9.1 Manicures, pedicures & nail structure/disorders
Key Takeaways
- The matrix is the only living, reproductive part of the nail; damage to it causes abnormal growth or stops the nail from growing.
- Fingernails grow about 1/10 inch (roughly 3 mm) per month and replace themselves completely in about four to six months.
- The eponychium is living skin sealing the matrix and must never be cut, whereas the cuticle is dead tissue on the plate that may be gently pushed back.
- Any nail showing fungus, bacteria such as pseudomonas or paronychia, pus, swelling, or broken skin must be referred to a physician, not serviced.
- Toenails are cut and filed straight across to prevent ingrown nails, and reusable implements must be disinfected in an EPA-registered disinfectant between clients.
The Natural Nail Unit
The natural nail, technically called the onyx, is an appendage of the skin made of hardened keratin — the same fibrous protein found in hair and the outer layer of skin. NIC theory questions repeatedly ask you to identify the parts of the nail unit and their functions, so master this vocabulary first.
The matrix is the only living, reproductive part of the nail. It lies beneath the skin at the base of the nail and contains nerves, lymph, and blood vessels that manufacture the cells that harden into the nail plate. If the matrix is injured or diseased, the nail grows abnormally or stops growing altogether. The nail plate is the visible, hardened keratin that rests on and slides across the nail bed; it has no nerves or blood supply of its own. The nail bed is the living skin beneath the plate, richly supplied with blood vessels that give a healthy nail its pink color and with nerves that make the area sensitive. Plate and bed are joined by the bed epithelium, a thin tissue that guides the plate forward as it grows.
The lunula is the whitish half-moon at the base of the plate — it is the visible front portion of the matrix. The cuticle is dead, colorless tissue attached to the plate surface, while the eponychium is the living skin at the base of the nail that seals and protects the matrix and must never be cut. The hyponychium is the thickened living skin beneath the free edge that seals the bed against pathogens, and the free edge is the portion of the plate extending past the fingertip. The nail folds, or mantle, are the folds of skin that frame and support the nail.
Nail growth
Healthy nails grow about 1/10 inch (roughly 3 mm) per month. Growth is fastest on the middle finger, slowest on the thumb and little finger, quicker in summer than winter, and faster in children than in older adults. A fingernail replaces itself completely in about four to six months; toenails grow more slowly.
Disorders versus diseases and infections
You may service a nail disorder — a condition caused by injury or an imbalance in the body — only when there is no sign of infection, swelling, broken skin, or inflammation. Any nail disease or infection must be referred to a physician; servicing it is outside your scope of practice and can spread the condition.
| Condition | What it is | Service or refer |
|---|---|---|
| Onychomycosis (tinea unguium) | Fungal infection of the nail | Refer |
| Paronychia | Bacterial inflammation of tissue around the nail | Refer |
| Pseudomonas | Bacterial infection; green/black stain under the plate | Refer |
| Onychia | Inflammation of the matrix with pus | Refer |
| Hangnail (agnail) | Split or torn cuticle | Service — soften with oil |
| Beau's lines | Depressions running across the plate after illness | Service with care |
| Leukonychia | White spots from minor injury | Service |
| Onychophagy | Bitten nails and damaged cuticle | Service |
| Onychorrhexis / onychauxis | Split brittle nails / nail overgrowth | Service |
The exam distinction is simple: fungus, bacteria, pus, swelling, or broken skin means refer. A structural or cosmetic change with intact, healthy skin is serviceable.
The basic manicure
A standard water (wet) manicure follows a set order: remove old polish; shape the nails with the coarse then fine side of an emery board, filing from each corner toward the center; soak to soften the eponychium in warm, soapy water; gently push back the eponychium; clean under the free edge; apply cuticle remover and nip only loose tags of dead skin — never live tissue; then massage, buff, and polish. Polish is applied in thin coats: a base coat, two color coats, and a top coat to seal and protect.
Nail shapes
The five basic nail shapes tested on the exam are square (straight sides with a flat free edge — the strongest, most durable shape), squoval (a square softened at the corners), round (following the natural fingertip, popular for men), oval (a rounded-square shape that lengthens and flatters most hands), and pointed (narrow and dramatic but the weakest and most prone to breaking). Choose the shape to suit the client's hand shape, finger length, and daily activities rather than fashion alone.
Pedicures
A pedicure services the feet and toenails. Toenails are cut and filed straight across to help prevent ingrown nails (onychocryptosis). The service includes soaking, exfoliation, callus smoothing with a foot file, cuticle work, massage, and polish. Never use a credo blade or razor to shave calluses — this is prohibited in North Carolina. Always inspect the feet for signs of infection or diabetes-related problems and refer when in doubt.
Implements, sanitation, and massage
Distinguish implements (reusable tools such as metal pushers, nippers, and tweezers) from disposable materials (single-use items such as cotton, orangewood sticks, and emery boards). Reusable implements must be cleaned and then disinfected in an EPA-registered, hospital-level disinfectant between every client; single-use items are discarded. Massage improves circulation and relaxes the client: effleurage (light gliding), petrissage (kneading), and friction (deep rubbing) are the primary movements. Avoid massage over varicose veins or any infected area.
Which part of the natural nail unit is the only living, reproductive part that produces the cells forming the nail plate?
A client's nail shows a green-black discoloration between the nail plate and bed. What is the correct action?
Which of the following nail conditions is serviceable rather than requiring referral to a physician?