11.2 Nail and Skin Analysis, Contraindications, and Service Plan

11.2 Nail and Skin Analysis, Contraindications, and Service Plan

Section 11.1 put facts on a card. This section is the look, the stop list, and the plan you speak before product leaves the bottle. NIC Domain 4 tests whether you can analyze nails and skin, recognize contraindications, and determine services and products. Washington adds a legal brake: WAC 308-20-110(1)(e) says you must not perform or continue services on a client with visible open sores, inflamed skin, rash, or parasitic infestations. Chapter 9 gave you the disease catalog. Here you turn that catalog into a chair decision in a Bellevue suite, a Spokane shop, or a mobile visit to a placebound client.

Analyze before you soak

Nail and skin analysis is a visual (and light-touch) exam of the service area while the plate is still dry. Water hides scale, vesicles, and redness. Polish and product hide lift. If the client is already in a pedicure basin, you are analyzing late.

Work in a consistent order so you do not skip a thumb or a fifth toe:

1. Skin of the hands or feet — dorsal and palmar/plantar surfaces, web spaces, nail folds, heels, and any area a file, bit, or basin will touch.
2. Nail plates — all ten, including the sides and free edges, not only the show-nail the client points to.
3. Existing product — if an enhancement is present, look at the join line, the free-edge seal, and whether the plate under the product is still attached.

You are describing, not diagnosing. "Moist lift with green-brown debris under the free edge, surrounding skin intact" is analysis. "Pseudomonas infection confirmed" is a laboratory sentence you do not own.

Plate shape

Plate shape is architecture: square, squoval, round, oval, almond, and the less-flattering shapes you still have to see — pinch/pincer curvature, a trumpet roll, a bitten short plate, a wide flat plate, a hooked or clawed toenail. Shape changes the service, the bit, and whether an enhancement is honest.

A severely pinched toenail that is already pressing the sulcus is not a candidate for a tight pointed extension. A bitten fingernail with intact skin may take a short overlay or a polish manicure. A thin, peeling, eggshell plate may take a gentle natural-nail manicure and should not take a heavy sculpted extension that the plate cannot support. Shape is not a fashion quiz on Domain 4. It is whether the unit can carry the product the client requested.

Look at symmetry and thickness too. One plate that is suddenly thicker, more yellow, or more crumbling than its neighbors is an infection-sign flag from Chapter 9, not a chance to even them up with a coarse e-file.

Moisture

Moisture under a plate or at a product join is a red flag even when the skin is not yet red. Dry, sealed product on a dry plate is a different story from a wet, white, or milky line. Moisture plus lift is how odor, green discoloration, and fungal or bacterial pictures get a home. Moisture between the toes or in web spaces is a rash and tinea pedis watch. Do not put that foot in a shared Everett basin "to soften it for a better look."

If the client just left a gym and the feet are wet with sweat, dry them and look again. Do not confuse workout moisture with macerated athlete's-foot skin. If you are unsure and you see scale, redness, or broken skin, refuse.

Lifting

Lifting is separation of product from plate, or of plate from bed (onycholysis). Small, clean, dry lift on otherwise sound nails may be a maintenance or removal decision. Moist lift, lift with odor, lift with green-black or yellow crumbly debris, or lift over thin peeling plate is unsound. Unsound nails do not get a new enhancement.

Do not lever a metal tool deep under a lift to "clean it out" as if you were irrigating a wound. Do not pack primer and powder into the space to hide it. Do not tell a Tacoma client that more dip will seal bacteria in so it cannot spread. Product over a moist lift is a trap, not a treatment.

Salon scenario — Tacoma dip. Several nails show moist lift and green debris under the free edge. The client prepaid for a color change. You refuse the dip. You document the lift and discoloration. You refer. You may discuss later natural-nail care if a physician clears the plates. You do not file the green line and dip over it because the appointment slot is already on the book.

Infection signs

You already learned the pictures in Chapter 9. Domain 4 is the moment you act on them during pre-service.

Stop the service path when you see:

• Pus, heat, swelling, throb, or spreading redness of a fold or fingertip.
• Thick, yellow/brown/white, crumbling plates with powdery debris (the onychomycosis picture).
• Itchy scale, macerated webs, vesicles on feet (the tinea pedis / rash picture).
• Clustered vesicles on a finger (viral-lesion picture).
• Warts on hands or plantar surfaces, including a "callus" with black dots that hurts when pinched from the sides.
• Green moist debris under a lift.
• Any open draining area.

Infections of nails or skin are refuse and refer. You do not skip one finger and soak the other nine in the same bowl. You do not "just do polish on the healthy ones" while a weeping fold sits in the same water. You do not diagnose the organism out loud. You write what you saw.

Skin of the hands and feet

The skin of the hands and feet is part of the manicure and pedicure, not a backdrop. Check:

• Nail folds (proximal and lateral) for redness, swelling, hangnails, and torn skin.
• Eponychium and hyponychium for intact vs open.
• Web spaces, especially on feet.
• Heels and weight-bearing skin for cracks, rash, and lesions that are not ordinary dry callus.
• Palms and soles for rash or parasitic signs.

Parasitic infestation is a WAC stop even if the nails themselves look pretty. You are not identifying the species as a lab. You are seeing a visible infestation picture and refusing. The same rule covers a spreading rash the client calls "winter dryness." If it is a rash or inflamed skin, WAC 308-20-110(1)(e) already answered.

A licensee with those same visible problems shall not provide services under WAC 308-20-110(1)(f). Analysis applies to the person holding the file too.

The five-way service decision

After analysis, you determine services and products. The exam choices are not "yes" and "upsell." They are:

1. Manicure — cosmetic care of the hands and nails (shape, cuticle care within scope, polish or buff) on sound nails and intact, uninflamed skin.
2. Pedicure — same idea on the feet, with basin rules from Chapter 5 still in force if you proceed.
3. Enhancement — tips, acrylic, gel, dip, wrap, or sculpted extension, only on plates that are sound and skin that is not a WAC stop.
4. Refuse — you do not perform the requested service. Visible WAC findings, infection signs, or unsound plates for the requested product.
5. Refer — you send the client to a physician (or podiatrist as the client chooses) for evaluation. Referral rides with almost every refuse that involves infection, open tissue, or unexplained dark change.

A client can receive a modified natural-nail manicure and still be refused an enhancement. Those are different services. Prepaid gel-X does not override unsound nails. A wedding date does not override an open sore.

Contraindications that prohibit service under WAC 308-20-110

Memorize the Washington prohibit list as a pre-service chant:

• Visible open sores
• Inflamed skin
• Rash
• Parasitic infestation

If any of those is in the service area, you do not perform and you do not continue. "Continue" matters: if you discover pus mid-manicure, you stop. Finishing the other nails in the same water is a continuation.

Infections of nails and skin sit on top of that list even when the client wants to bargain. Fungal plates, infected folds, viral vesicles, and warts are not "a little inflammation." They are infection signs. Do not apply enhancements over infected or unsound nails. Unsound includes thin peeling plate, wet lift with debris, crumbling thickness, and any plate that cannot support product without trapping moisture. Covering an infected toenail with acrylic for photographs is still a cover-up, not a therapy.

Razor-edged callus tools remain banned under WAC 308-20-110(16) even when the skin is intact. Analysis never leads to a credo blade.

Building the service plan

A service plan is the spoken and written agreement that follows analysis. It has four exam pieces:

• Products chosen — system and why (nitrile not latex; EMA not a banned MMA bottle; polish not dip; removal not a late fill). Name what will touch the client.
• Time — how long the chair will take, including extra time for removal if the fill is actually a soak-off. A 25-minute slot cannot honestly hold a full set plus removal.
• Aftercare preview — oil, gloves for dishes, no picking, when to return for a fill, what to do if redness appears. Preview is not a substitute for the post-service talk in Chapter 18; it is the consent piece so the client is not surprised.
• Price honesty — business ethics. Charge for the service you will perform. Do not quote a new-set price, take the money, and then apply product the analysis forbade. Do not keep a fill price when you are actually doing a 40-minute removal. Do not add on a "medical antifungal" oil as if it were treatment. If you refuse, you do not keep a full-service fee for work you did not do; you explain the refuse, you document, and you handle the appointment according to shop policy without pretending the service happened.

Price honesty is on Domain 4 because determining the service includes determining that you will not sell a lie. A Kirkland client who brought a sculpted-stiletto photo still deserves the sentence: "Your plates are lifting and moist; I will not put a new set on unsound nails; here is what I can do today, here is the time, here is the price."

Floor pictures

Shoreline shape request. A client wants extra-long almond tips on bitten, peeling plates with intact skin. Analysis says unsound. The plan is a short natural-nail manicure or a refusal of the tip set, an honest time and price, and aftercare about picking. Selling the long set anyway is a Domain 4 miss and a later lift complaint.

Yakima rash. Itchy, peeling skin between the toes. That is a rash. Refuse the pedicure. Do not "wash it off in the spa." Document. Refer. Disinfect anything that already touched the foot.

Olympia ethics. A client argues that she already paid online for acrylic. Analysis shows an open, inflamed sidewall. You refuse. You do not apply product to the other nine nails in the same bowl. You do not keep a full-set fee as if the work were done. You write the open inflamed fold and the refusal. WAC 308-20-110 does not have a prepaid exception.

Analysis plus contraindications plus an honest plan is the whole middle of Domain 4. Setup in 11.3 only happens after this decision is "proceed" — and it happens with the products you just named, not a mystery kit.