5.3 Nail Disorders and Diseases
Key Takeaways
- Onychomycosis, paronychia, and tinea pedis are infectious contraindications: stop the New Jersey manicure or pedicure on affected nails or feet and refer; basin disinfection under N.J.A.C. 13:28-3.2 does not authorize serving an infectious patron.
- N.J.A.C. 13:28-3.3(d) is the same refuse rule used on scalp and skin: reasonable grounds of a transmissible disease are enough to stop.
- Onycholysis without obvious infection is proceed-with-caution (do not probe under the plate); yellow-green, thick, or odorous separation is treated as possible infection and stopped.
- Onychophagy, eggshell nails, and leukonychia are usually non-infectious disorders: gentle services if surrounding skin is intact; stop if hangnails or bitten skin are red, swollen, or draining.
- Pterygium is not cut as living skin; unexplained blue nails are referred rather than covered as a polish problem; N.J.A.C. 13:28-2.15 still forbids disease-cure claims and credo blades.
Nail services stop for infection, not for every white spot
Quick Answer: Onychomycosis, paronychia, and tinea pedis are infectious contraindications—stop the manicure or pedicure, refer, and do not claim to cure fungus or bacteria (N.J.A.C. 13:28-2.15(b)6). N.J.A.C. 13:28-3.3(d) forbids serving a patron you know or have reasonable grounds to believe has a transmissible disease. Cleaning the pedicure tub to N.J.A.C. 13:28-3.2 is mandatory hygiene; it is not permission to soak an infectious foot. Leukonychia, eggshell nails, and onychophagy on intact skin are usually caution. Infected hangnails, pterygium you would have to cut as living tissue, and unexplained blue nails are stop or refer.
Manicuring and pedicuring are 135 of the 1,200 curriculum hours in N.J.A.C. 13:28-6.29, so the theory exam expects you to protect the nail unit: plate, bed, folds, and adjacent skin. Implements that cannot be sanitized—emery boards, orangewood sticks—are discarded after each use under 13:28-3.2(d). That discard rule still assumes you were allowed to start the service.
Infectious conditions that stop a NJ manicure or pedicure
Onychomycosis (tinea unguium) is fungal disease of the nail. Signs: yellow, white, or brown discoloration; thickening; crumbling free edge; debris under the plate; odor. Toenails are common; fingernails occur too. It is infectious in salon terms because files, nippers, and foot basins move organisms. Stop services on the affected nails. Do not grind a thick mycotic nail as a cosmetic reduction. Do not apply enhancement product to hide fungus. Refer to a physician. After refusal, sanitize reusable tools per 13:28-3.2, including the enzyme pre-soak and ultrasonic cycle required for manicuring implements in 13:28-3.2(b).
Paronychia is infection of the tissue around the nail, usually bacterial, with redness, swelling, pain, and sometimes pus. Hangnail picking and wet work are common stories; you still do not diagnose the organism. Stop. Do not drain an abscess. Do not push the fold harder to tidy the eponychium. Refer. This is one of the cleanest contraindication items on the exam.
Tinea pedis (athlete's foot) is a dermatophyte infection of the foot skin: itching, scaling, maceration especially between the toes, sometimes blisters. It is contagious. Stop the pedicure. Do not put that foot in a whirlpool and rely on later disinfection as a substitute for 13:28-3.3(d). 13:28-3.2(c) still requires between-client detergent, rinse, dry, and tuberculocidal contact (or the listed bleach-wipe alternative), plus end-of-day screen and bleach procedures—but those steps protect the next patron after a lawful pedicure, not this infectious one.
Fish pedicures are separately banned (13:28-2.15(b)4). They are not a treatment for tinea pedis.
Onycholysis: caution or stop depends on infection signs
Onycholysis is separation of the nail plate from the nail bed, starting distally. A clean, painless lift after trauma, with no odor or color, is proceed with caution: keep the service short, do not probe under the plate, do not pack product into the space, keep the area dry. Yellow-green discoloration, thickness, debris, or tenderness moves the finding into possible infection (fungal or bacterial, including the green-nail story from Pseudomonas in some texts). That is a stop, not a fill.
Non-infectious disorders: usually caution, not an automatic refuse
Onychophagy is nail biting. The bitten free edge is a disorder, not a fungus. If surrounding skin is intact, you may proceed with caution: gentle shaping, no cutting living tissue, talk about keeping hands off the mouth as a habit—not as medical therapy. If the skin is broken, red, swollen, or draining, treat it like an infection risk and stop until a physician has cleared it.
Eggshell nails are thin, white, and flexible, often curving over the free edge. Causes in textbooks include illness, diet, or medication—none of which you diagnose. Proceed with caution: very light filing, no aggressive machine work, no heavy enhancements that lever a fragile plate. Stop if the bed is inflamed or the plate is separating with infection signs.
Leukonychia is white spotting of the plate, most often from injury to the matrix (a slammed finger), not from a calcium myth you must treat. Proceed with ordinary manicure care on an intact, non-infectious nail. Do not sell a supplement as a cure for white spots.
Pterygium, blue nails, hangnails
Pterygium here means abnormal adhesion or overgrowth of eponychium onto the plate (dorsal) or related scarring that tethers skin to nail. It is not the ordinary thin cuticle you may gently reduce with product on intact tissue. Do not cut living skin. If the growth is tight, inflamed, or the result of injury or disease, refer. A credo blade or skin scraper used to peel pterygium is 13:28-2.15(b)1.
Blue nails may follow bruising (subungual hematoma) from trauma—caution if the skin is closed and there is no infection, and still refer if pain is severe or you cannot explain the color. Blue or purple nails from poor circulation or systemic illness are not a polish-correction service. Unexplained cyanotic color: refer, do not diagnose heart or lung disease, do not hide it with opaque color as a treatment.
Hangnails (agnails) are splits of living skin beside the nail. Intact, non-red hangnails: caution—do not rip; you may carefully trim only the loose dead tag if your training allows, never living tissue. Red, swollen, tender, or pus-filled hangnails: stop (this is paronychia territory). New Jersey does not authorize you to perform a mini-surgery on a hangnail.
Which findings stop a NJ manicure or pedicure?
| Finding | Typical signs | Manicure / pedicure |
|---|---|---|
| Onychomycosis | Discoloration, thickness, crumbly debris | Stop; refer |
| Paronychia | Red, swollen, painful fold; possible pus | Stop; refer |
| Tinea pedis | Itchy scale or maceration between toes | Stop pedicure; refer |
| Onycholysis (clean, post-trauma) | Plate lifted, no infection signs | Caution; do not probe under the plate |
| Onycholysis (color, odor, pain) | Suggests infection | Stop; refer |
| Onychophagy (intact skin) | Bitten free edge | Caution |
| Onychophagy (broken, infected skin) | Open or draining folds | Stop |
| Eggshell nails | Thin, flexible, white plate | Caution; light filing only |
| Leukonychia | White spots, often from injury | Proceed if otherwise healthy |
| Pterygium | Skin grown or scarred onto plate | Caution / refer; do not cut living skin |
| Blue nails (explained bruise, closed) | Traumatic color | Caution; refer if unsure |
| Blue nails (unexplained) | Possible circulation or systemic issue | Stop / refer; no diagnosis |
| Hangnail, not infected | Small dry split | Caution |
| Hangnail, infected | Red, swollen, pus | Stop (paronychia) |
Scope limits that show up on nail items
- No disease-cure claims for fungus, bacteria, or psoriasis of the nail (13:28-2.15(b)6).
- No credo blade to scrape the sulcus or callus as if you were treating an ingrown or wart (13:28-2.15(b)1).
- No work below the stratum corneum on periungual skin (13:28-2.15(b)2).
- 13:28-3.2 disinfection is how you treat tools and tubs, not how you treat onychomycosis.
Exam traps
- Trap: Soak the athlete's-foot client anyway because the tub gets bleach at night. 13:28-3.3(d) stops the service now.
- Trap: Buff fungus thin so polish hides it. That is still serving an infectious nail and a cure-by-concealment problem.
- Trap: White spots mean refuse for onychomycosis. Leukonychia from injury is usually proceed.
- Trap: Cut pterygium off like cuticle. Living skin is not cuticle.
- Trap: Drain paronychia with a nipper. That is medical care, not manicuring.
A pedicure client has itchy, macerated skin between the toes and scaling on the soles. The shop follows N.J.A.C. 13:28-3.2 tub disinfection. What is the correct action?
Which nail finding is ordinarily a proceed, not an infectious stop, on a New Jersey manicure?
A fingernail has lifted from the bed after a door injury. The space is clean, not tender, and has no discoloration or odor. What is the best service decision?
When does a hangnail stop a New Jersey manicure?