9.1 Infectious Nail Diseases

9.1 Infectious Nail Diseases

NIC Theory Domain 2, Anatomy and Physiology, is about 15% of the scored written exam. A large piece of that domain is not reciting phalanges. It is recognizing signs, symptoms, and causes of disorders, diseases, and conditions of the nails and skin. Washington then puts a legal brake on the same pictures. WAC 308-20-110(1)(e) forbids performing or continuing services on a client with visible open sores, inflamed skin, rash, or parasitic infestations. WAC 308-20-110(1)(f) says a licensee who has those same visible problems shall not provide services while the symptoms are present. You are licensed as a manicurist. You are not licensed to diagnose, treat, drain, or cure. The exam skill is: see the infectious picture, refuse, document what is visible, and refer to a physician.

Chapter 4 taught how pathogens move. This section names the nail-table diseases those pathogens produce. If you cannot tell a crumbling fungal toenail from a cosmetic ridge, you will miss Domain 2 items and you will also miss the moment a Spokane pedicure should have been a medical referral.

Serve versus refuse is the first decision

Infectious nail and skin problems are usually refuse and refer. The organism can leave a toe, ride a porous file, land in a basin, and meet the next client in the same chair. Noninfectious disorders in section 9.2 are often service with modifications, unless the surrounding skin is inflamed or open. Memorize that split before you memorize Latin. A yellow, crumbling toenail is not a chance to show off your e-file. A white spot from a slammed finger is not a reason to cancel a Bellevue polish change.

When you refuse, you do not lecture and you do not guess a prescription. You use ordinary language, you decline the service, you recommend a medical evaluation, and you write the observation on the client card. Thickened, yellow, crumbling great toenail with powdery debris under the free edge; service refused; referred to physician is professional. You have onychomycosis is a diagnosis you are not licensed to make. NIC still expects you to know the names, because the written stem will use them. In a Kirkland suite you still write what you saw, not what you think the laboratory would grow.

Look before you soak. Macerated wet skin hides scale, vesicles, and redness. A two-minute visual pass of both hands or both feet, including web spaces and nail folds, is part of Domain 2 in the real world. Chapter 11 will turn that look into a consultation form. This chapter is the catalog of findings that stop the service.

Tinea unguium / onychomycosis (nail fungus)

Onychomycosis is a fungal infection of the nail. Tinea unguium is the classic name for that infection on a nail plate. NIC items use either term. The picture you must recognize: a nail that is thickened, yellow, brown, or chalky white, brittle or crumbling, often with keratin debris under the free edge, and sometimes lifting from the bed. Distorted shape and a musty odor can ride along. Toenails are more common than fingernails because shoes stay warm and moist.

Fungus is a living organism, not a stain. It sheds fragments onto porous files, buffer blocks, toe separators, sandals, towels, and pedicure basins. An e-file used on an infected plate throws contaminated keratin dust across a Tacoma table and onto the licensee's own cuticles. That is why you refuse instead of just taking the thickness down so polish will sit. Filing does not cure fungus. Filing spreads it. Soaking a fungal foot in a circulating spa that was only dumped is how one Yakima guest becomes a Saturday problem.

Do not apply acrylic, gel, dip, or a wrap to hide a suspected fungal nail. Product traps moisture, delays later medical treatment, and gives you no legal cover if the next client sits in the same bowl. Do not sell a salon antifungal oil as treatment. Treatment belongs to a physician. Do not reuse the grit, the toe separator, or the sandal that already touched that foot.

Salon scenario — Spokane gel toes. A walk-in wants gel polish on every toenail for a wedding. The right great toenail is thick, yellow, and crumbling, with powdery debris. You stop the intake. You refuse the pedicure. You discard any single-use item that already touched that toe. You refer. You do not diagnose fungus out loud. You describe the nail and you keep the rest of the shop's files out of that debris.

Tinea pedis (athlete's foot)

Tinea pedis is a fungal infection of the foot skin, classically between the toes and on the sole. Look for itching, scaling, redness, macerated white skin in the web spaces, and sometimes blisters. It is contagious. It shares the same wet-shoe ecology as nail fungus, and the two often travel together. A runner who calls it dry skin from miles still has a rash. WAC 308-20-110(1)(e) does not have a sports exemption.

You do not have to name tinea pedis to refuse. You have to see visible rash or inflamed skin. Soaking that foot in a shared Everett basin is how you turn one client's athlete's foot into a shop-wide fomite. Do not dry it and hope. Do not put a toe separator on macerated web skin and call it a modification. Do not file scale off the sole as if it were ordinary callus; that grit is now a fungal delivery system.

Paronychia

Paronychia is infection of the tissue surrounding the nail — the lateral fold, the proximal fold, or both. Acute bacterial paronychia often follows a hangnail, an over-nipped eponychium, or a torn sidewall. Signs: redness, swelling, heat, pain, and often pus. The fold may look tight and shiny. The client may flinch when you barely touch the sidewall.

This is a refuse. You do not skip that finger and then soak the same hand in a bowl that will splash the infected fold. You do not lance pus with a nipper. You do not push the cuticle on an already swollen fold. You do not tell the client they have a staphylococcal infection; that sentence is a diagnosis. You document redness, heat, swelling, and any visible pus, and you refer to a physician. If you already started, treat drainage with the blood-exposure mindset from Chapter 5: stop, gloves, contain, disinfect or discard, wash.

Chronic paronychia can be associated with frequent water work and yeast. You still do not diagnose the organism. You still refuse if the fold is inflamed or draining.

Onychia

Onychia is inflammation of the nail matrix, often involving the nail bed, commonly with pus and a risk that the plate will shed. It may follow injury or bacterial invasion at the proximal nail. The area around the lunula can look swollen, painful, and distorted. New plate that grows after a severe matrix infection may be permanently ridged — a later Beau's-line or corrugation story, not a reason to keep working while pus is present.

Refuse. Matrix inflammation is not a cuticle-oil problem. Do not e-file near a painful proximal fold. Do not apply primer or monomer to a draining matrix area. Refer. A manicurist who keeps going because the client has a flight in the morning is practicing outside RCW 18.16.020 and outside WAC 308-20-110(1)(e).

Pyogenic granuloma and other bacterial-infection signs

Pyogenic granuloma in the nail unit is a mass of red, easily bleeding tissue that can grow from the nail bed toward or over the plate, often after injury. NIC wants the association with bacterial infection and inflammation. You will also see generic bacterial signs that should stop a service even when you cannot attach a textbook name: pus, heat, swelling, spreading redness, throb, and red streaks. Red streaks moving up a finger or toe are a medical-emergency picture, not a polish delay.

A related bacterial picture under a lifting nail is a green to black discoloration often taught as Pseudomonas colonization (chloronychia). You do not have to say the genus. Green, moist debris under a separated plate is an infection sign. Do not file it out. Do not trap it under a new enhancement. Refuse and refer.

Do not cauterize a red lump with monomer. Do not trim extra tissue. Do not put a tip over a draining nail. Pus, heat, and swelling mean refuse and refer.

Salon scenario — Tacoma fill. Mid-service, a drop of pus appears at a swollen sidewall. You stop. You do not finish the other nine nails in the same water or with the same unwashed hands as if nothing happened. Contain the drainage, refuse continuation, document, and refer.

Herpetic whitlow and other viral lesions

Herpetic whitlow is a herpes simplex virus infection of a finger, often the fingertip pad or the tissue beside the nail. Look for painful clustered vesicles (fluid-filled blisters) on a red base, sometimes with swelling of the whole distal finger. It is highly contagious by contact. Picking, nipping, or pushing a vesicle spreads virus onto implements, towels, and your own broken cuticle.

Refuse. Do not pop vesicles. Do not work around them with a finger cot and hope. Viral lesions on the hands belong with a physician, not under a Bellevue gel overlay. The same refuse applies to other obvious viral lesions in the service area: grouped blisters, open weeping sores, and a cold-sore-type lesion that has reached a working finger. WAC 308-20-110(1)(e) already bars open sores.

A licensee with herpetic whitlow on a working hand is barred by WAC 308-20-110(1)(f) until those symptoms are gone. Working only on the other hand still puts a contagious lesion over a client's nails.

Warts (verruca)

Warts (verruca) are caused by human papillomavirus (HPV). They are contagious. On hands they may be rough, grainy papules. On feet, plantar warts can look like callus with tiny black dots (thrombosed capillaries) and hurt on weight-bearing. You do not diagnose HPV. You do recognize a contagious lesion on skin you were about to soak, file, or rasp.

Refuse service on the affected area. Do not file a plantar wart as ordinary callus — that is how you seed virus into a grit and into the next Kennewick client. Do not use a razor-edged callus tool to cut it out. WAC 308-20-110(16) already prohibits any razor-edged tool designed to remove calluses, and cutting a wart is medical practice besides. Refer.

Infectious conditions as a salon chain

Infectious nail disease is infection control wearing a Domain 2 costume. The routes from Chapter 4 still apply:

• Direct contact: unwashed hands, a licensee's open sore, skin-to-skin at the table.
• Fomites: porous files, buffers, toe separators, sandals, metal bits used on a crumbling toenail then on a healthy one.
• Water: shared bowls and circulating spas that were only dumped, not cleaned and disinfected.
• Dust: e-file plumes from a fungal plate.

Single-use items that touched a refused client's skin are discarded. Multi-use tools that contacted the area still go through the WAC 308-20-110 cleaning and disinfection sequence if you already started. Presence of used porous articles in the work area is treated as reuse. Do not keep a fungal-toenail file in an open cup labeled for that client if the inspector will see a used article at the station.

Washington floor pictures

Olympia enhancement request. A client with several thickened yellow toenails wants acrylic so they look normal for photographs. Cosmetic cover is not a therapy. Refuse, refer, and offer to reschedule if a physician later clears the nails. Do not take a deposit and hope the camera hides the crumbling free edge.

Vancouver, WA athlete. A runner has itchy, peeling skin between the toes and a scaling sole. You see a rash. Refuse the pedicure. Do not put her in the circulating spa. Drain, scrub, and disinfect the station as if the exposure already happened if she already sat in a filled bowl.

Bellingham wart. A client wants a smooth heel. One weight-bearing spot looks like callus but shows black dots and hurts when pinched from the sides. Treat it as a contagious lesion, not a callus add-on. Refuse that work. Leave the credo blade in the catalog; it is already illegal.

Lynnwood licensee vesicle. A manicurist has a painful blister cluster on a working fingertip and plans to glove up. Subsection (1)(f) does not bless that plan. Stay off the floor until the symptoms are gone.

Keep the Domain 2 infectious list short enough to recite on the drive to Prov: fungus of nail, fungus of foot, infected folds, infected matrix, pus-heat-swelling including pyogenic granuloma, viral finger lesions, warts. Every one of those is usually stop, refuse, refer. Section 9.2 is the other half of the catalog: disorders you can often service, as long as you do not invent a medical treatment and as long as the skin stays intact.