Green Discoloration Under a Lifted Gel Overlay
A 34-year-old client comes in for a three-week fill on a gel overlay. On the index and middle fingers of her right hand the product has lifted along both sidewalls, and under the lifted edge there is a dark green-black stain on the nail plate that reaches about 3 mm in from the lateral fold. The skin around the nail is not swollen or hot, there is no pus, and she reports no throbbing pain, but the plate is slightly separated at the free edge. She has a wedding in five days and asks you to 'just fill the lifted parts and cover it with a darker color.' The salon is fully booked, and the next client is already waiting. You have a 30-minute slot and a stock of opaque gels that would hide the stain.
1. Is the requested fill acceptable? State your working assessment and the immediate decisions you make.
Read the worked answer
No - the fill as requested is not acceptable. The localized green-black discoloration under a lifted enhancement is most consistent with Pseudomonas aeruginosa colonization (green nail syndrome), not a cosmetic stain or a pigment from the product. The reasoning matters: the color is confined to the plate and the space under the lifted product, there is no pus, spreading redness, or pain, so it looks like localized bacterial colonization rather than a deep infection. But covering it would trap moisture and bacteria, hide progression, and remove your ability to monitor the nail. The opaque gel is exactly the wrong tool because it makes the area invisible.
Immediate decisions:
- Remove the product on the two affected fingers, not only the lifted edge, so the whole plate can be assessed.
- Gently debride loose stained material with a disposable tool; do not dig into the plate.
- Clean with soap and water, disinfect the plate with a suitable product, and dry thoroughly.
- Do not apply a new enhancement over discolored or separated plate.
- Continue only on unaffected nails if the client agrees, or rebook.
A 30-minute slot is not enough for proper removal, assessment, and documentation; the safe choice is to rebook the fill.
2. How do you reprocess the tools and the station after removing the product, and why does the order of steps matter?
Read the worked answer
The order is not optional: mechanical cleaning first, then disinfection or sterilization, because organic residue such as keratin dust, product, or blood inactivates disinfectants.
- Single-use files, buffers, and any porous item that contacted the affected area go straight into the waste. They do not go back into the drawer.
- Reusable nippers and pushers: brush off visible debris, clean in soap or enzymatic cleaner, rinse, dry, then treat with a hospital-grade disinfectant that carries the required label claim, for the full contact time. If the implements contacted blood or the separated area, clean and then sterilize by autoclave.
- The fabric towel goes into the laundry at the appropriate temperature; the work surface is wiped with disinfectant and left wet for the stated contact time.
- Change gloves after handling the affected area and perform hand hygiene before and after.
The rationale is that a quick wipe with disinfectant over debris gives a false sense of safety. Contact time and prior cleaning are what actually reduce transmission risk.
3. What do you tell the client about the wedding, re-service, and warning signs that require medical referral?
Read the worked answer
Be direct but non-alarming, and separate what you can do from what you cannot:
- Explain that the green color is likely bacterial and that covering it would make it worse and hide it. This is a safety decision, not a style preference.
- Offer to finish the unaffected nails so she leaves with a consistent look, but keep the two affected nails product-free and dry.
- Do not promise that the area will be clear by the wedding. Re-service only when the discoloration has resolved and the plate is dry and intact; a realistic review is in two to four weeks, sooner if it worsens.
- Warn her not to apply her own polish over the affected nails, because that recreates the occlusion.
Refer for medical assessment if she develops pain, throbbing, pus, spreading redness or swelling, fever, or if the discoloration extends into the nail bed or the separation increases. Document the findings, the advice given, and the refused service in her record. The professional judgement is that client pressure and a deadline do not change the infection-control reasoning.