9.2 Noninfectious Nail Disorders

9.2 Noninfectious Nail Disorders

Section 9.1 was the stop list. This section is the catalog NIC still expects you to name, plus the Washington question that follows every name: can I service this plate, or did the skin just become a WAC 308-20-110(1)(e) problem? Most of the disorders below are not contagious. They come from injury, growth interruption, habit, shape, product, or a medical condition you are not licensed to label. They are often service with modifications. They become refuse-and-refer the moment you see inflammation, pus, open tissue, or a rash on the surrounding skin.

You still do not diagnose. A horizontal groove is a Beau's line in your study notes. On a Renton client card it is a horizontal depression across the nail plates; skin intact; modified manicure. That habit keeps you inside RCW 18.16.020 and keeps Domain 2 items honest.

Beau's lines

Beau's lines are horizontal depressions that run across the nail plate. They form when the matrix temporarily slows or stops making plate — illness, high fever, surgery, injury, or certain medications in the medical story you will not write as a diagnosis. The groove then grows out with the nail. Several nails at once often means a systemic interruption; one nail often means a local injury.

If the skin is intact and there is no infection, you may manicure. Do not grind the groove away with a coarse e-file. File gently, keep the free edge shorter if the plate is weak at the line, and skip heavy enhancement if the plate would flex and crack. A Bellingham client who had a high fever two months ago and now shows neat horizontal lines is not a fungus case just because the nails look different.

Leukonychia

Leukonychia is white spotting or white streaks in the plate. The usual salon cause is minor injury to the matrix — a slam, a sports ball, aggressive pushing. The white grows out. It is not, by itself, a calcium-deficiency diagnosis you are qualified to make, and it is not a fungus diagnosis either.

Service if surrounding skin is intact. Do not drill through the spots. Do not sell a supplement as treatment. A Renton client with small white spots and healthy folds gets a gentle manicure and polish. If the white is a crumbling, spreading, debris-filled change instead of a discrete spot, you are back in section 9.1.

Pterygium

Pterygium here means abnormal skin stretched onto the nail plate — classically the eponychium growing forward (dorsal pterygium) or the hyponychium attaching too far under the free edge (inverse pterygium). Injury can produce the picture. Medical disease can too. You do not name lichen planus at the table.

Do not cut pterygium. Living skin stretched onto the plate is not excess cuticle. Cutting it is an injury and an infection door. Soften gently if the physician-cleared skin is intact, keep product off living tissue, and refer if the attachment is severe, painful, or splitting. A Shoreline tech who trims a pterygium because it looks messy has left manicuring and entered wound creation.

Onycholysis

Onycholysis is separation of the nail plate from the nail bed, usually starting at the free edge and moving back. Causes in exam language include injury, aggressive cleaning under the nail, tight shoes, product lifting, and medical conditions including psoriatic change. The space can stay clean and dry, or it can collect debris and moisture.

If the lift is small, the bed looks clean, and the surrounding skin is not red or draining, you may service with modifications: keep the free edge short, do not lever a metal tool deep under the plate, do not pack primer and acrylic into the space, and do not create a moisture trap with a full-cover enhancement. If the space is green, yellow-crumbly, wet, foul, or the skin is inflamed, refuse. Green-black discoloration under a lift is a bacterial-colonization picture from section 9.1, not a color-correction add-on.

Salon scenario — Redmond dip. A client has a three-millimeter clean lift on two nails after a long set. Skin is pale and dry, no odor, no pus. You shorten, you do not tunnel under the plate, and you skip trapping a new thick overlay over the open space. If the same nails were green and moist, you would refuse and refer.

Onychorrhexis

Onychorrhexis is split or brittle nails with lengthwise ridges. Aging, harsh solvents, repeated water-and-dry cycles, injury, and some medical states appear in textbooks. You do not diagnose thyroid disease because a plate splits.

Service gently. Do not buff until the plate is thin enough to see pink through a hole. Do not e-file ridges down to wood. Use fine grit, moisturize intact skin, keep enhancements light if you use them at all, and educate the client that acetone marathons and using nails as tools will keep the splits coming. Brittle is not infectious. Torn, bleeding sidewalls are a different decision.

Onychophagy

Onychophagy is nail biting. The plates are short, uneven, and often accompanied by chewed skin. If the skin is intact, you may manicure: even the free edge, gentle cuticle work without nipping living tissue, polish or a short overlay if the client wants a barrier. If the skin is torn, inflamed, or open, WAC 308-20-110(1)(e) already answered. Do not work on bitten hangnails that are red and wet. Do not shame the client. Do not diagnose an anxiety disorder. Document short bitten plates and the condition of the surrounding skin, then either modify or refuse.

Onychocryptosis (ingrown nail)

Onychocryptosis is an ingrown nail, usually a toenail whose lateral edge has pierced or pressed into the sulcus. Tight shoes, curved plates, and cutting nails too rounded are common setup stories. The exam action is more important than the cause: do not dig.

If the fold is only slightly tender, not red, not draining, and there is no open sore, you may gently file or trim the accessible free edge straight across. You do not bury a nipper into the sulcus to excavate a spike. You do not pack monomer into the fold. You do not cut living tissue. If the fold is red, hot, swollen, seeping, or openly broken, that is infection and a WAC refuse. Refer to a physician or podiatrist.

Salon scenario — Olympia sandals. A client wants the buried corner dug out so she can wear sandals this weekend. The fold is red, hot, and seeping. You refuse. You do not dig. You refer. A cosmetic pedicure is not a surgical extraction.

Eggshell nails

Eggshell nails are thin, white, and more flexible than normal, often curving over the free edge. Older texts link them to diet, medication, or nervous conditions. You will not diagnose those. You will recognize a plate that can split if you treat it like a thick toenail.

Service with a light hand. No coarse e-file. No heavy acrylic that the thin plate cannot support. Short shape, fine grit, and protection rather than thinning. If the plate is so thin that pink bed shows through cracks, skip anything that would lever or heat the nail.

Corrugated or ridged nails

Corrugated or ridged nails show waves or ridges. Vertical ridges are common with aging as the matrix becomes less even. Horizontal waves may be Beau's lines or injury records. Uneven washboard texture can follow habit-tic picking of the proximal fold — still not a fungus by itself.

Do not buff ridges until the plate is weak. Ridges are architecture, not dirt. Fill them with a ridge-filling polish if the client wants a smoother look, or live with them. Aggressive buffing to make a corrugated nail look like a magazine ad is how eggshell iatrogenic damage is born in a Kent suite.

Hangnails

A hangnail is a strip of torn skin at the lateral nail fold, not a piece of nail plate. Dryness, biting, and over-nipping cause most of them. If the skin is not infected, you may carefully trim the loose tag with a disinfected nipper — trim the dead tag, do not cut living sidewall. Moisturize intact skin. If the hangnail is red, hot, pus-filled, or openly cracked into the fold, stop. That picture has become paronychia or an open sore. Refuse, do not rip the skin off with your fingers, and refer if infection signs are present.

Bruised nail (blood under the plate)

A bruised nail is discoloration from blood under the plate after trauma — a slammed door, a dropped weight, a stubbed toe. Colors run red, purple, brown, or black as the blood breaks down, and the spot usually grows out. Treat it as possible blood under the plate.

Do not drill into it. Relieving pressure by putting an e-file hole through the plate is a medical procedure, not manicuring, and it opens a blood-exposure event on purpose. Do not grind until you hit the stain. Avoid heavy enhancement that would trap and hide a changing lesion. If the nail is painful, the plate is detached, there is an open injury, or the discoloration is spreading without a remembered injury, refer. You do not diagnose melanoma versus bruise. You do not reassure a Kirkland client that a dark streak is definitely a hematoma. You record the color, the history of trauma if they give one, and you stay out of the plate.

Salon scenario — Kirkland car door. The client wants a drain hole and a gel overlay for a party. You refuse the drill. You may do a gentle cosmetic service on intact surrounding skin if there is no open wound and pain is not severe, or you may postpone if the finger is too tender. You never turn a bruise into a vented enhancement.

Pincer nail and trumpet nail

A pincer nail has excessive transverse curvature that pinches the lateral folds. A trumpet nail is the severe cone-like version: the free edge rolls toward a tight tube. Shoes, inherited shape, and some medical states appear in references you will not recite as diagnoses.

Do not force the plate flat with an e-file or by cutting deep into the sulcus. Do not pack the sides with acrylic to wedge the folds apart as if you were a clinician. If the pinching is only a shape issue and skin is intact, a careful trim of the accessible free edge and a roomy shoe conversation is the cosmetic limit. If the folds are painful, red, or broken, treat it like onychocryptosis: refuse and refer.

Psoriatic nail changes — observe, do not name the disease

Nails associated with psoriasis in medical texts can show pitting, an oil-drop (salmon) patch, onycholysis, crumbling, and ridging. The surrounding skin may show plaques, which section 9.3 covers. You do not diagnose psoriasis. You describe pits, salmon discoloration, or lifting. If the skin is inflamed or open, refuse under WAC 308-20-110(1)(e). If the plates are pitted but the folds are intact and there is no rash in the service area, a gentle cosmetic manicure may be possible. Do not e-file pits as if they were product. Do not promise that gel will treat the condition.

Blue nails and yellow nails are questions, not labels

Blue nails can reflect poor circulation, cold, heart or lung issues, or medication effects in medical references. Yellow nails can be nicotine stain, leftover polish, a rare medical syndrome, or the fungal picture from 9.1. A Washington manicurist asks health-history questions and looks at the rest of the unit. You do not tell a client they have heart disease because the lunula looks dusky. You do not ignore a thick crumbling yellow toenail because yellow can also be stain.

Decision rule: stain plus intact thin plate and healthy skin can be a cosmetic service (you may gently buff stain on a dry plate, or wait it out). Thick, crumbling, debris-filled yellow follows the infectious refuse path. Blue, cold, painful digits plus a client who reports chest symptoms is a medical referral, not a paraffin add-on. Document color, ask about recent illness, smoking, and medications if they volunteer them, and stay inside observation.

Modification is not medical treatment

A Pullman student who can recite every Latin name and still nips living pterygium has failed the section. Modifications that stay inside manicuring look like this:

• Shorter length on a weak, lifting, or ridged plate
• Fine grit instead of coarse grinding
• No product in a separation space
• No digging, drilling, or cutting of living tissue
• Moisturize intact skin; do not oil an open hangnail and call it therapy
• Document what you saw in plain language
• Refer when pain, pus, heat, open skin, or unexplained dark color shows up

Salon scenario — Yakima ridges. A client wants ridges erased so red polish looks glassy. You offer a ridge-filling polish and a light buff. You refuse to e-file the plate until it is flexible. Cosmetic smoothness is not worth a thinned, burning nail.

Salon scenario — Walla Walla bite. Bitten nails, skin intact, no redness. You even the edges and apply polish. Same client next month with torn, wet sidewalls: refuse, refer if infection signs are present.

Noninfectious does not mean ignore. It means you may often work, you may never play physician, and you stop the instant the skin becomes the WAC problem. Section 9.3 is that skin problem in full: eczema, psoriasis plaques, monomer rash, diabetic feet, parasites, and the exact refuse language Washington will hold you to.