3.3 Fungi & Parasites in Nail Services

Fungi and Parasites in Nail Services

Ohio State Board Exam Alert: "Fungus" and "Parasites" are two separate named leaves under Understanding Infection. For a nail technician they are also the two categories most likely to walk through the door, because feet spend their days in warm, dark, damp shoes. Ohio's response is legal as well as clinical: OAC 4713-15-13(A) bars service on a client with a visible rash, eruption or parasitic infestation in the service area without written permission from a physician.

---

1. Fungal Pathogens and Parasitic Infestations

Fungal Organisms (Mycology)

Fungi (singular: fungus) are eukaryotic organisms—including molds, mildews, yeasts, and dermatophytes—that lack chlorophyll, obtain nutrients through absorption of organic compounds, and reproduce via microscopic spores.

+-------------------------------------------------------------------------+
|                   COMMON FUNGAL AND BACTERIAL LESIONS                   |
+-------------------------------------------------------------------------+
| ONYCHOMYCOSIS (Tinea Unguium)         | PSEUDOMONAS AERUGINOSA          |
| • True fungal infection of nail plate | • Bacterial infection (NOT mold)|
| • Keratin-destroying dermatophyte     | • Secretes pyocyanin (green)    |
| • Thickened, brittle, yellow/crumbly  | • Trapped moisture under lifts  |
| • Subungual hyperkeratosis            | • Rapidly darkens green-to-black|
| • Action: REFUSE SERVICE; REFER       | • Action: REMOVE PRODUCT; REFER |
+-------------------------------------------------------------------------+

• Dermatophytes: A specialized pathogenic group of filamentous fungi (Trichophyton, Microsporum, and Epidermophyton) that secrete keratinase, an enzyme that digests and feeds upon keratin—the fibrous protein constituting human hair, nail plates, and the stratum corneum.
• Onychomycosis (Tinea Unguium): A fungal infection of the nail unit. It typically begins at the distal or lateral nail margin and migrates proximally beneath the nail plate. The nail becomes severely thickened, discolored (yellow, chalky white, or dull brown), brittle, friable (crumbly), and may separate from the nail bed (onycholysis). Under Ohio Administrative Code (OAC) 4713-8-07, manicurists are strictly prohibited from performing any nail service or applying artificial enhancements over an onychomycotic nail; the client must be referred to a medical doctor.
• Tinea Pedis (Athlete's Foot): A dermatophytic fungal infection of the plantar aspect of the foot and interdigital web spaces. Manifestations include erythema, intense pruritus (itching), burning, scaling, maceration (white soggy skin between toes), and painful fissures. Pedicure services must be deferred if weeping lesions or open skin breaks are present.
• The "Nail Mold" Myth vs. Pseudomonas aeruginosa:
  • For decades, clients and uneducated technicians erroneously referred to green discolorations on the natural nail plate as "nail mold." In clinical reality, true molds do not infect human nail plates.
  • The green discoloration is caused by Pseudomonas aeruginosa, an opportunistic, motile, gram-negative bacterium commonly present in environmental water and soil.
  • Pseudomonas thrives in the warm, dark, moist pocket created when an artificial enhancement lifts from the natural nail plate. As the bacterial colony metabolizes dead tissue and trapped moisture, it produces colorful, water-insoluble metabolic pigments: pyocyanin (blue-green) and pyoverdine (yellow-green). As the colony ages, the stain transitions from faint light green to dark green, brown, and black.
  • Clinical Protocol: The technician must safely remove the artificial enhancement to expose the bacteria to dry oxygen, clean the nail plate thoroughly, and refuse to apply any new enhancement or polish until the natural nail has grown out completely healthy and clear. The client should be advised to consult a physician if tenderness, inflammation, or periungual swelling is present.

Parasitic Infestations

Animal parasites are multicellular organisms that derive nourishment, protection, and shelter by living on or inside a host organism while contributing nothing beneficial to the host.

• Scabies (Sarcoptes scabiei): A highly contagious dermatological disease caused by the microscopic human itch mite. The fertilized female mite uses specialized jaw parts to burrow tunnels into the stratum corneum of the epidermis, where she deposits eggs and fecal pellets over several weeks. Burrows appear as thin, wavy, thread-like grey lines, predominantly located in the webbed skin folds between fingers, on the flexor surfaces of wrists, on elbows, and along the nail folds. Scabies triggers an intense allergic reaction characterized by vesicular pustules and ferocious itching, which worsens dramatically at night. Transmission occurs through direct, skin-to-skin touch or contact with infested salon towels. Services must be refused immediately, and all contacted linens must be laundered in boiling water and high-heat drying.
• Pediculosis Capitis (Head Lice): Infestation of the scalp by the parasitic insect Pediculus humanus capitis. The female louse cements translucent oval egg cases (nits) to the base of hair shafts near the scalp. Lice feed on human blood several times daily. While head lice are encountered primarily during cosmetology hair services, manicurists must recognize the infestation and maintain strict salon sanitation to prevent cross-infestation.

---

---

2. Why Feet Are the High-Risk Site

Dermatophytes need three things: keratin to feed on, warmth, and moisture. A shoe supplies all three for sixteen hours a day, which is why the foot — not the hand — is where a nail technician meets fungal disease.

The three recognition patterns worth knowing

1. Distal subungual onychomycosis — the common pattern. Discolouration and thickening begin at the free edge and advance toward the matrix, with crumbling subungual debris lifting the plate off the bed.
2. Superficial white onychomycosis — chalky white patches on the surface of the plate that can be scraped, usually on toenails.
3. Tinea pedis — itching, scaling and maceration between the toes, or a dry "moccasin" scaling pattern across the sole, frequently accompanying nail involvement.

A manicurist does not distinguish these from nail psoriasis, trauma or a drug reaction — they overlap clinically and require laboratory confirmation. The professional act is to observe, decline the service to the affected area, refer, and decontaminate everything the client touched under OAC 4713-15-13(D).

Moulds, yeasts and the "greenies" myth

Two persistent misconceptions are worth correcting:

• The green-black staining under a lifted enhancement is not mould. It is almost always Pseudomonas aeruginosa, a bacterium that produces blue-green pigments and thrives in the warm, moist pocket beneath lifted product. Calling it mould leads technicians to reach for the wrong response.
• Candida (a yeast) is a genuine cause of chronic paronychia in people whose hands are constantly wet — bartenders, dishwashers, cleaners — and it presents as a boggy, swollen proximal fold rather than as plate discolouration alone.

Neither is diagnosed or treated by a manicurist. Both are removal-plus-referral situations.

3. Parasites the Blueprint Expects You to Know

Parasites are the category Ohio names explicitly in its service-refusal rule, alongside swelling, eruption, redness, bruising and rash. Under OAC 4713-15-13(B) and (C), the same standard applies to a licensee who shows signs of infestation: no practice without written permission from a physician, and the salon must ask the individual not to work until that statement is produced.