5.4 Skin Diseases & Disorders of the Hands and Feet; Contraindications to Nail Enhancement Services
Key Takeaways
Primary skin lesions include macules, papules, vesicles, bullae, pustules, wheals, nodules and cysts; secondary lesions include crusts, scales, fissures, ulcers, excoriations and scars.
Contagious skin conditions such as tinea, warts, herpes simplex, scabies and impetigo are not serviced; refer the client to a physician.
Non-contagious conditions such as vitiligo or mild, closed eczema can be serviced with care if the skin is intact and not inflamed.
Melanoma warning signs follow ABCDE: Asymmetry, Border irregularity, Color variation, Diameter usually over 6 mm, and Evolving change.
Do not apply nail enhancements over infected, lifting, separated or broken nails or skin, or for a client with a known allergy to the product.
The vocabulary of skin lesions
A lesion is a mark or change on the skin. The textbooks sort lesions into primary (the first change) and secondary (what develops later). Expect definition questions.
| Primary lesion | What it looks like |
|---|---|
| Macule | Flat spot of different color, such as a freckle |
| Papule | Small, solid, raised bump |
| Vesicle | Small blister filled with clear fluid |
| Bulla | Large blister filled with fluid |
| Pustule | Raised bump containing pus |
| Wheal | Itchy, swollen lump, as in hives or an insect bite |
| Nodule or tubercle | Solid lump extending deeper into the skin |
| Tumor | Larger abnormal mass |
| Cyst | Closed sac containing fluid or semi-solid material |
| Secondary lesion | What it looks like |
|---|---|
| Crust | Dried serum, blood or pus on the surface |
| Scale | Flakes of dead skin, as in dandruff or psoriasis |
| Fissure | Crack in the skin, such as on chapped heels |
| Ulcer | Open sore extending into deeper layers |
| Excoriation | Scrape or scratch mark from injury or scratching |
| Scar and keloid | Healed tissue; a keloid is thick, raised overgrowth of scar tissue |
Describe what you see using these words. The diagnosis belongs to a physician.
Skin conditions on the hands and feet
| Condition | What you see | Contagious? | Salon action |
|---|---|---|---|
| Contact dermatitis (irritant or allergic) | Redness, itching, dryness, blisters where a substance touched | No | Do not serve inflamed, blistered or broken skin. Identify and avoid the trigger product (section 3.4). Refer if severe. |
| Eczema (atopic dermatitis) | Dry, itchy, red patches, sometimes cracked or weeping | No | Serve only intact, calm skin with gentle products. Postpone if weeping or broken. |
| Psoriasis | Thick red patches with silvery scales; nail pitting | No | Gentle service on intact skin. Avoid trauma, which can trigger new patches. No enhancements over affected nails with separation. |
| Tinea pedis (athlete's foot) and tinea manuum | Scaling, peeling, itching between toes or on palms and soles; blisters | Yes | No service on affected area. Refer. |
| Verruca (warts), including plantar warts | Rough raised growths, often with tiny dark dots | Yes (HPV) | Do not file or cut over them. Postpone service to the area and refer. |
| Herpes simplex, including herpetic whitlow on a finger | Painful clustered blisters on red base | Yes | No service while lesions are present. Refer. |
| Impetigo | Honey-colored crusts over oozing sores | Yes (bacterial) | No service. Refer. |
| Scabies | Intense itching, small bumps and burrows, often between fingers | Yes (mites) | No service. Refer. |
| Cellulitis or any red, hot, swollen spreading area | Warm, tender, swollen skin, sometimes with fever | Infection | No service. Refer promptly. |
| Callus (keratoma) and corn | Thickened skin over pressure points; a corn has a hard central core | No | Soften and smooth with approved abrasives. Never cut, and no blades in Michigan (section 6.2). Refer painful corns. |
| Vitiligo | Smooth white patches from loss of pigment | No | Serve normally and protect from irritation |
| Hyperpigmentation and age spots | Flat darker spots | No | Serve normally. Watch for changes. |
Skin cancer warning signs
You may be the person who looks most closely at a client's hands and feet. Know the signs and refer without alarm:
- Basal cell carcinoma: often a pearly or shiny bump, or a sore that does not heal.
- Squamous cell carcinoma: often a scaly red patch, rough bump or sore that crusts or bleeds.
- Melanoma: the most serious. Use the ABCDE warning signs from dermatology:
- Asymmetry: one half does not match the other
- Border: irregular, ragged or blurred edges
- Color: several shades of brown, black, red, white or blue
- Diameter: usually larger than 6 mm, about the size of a pencil eraser, though melanomas can be smaller
- Evolving: changing in size, shape or color
A new or changing dark streak in a nail, especially with pigment spreading onto the surrounding skin, needs a physician (section 5.1).
Contraindications to manicure and pedicure services
Postpone or decline the service, or the part of it affecting the area, and refer when you see:
- signs of infection: redness, heat, swelling, pain or pus
- contagious conditions from the table above
- open wounds, broken or weeping skin
- unexplained swelling of the leg, or a client with known blood clots (no massage, section 6.2)
Medical conditions such as diabetes, circulatory problems, blood thinners and neuropathy call for modified services and sometimes physician clearance (section 5.3).
Contraindications to nail enhancement services
Do not apply tips, wraps, liquid and powder, gels or dip systems when:
| Situation | Why |
|---|---|
| Suspected fungal or bacterial infection of the nail or folds | Covering it traps moisture and hides the problem. Refer. |
| Onycholysis (separation) or a lifting, loose plate | The pocket under the enhancement collects moisture and bacteria |
| Broken, bleeding or inflamed skin around the nail | Chemicals reach living tissue and raise allergy risk |
| Known allergy to the product family, such as acrylates, or a positive patch test | Repeat exposure worsens the reaction |
| Severely damaged, very thin or bitten-to-the-bed nails | No sound plate to bond to. Restore with natural nail care first. |
| Client cannot keep the appointment schedule for maintenance | Grown-out enhancements become levers that crack and lift (section 7.3) |
If the problem is a mechanical one that will grow out, such as a minor split or a short bitten nail with intact skin, a natural-nail service or a light repair may be appropriate. When infection, separation or allergy is involved, the answer is no enhancement until a physician says otherwise.
Explaining a postponement
Use the client-record and refusal approach from section 5.3:
- Speak privately, and describe what you observe without naming a disease.
- Explain that the service could make it worse or spread it.
- Suggest the client see a physician.
- Offer a service on an unaffected area if that is safe, and record the decision.
- Clean and disinfect anything that touched the area.
Which primary skin lesion is a small blister filled with clear fluid?
Macule
Vesicle
Wheal
Fissure
A pedicure client has smooth, white, painless patches of skin on the tops of both feet. The skin is intact. Which action is appropriate?
Refuse service, because the white patches are contagious
Apply a bleaching cream so the skin color is more even
File the patches lightly to remove the white surface layer
Serve normally, avoiding irritation; vitiligo is not contagious
Which situation is a contraindication to applying a nail enhancement?
A plate partly separated from the nail bed (onycholysis)
Healthy nails that show only mild vertical ridges
A client who prefers a long almond-shaped nail
Nails that were recently polished with regular lacquer
Sections you finish are checked off in the contents.