6.2 Diseases and Disorders of the Nails
Key Takeaways
- Cosmetologists are strictly prohibited by Florida DBPR rules from performing nail services on any client showing signs of a nail disease.
- Beau's lines appear as horizontal depressions across the nail plate, caused by a temporary pause in matrix cell production due to illness or trauma.
- Nail diseases like paronychia (bacterial) and onychomycosis (fungal) are infectious, highly contagious, and require referral to a physician.
- Onycholysis is the lifting of the nail plate from the nail bed without shedding, which creates a warm, moist pocket susceptible to infections.
- Nail disorders like eggshell nails, onychophagy, and onychorrhexis may be serviced using gentle cosmetic adjustments if skin is intact.
6.2 Diseases and Disorders of the Nails
A professional cosmetologist must be able to recognize the difference between healthy nails, nail disorders, and nail diseases. While many nail disorders can be safely serviced in the salon with cosmetic improvements, nail diseases are caused by pathogens and represent infections or inflammations.
[!IMPORTANT] Under Florida Department of Business and Professional Regulation (DBPR) rules, cosmetologists are strictly prohibited from performing services on any client exhibiting signs of a nail disease. If a disease is present, the cosmetologist must refuse the service and recommend that the client consult a licensed physician. Performing services on infected nails is a serious safety violation that can spread infection and result in license suspension.
Nail Disorders: Conditions You Can Service
A nail disorder is a condition caused by injury, heredity, or a systemic malfunction of the nail unit. If the skin surrounding the nail is not inflamed, infected, or broken, these conditions can be cosmetically serviced to improve the nail's appearance.
Bruised Nails and Splinter Hemorrhages
- Bruised nail beds occur when a blood clot forms under the nail plate, causing a dark purplish spot. This is usually due to localized physical injury to the nail bed. The nail plate should be treated gently, avoiding excess pressure.
- Splinter hemorrhages are caused by physical trauma or injury to the nail bed, which damages the capillaries and allows small amounts of blood to flow. This creates thin, vertical brown or black lines that resemble splinters under the nail plate. They are harmless and will grow out with the nail.
Eggshell Nails
Eggshell nails are noticeably thin, white nail plates that are much more flexible than normal. They curve over the free edge and are prone to breaking. This condition is typically caused by improper diet, hereditary factors, internal disease, or medication. When servicing eggshell nails, use the fine side of an abrasive board (240 grit or higher) and avoid applying heavy pressure.
Beau's Lines
Beau's lines (sometimes called furrows or depressions) are visible horizontal depressions running across the width of the natural nail plate. They occur because the matrix slows down or stops producing nail cells for a period of time, usually due to a severe systemic illness (such as a high fever), major surgery, or localized trauma. The lines will eventually grow out if the cause of the disruption is resolved.
Hangnails (Agnails)
A hangnail is a condition in which the living skin surrounding the nail plate splits or tears. This is typically caused by dryness of the skin or repeated exposure to harsh chemicals.
- Treatment: Gently push back the skin and use sharp cuticle nippers to trim only the dead, loose skin. Never cut the living skin.
Leukonychia and Melanonychia
- Leukonychia spots are white discolorations on the nail plate, usually caused by minor injury to the nail matrix. They are not a sign of vitamin or mineral deficiency, contrary to popular belief. They will grow out and disappear as the nail grows.
- Melanonychia is a darkening of the fingernails or toenails, presenting as a black or brown band within the nail plate. It is caused by a localized excess of melanin cells in the matrix. While normal in dark-skinned individuals, a sudden appearance of melanonychia in light-skinned individuals should be evaluated by a physician, as it can indicate melanoma.
Onychophagy and Onychorrhexis
- Onychophagy (bitten nails) is the result of a habit of chewing the nail or the hardened, damaged skin surrounding the nail plate. Once the skin has healed and is no longer broken or bleeding, the nails can be serviced. Frequent manicures and artificial enhancements can help discourage this habit.
- Onychorrhexis refers to split or brittle nails that have a series of lengthwise ridges, giving a rough appearance. This is caused by injury to the matrix, excessive exposure to harsh cleaning agents, or hereditary factors. These nails can be serviced using penetrating nail oils to rehydrate the plate.
Ridged Nails
Ridged nails are vertical lines running down the length of the natural nail plate. This is usually caused by uneven growth of the nails, which is common in older clients. This is a disorder, not a disease. The ridges can be minimized by gently buffing the nail plate or applying a ridge-filling base coat before polishing.
Nail Diseases: Conditions You CANNOT Service (Refer to a Physician)
A nail disease is an infectious or inflammatory condition of the nail unit. Cosmetologists must never perform services on clients with these conditions.
| Disease Name | Common Name / Cause | Key Visual Symptoms | Action Required |
|---|---|---|---|
| Tinea Pedis | Athlete's foot / Fungal | Red, itchy, peeling skin on soles and between toes | Refuse service; refer to physician |
| Onychomycosis | Nail fungus / Fungal | Thickening, whitish/yellowish discoloration, crumbling plate | Refuse service; refer to physician |
| Paronychia | Bacterial infection | Redness, swelling, and pus in the skin folds surrounding the nail | Refuse service; refer to physician |
| Pyogenic Granuloma | Severe inflammation | A lump of red tissue growing from nail bed to plate | Refuse service; refer to physician |
| Onychia | Matrix inflammation | Redness, swelling, and shedding of the natural nail plate | Refuse service; refer to physician |
| Onycholysis | Lifting of the nail | Separation of nail plate from bed without shedding | Refuse service; refer to physician |
Tinea Pedis and Onychomycosis
- Tinea pedis is a fungal infection of the feet. It typically appears as a red, itchy rash between the toes or on the soles of the feet. It is highly contagious.
- Onychomycosis is a fungal infection of the natural nail plate. Symptoms include whitish patches on the nail, yellow streaks, and a thick, crumbling nail plate that separates from the nail bed. Fungi thrive in warm, dark, moist environments.
Paronychia and Pyogenic Granuloma
- Paronychia is a bacterial inflammation of the skin folds surrounding the nail. It is characterized by redness, swelling, tenderness, and sometimes pus. It is common in individuals who wash their hands frequently or work with their hands in water.
- Pyogenic granuloma is a severe inflammation of the nail in which a lump of red tissue grows from the nail bed to the nail plate. This is a highly sensitive condition that requires immediate medical treatment.
Onychia and Onycholysis
- Onychia is an inflammation of the nail matrix, followed by the shedding of the natural nail plate. Pathogens enter through open wounds or improper use of sharp implements.
- Onycholysis is the lifting of the nail plate from the nail bed without shedding, usually starting at the free edge and progressing toward the lunula. It can be caused by physical trauma, allergic reactions to nail products, or systemic health issues. While not always infectious, the space created under the nail plate can collect water and dirt, providing a breeding ground for bacteria or fungi. Therefore, services must be avoided until the nail has grown out and reattached.
Which of the following nail conditions is classified as a disease, meaning the cosmetologist must refuse service and refer the client to a physician?
What is the cause of Beau's lines?
Which condition is characterized by a bacterial inflammation of the skin folds surrounding the nail, causing redness, swelling, and tenderness?