9.2 Nail Conditions That Preclude Treatment
Key Takeaways
Onychomycosis, paronychia, onychia, tinea pedis, and any broken skin, pus, or inflamed tissue are reasons to stop the affected service and refer, not to diagnose or treat.
Green Pseudomonas discoloration is not covered with a new enhancement. Loose product may be removed only to clean a separation the client already has, and infected tissue is refused.
Onycholysis is not glued down and the separated space is not filled with monomer. An ingrown nail is not cut out of living tissue, and a red, swollen, or draining fold is referred.
A dark band or a changing pigmented streak in the plate can need medical evaluation, including for melanoma, and is not dismissed as a bruise and covered with polish.
Recognize, then refuse or refer
The skill here is recognition, not diagnosis or treatment. The descriptions below are standard instruction for when to refuse work that would cover, soak, glue, or cut the wrong tissue. Pennsylvania Code does not define onychomycosis or these other conditions. Broken skin, pus, or inflamed tissue in the service area stops that service. Refer the client when the problem is medical.
Onychomycosis
Onychomycosis is a fungal infection of the nail. Standard instruction describes a plate that may be thickened, yellow or brown, crumbly, or lifted, sometimes with debris under the free edge. Those signs are a reason to stop and refer. Do not place an enhancement over that nail, and do not polish the debris as if the change were only cosmetic.
Paronychia and onychia
Paronychia is bacterial inflammation of the nail fold, often red, swollen, painful, and holding pus. No service is performed on that inflamed fold. Do not push it, nip it, or soak it as treatment. Refer the client.
Onychia is inflammation of the nail matrix, the tissue that produces the plate. No service is performed on that nail. Product, pushing, or filing on an inflamed matrix can extend the injury. If you cannot tell a fold infection from a matrix infection, leave that nail alone and refer.
Pseudomonas and green discoloration
Pseudomonas is the name tied to green discoloration when bacteria are trapped between the plate and a lift, or between the plate and an enhancement. Clients often call the stain mold. Standard instruction treats it as a bacterial problem, not as a color to paint over.
When the skin is intact and the client already has a separation, remove the loose product if that is the only way to clean the area. Do not cover the green discoloration with a new enhancement, and do not fill the gap with monomer, gel, or glue. If the tissue is infected, with pain, swelling, pus, or broken skin, refuse that nail and refer. Do not send the client home with a home antibiotic. Stain left in the plate is still not a base for a new overlay.
Onycholysis
Onycholysis is separation of the plate from the bed, often from the free edge, so a pale pocket appears where the bed no longer shows through. Do not glue the plate down, and do not fill the space with monomer or any other enhancement product. Keep enhancements off that nail, and refer when the cause is unknown, the area hurts, or the skin is involved.
Onychocryptosis
Onychocryptosis is an ingrown nail. The plate edge presses into the lateral fold. Do not cut into living tissue to dig out the corner. When the fold is red, swollen, or draining, refuse that nail and refer. A corner that is only long, without redness, swelling, or drainage, may be shortened at the free edge without entering the fold. Once the skin is open or inflamed, that shortening stops.
A dark band needs a medical look
A dark band or a changing pigmented streak in the plate may need medical evaluation, including melanoma. A streak that runs with growth, a band that is new or widening, or pigment on the skin beside the plate is a reason to refer. You cannot decide in a manicure that the mark is only a bruise. Do not cover it with polish, and do not buff it away.
Tinea pedis and any open skin
Tinea pedis, athlete's foot, is a fungal infection of the skin around a pedicure, often scale, itch, or cracks between the toes. Do not soak the feet, and do not use the foot basin. Water and a shared basin spread the organism. Refer the client. The pedicure stops even if the plates look clear. With or without a textbook name, any broken skin, pus, or inflamed tissue in the service area ends that service. You may not lance, drain, medicate, or polish over it.
Signs and the service decision
| What you see | Name in standard instruction | Decision |
|---|---|---|
| Thick, discolored, crumbly nail | Onychomycosis, fungal infection of the nail | No enhancement; refer |
| Red, swollen fold, often with pus | Paronychia | No service on that fold; refer |
| Inflamed matrix | Onychia | No service on that nail; refer |
| Green stain under a lift, skin intact | Pseudomonas discoloration | Remove loose product only to clean the separation; do not re-cover |
| Green area with pain, swelling, pus, or broken skin | Infected tissue | Refuse and refer; no home antibiotic |
| Plate separated from the bed | Onycholysis | Do not glue or fill the gap with monomer |
| Edge in the fold with redness, swelling, or drainage | Onychocryptosis | Do not cut living tissue; refer |
| Dark or changing streak in the plate | A mark that can include melanoma | Do not cover it with polish; refer |
| Scale or cracks between the toes | Tinea pedis, athlete's foot | No soak and no foot basin; refer |
| Broken skin, pus, or inflamed tissue | Open or infected service area | Stop that service |
A decision at the table
A client wants a gel fill to hide a green lift on the ring finger before an event. The sidewall is not red, nothing is draining, and you see no pus. The other nails are intact.
Modify the service. Remove the loose product so the separation can be cleaned. Do not put new gel, acrylic, or any other enhancement over the green area, and do not fill the gap. If the removal shows pus, swelling, or broken skin, refuse that nail and refer. Intact nails may be finished only with implements that were not used on the green nail.
A client has a thickened, yellow, crumbly nail plate of the kind standard instruction describes as onychomycosis. What should the technician do?
Fill any lifted area with monomer so the plate lies flat.
Diagnose the fungus and give the client an antifungal drug to use at home.
Refuse an enhancement on that nail and refer the client for medical care.
Apply acrylic over the plate so water cannot reach the damage.
A lifted enhancement shows green discoloration on the plate. The surrounding skin is intact, with no pus and no swelling. What is the appropriate action?
Remove loose product to clean the area, and do not re-cover the green spot.
Glue the plate to the bed and buff the color off through the new product.
Send the client home with an antibiotic ointment to apply for one week.
Cover the green area with a fresh gel so the nail looks finished.
Before a pedicure, the skin between the toes is scaly and cracked in the pattern standard instruction calls tinea pedis. What should the technician do?
Use the foot basin, then disinfect it after the appointment.
Soak the feet longer so the scale softens before filing.
Cover the skin with polish and finish the pedicure.
Skip the soak and the foot basin, and refer the client.
Sections you finish are checked off in the contents.