The ring-shaped patch could be a contagious fungal infection, so Rule 1.7(E) applies to the affected area. The technician should decline enhancements on the lifting nails and avoid the patch. She should recommend medical evaluation, offer a natural-nail service on the unaffected nails if that can be done safely, and record her findings.
Under Colorado Rule 1.7(E), when may a technician perform a service on an area showing a contagious rash?
Never under any circumstances
Whenever the client says a doctor approved it
Only if the technician wears gloves throughout and disinfects the skin before and after the service
Only with written authorization from a physician, physician assistant or advanced practice nurse
Which skin condition seen at the nail table is NOT contagious?
Impetigo
Psoriasis
Tinea pedis
Verruca (wart)
Why is onycholysis a contraindication to applying a new nail enhancement?
It means the client is allergic to methacrylates
It causes the enhancement product to cure too quickly and unevenly under the lamp
It makes the nail plate too thick to file
The overlay would hide the separation and trap moisture under the plate
How is a vesicle described in skin analysis?
A dry flake of dead skin
A small blister filled with clear fluid
A crack in the skin that may reach the dermis
A flat, discolored spot
Sections you finish are checked off in the contents.