7.3 Skin Diseases & Disorders of the Hands and Feet
Key Takeaways
- OAC 4713-15-13(A) bars any service on a client with visible swelling, eruption, redness, bruising, rash or parasitic infestation in the service area without written permission from a physician.
- A callus (keratoma) is diffuse hyperkeratotic thickening and a corn (heloma) is focal with a hard central core; both may be smoothed with abrasives and neither may be reduced with a bladed implement.
- Allergic contact dermatitis to uncured acrylates is immune-mediated and permanent, and typically appears at the fingertips and at the eyelids, face and neck.
- Nail psoriasis produces pitting, oil-drop discolouration, onycholysis and subungual hyperkeratosis and is frequently mistaken for fungal infection; a manicurist cannot distinguish them and must refer.
- A new, widening, single-digit pigmented band, especially with pigment spreading onto surrounding skin, must be referred promptly and never concealed with polish.
Skin Diseases and Disorders of the Hands and Feet
Ohio State Board Exam Alert: "Skin Diseases/Disorders" is a named leaf under the 20 % Anatomy & Physiology domain, sitting alongside skin structure and skin function. Ohio pairs it with a hard legal rule: OAC 4713-15-13(A) bars any service on a client with visible swelling, eruption, redness, bruising on skin, rash, or parasitic infestation in the service area without written permission from a physician. Recognition plus refusal is the tested behaviour — never diagnosis.
A manicurist sees more hand and foot skin than most clinicians do. That makes recognition a professional duty, and it makes the boundary sharp: you learn these conditions in order to know when to stop, not in order to name a disease to a client.
1. The Vocabulary of Skin Lesions
Examination items often describe a lesion rather than name a disease, so the vocabulary matters.
Primary lesions
| Lesion | Description | Nail-salon example |
|---|---|---|
| Macule | Flat, discoloured spot, no elevation | Freckle; a flat age spot on the dorsum of the hand |
| Papule | Small solid raised lesion, no fluid | An early wart; an insect bite |
| Vesicle | Small blister containing clear fluid | Contact dermatitis blister; early herpes |
| Pustule | Raised lesion containing pus | Acute paronychia at the nail fold |
| Wheal | Itchy raised area from an allergic reaction or bite | Hives after a product reaction |
| Tubercle | Solid abnormal mass larger than a papule | A nodule under the skin |
| Cyst | Closed, abnormally developed sac containing fluid or semi-solid matter | Digital mucous cyst near the eponychium |
Secondary lesions
| Lesion | Description | Nail-salon example |
|---|---|---|
| Scale | Plate of dry or greasy flakes | Psoriasis; chronic tinea pedis |
| Crust | Dried mass of serum, blood or pus | Healed scratch; impetigo |
| Excoriation | Sore or abrasion from scratching or scraping | Over-filed skin at the sidewall |
| Fissure | Crack in the skin penetrating into the dermis | Split heel; cracked knuckles |
| Ulcer | Open lesion with loss of skin depth and often fluid or pus | Diabetic foot ulcer — an absolute stop |
| Scar / cicatrix | Fibrous tissue after an injury heals | Old matrix injury |
| Keratoma / callus | Thickened patch of epidermis from pressure or friction | Callus on the heel or ball of the foot |
Hyperkeratosis is the general term for a thickening of the stratum corneum. A callus (keratoma) is diffuse thickening; a corn (heloma) is a focal, cone-shaped thickening with a hard central core that presses inward and causes pain. Both are pressure responses. Both may be smoothed with abrasives, and neither may be pared with a blade — OAC 4713-1-07(G)(1) makes use of a bladed implement to remove skin cells below the stratum corneum an out-of-scope act.
2. Inflammatory and Allergic Conditions
| Condition | Presentation | Salon response |
|---|---|---|
| Irritant contact dermatitis | Dry, red, cracked, sometimes fissured skin from repeated chemical or wet exposure; no immune memory — anyone gets it with enough exposure | Extremely common in technicians. Barrier creams, nitrile gloves, warm not hot water. On a client, refuse service to an affected area without written physician permission |
| Allergic contact dermatitis | Red, itchy, sometimes vesicular reaction confined initially to contact sites — classically the fingertips, eyelids and neck of a client sensitised to uncured acrylate; immune-mediated and permanent once established | Stop using the product on that client. Sensitisation to HEMA and other acrylates is the profession's most significant occupational allergy. Refer for medical assessment |
| Eczema (atopic dermatitis) | Chronic, itchy, dry, inflamed patches, often on flexural skin and hands | Service only if the treatment area is clear; a flare in the service area triggers OAC 4713-15-13(A) |
| Psoriasis | Sharply demarcated red plaques with silvery scale on elbows, knees, scalp and hands; nail changes are common — pitting, oil-drop discolouration, onycholysis, subungual hyperkeratosis | Not contagious, but scaling, cracked, bleeding plaques in the service area require written physician permission. Nail psoriasis is frequently mistaken for fungal infection; a manicurist may not distinguish them — refer |
| Urticaria (hives) | Transient wheals, often with a known trigger | Stop, note the trigger, refer if severe or if breathing is affected |
3. Infectious Skin Conditions a Nail Technician Meets
| Condition | Organism | Recognition | Contagious? |
|---|---|---|---|
| Tinea pedis (athlete's foot) | Dermatophyte fungi | Itching, scaling and maceration between the toes; dry moccasin-pattern scaling on the sole | Yes — spores survive on floors, mats and basins |
| Tinea manuum | Dermatophyte fungi | Dry scaling of one palm, often with tinea pedis on both feet | Yes |
| Tinea corporis (ringworm) | Dermatophyte fungi | Annular red patch with a raised, scaly, advancing border and central clearing | Yes |
| Impetigo | Staphylococcus aureus / Streptococcus pyogenes | Superficial vesicles and pustules rupturing to a honey-coloured crust | Highly |
| Cellulitis | S. aureus / S. pyogenes | Spreading hot, red, tender, swollen area with poorly defined edges, often with fever | Not by casual contact, but a medical emergency — refer immediately |
| Herpes simplex / herpetic whitlow | HSV | Painful grouped vesicles; on a finger it produces an intensely painful whitlow | Yes — direct contact |
| Verruca (common wart) | Human papillomavirus | Rough, raised, cauliflower-textured papule; plantar warts grow inward on the sole and often show punctate black dots | Yes |
| Scabies | Sarcoptes scabiei mite | Intense night-time itching, burrows in finger webs and wrists, papular rash | Yes — direct and prolonged skin contact |
| Pediculosis | Lice | Itching and visible nits | Yes |
Every condition in this table is a stop. The Ohio rule does not require you to determine whether it is contagious, only to observe swelling, eruption, redness, bruising, rash or parasitic infestation in the service area and to obtain written physician permission before proceeding.
4. Pigmentation and Growth Changes
| Change | Notes for a nail technician |
|---|---|
| Lentigines / age spots | Flat brown macules from cumulative sun exposure on the dorsum of the hand. Harmless, but a reminder that UV/LED lamp exposure is a real if small dose |
| Hyperpigmentation / hypopigmentation | Post-inflammatory darkening or lightening after injury or dermatitis |
| Vitiligo | Patchy loss of pigment; not contagious; those areas burn readily |
| Nevus (mole) | Any mole that changes in size, shape, colour, border or symmetry, or that bleeds, warrants prompt medical review |
| Longitudinal melanonychia | A pigmented band running the length of the nail. It has benign causes, but a new, widening, single-digit band, especially with pigment spreading onto the surrounding skin, must be referred urgently and never concealed with polish |
A manicurist does not diagnose any of these. What a manicurist does is notice a change, decline to cover it up, and say clearly that a physician should look at it.
5. The Refusal Script
Handling a refusal well protects the client, the salon and the licence.
- Observe and describe, do not name. "I can see some redness and cracking between these toes."
- State the rule, not a judgement. "Ohio's board rules don't let me work over that area without written permission from a physician."
- Refer specifically. A physician, a dermatologist or a podiatrist — never a product.
- Offer what you can lawfully do. Service the unaffected hand or foot if the condition is localised and you can work without cross-contact, or rebook.
- Decontaminate. OAC 4713-15-13(D) requires that every area and item of equipment that contacted the affected individual be cleaned and disinfected with an appropriate disinfectant.
- Document. Note the observation, the refusal and the referral on the client record.
Exam trap: an option in which the technician "explains that the client has a fungal infection and recommends an over-the-counter antifungal" fails twice: it is a diagnosis, and it is a treatment recommendation. Both are barred by OAC 4713-8-07(D).
A pedicure client has itching, scaling and maceration between the fourth and fifth toes of both feet. What is the correct sequence of actions for an Ohio manicurist?
Which description correctly distinguishes a callus from a corn, and what may a manicurist lawfully do about either?
A long-standing client returns with a single dark brown band running the full length of her right thumbnail. She says it appeared a few months ago and looks wider than it was, and asks for a dark polish to hide it. What should the manicurist do?
Which lesion definition is correct?