Green Discolouration Under Lifted Gel: Cover It or Stop?
A 34-year-old client attends for a rebalance of gel overlays applied three weeks ago at a different salon. She says two nails 'lifted within days' and that she has been picking at them. On examination, the natural nail plate of the right index finger shows a 6 mm area of onycholysis with dark green-black discolouration beneath the lifted product, and there is a distinct musty smell. The surrounding skin is intact, not swollen and not hot, and she reports no pain. Three other nails show lifting with white, crumbly debris at the free edge. Her nails are otherwise thin, with visible surface scoring from previous filing. She is a swimming instructor and is in chlorinated water five days a week. She is adamant she wants a fresh set today because of a wedding on Saturday, and asks you to 'just cover it with a darker colour'.
1. What is the most likely cause of the green-black discolouration, how do you distinguish it from other possibilities, and why is covering it unsafe?
Read the worked answer
Most likely: bacterial colonisation by Pseudomonas aeruginosa - 'greenies'. Moisture becomes trapped in the pocket created by the lifted enhancement; the bacteria proliferate in that warm, dark, wet space and produce green pyocyanin pigment that stains the nail plate. The musty smell and the precise correspondence with the lifted area are typical.
Why not the alternatives:
- Candida/paronychia - would usually show redness, swelling and tenderness of the nail folds, and often a yellow-green discharge; her folds are intact and pain-free.
- Onychomycosis - slow, progressive thickening, yellow-brown discolouration and crumbly subungual debris, usually starting at the free edge over months, not a discrete green patch under a lifted product.
- Subungual haematoma - a history of trauma, and the colour is red-purple-black and does not smell.
- Melanonychia - a longitudinal streak, no lifting, no smell.
Why covering is unsafe: the enhancement would seal the bacteria in, the discolouration would spread further along the plate, onycholysis would worsen, and the client cannot see the nail deteriorating. Dark colour also hides the problem until it is much worse. Adding product over an active bacterial pocket is a cross-contamination and client-safety failure, and it breaches the professional duty to decline treatment that would cause harm.
2. What do you do today, what do you refuse, and what aftercare do you give?
Read the worked answer
Today:
- Explain the finding in plain language - bacteria trapped under the lifted gel, not a 'nail fungus' - and show her the area in a mirror.
- Remove all gel from the affected hand, and ideally all ten, using your normal remover rather than aggressive filing over the thin plates. Do not re-file the scored surface further.
- Do not apply any enhancement, base coat or polish to the index finger; the other nails may have a clear strengthening treatment only if the plate is intact and dry.
- Discard every file, buffer and disposable used on that hand; disinfect reusable implements with an appropriate virucidal/bactericidal product and follow your salon's infection-control policy.
- Do not treat with an over-the-counter 'fungal' lacquer - the organism is bacterial, and self-diagnosis delays appropriate care.
Aftercare:
- Keep the nail short and dry; pat dry after swimming, do not pick or scrape the discolouration.
- Advise she asks her pharmacist or GP about the discolouration if it spreads, the nail becomes painful, the skin becomes red, hot or swollen, or there is any discharge - those are referral triggers.
- No enhancements on that nail until the discolouration has grown out and the plate has reattached; with normal growth that is several months, so set that expectation now.
- Rebook a review in two weeks; if it has not improved, she must see her GP or a podiatrist.
Refusal: decline the fresh set today, record the refusal and the reason, and offer a booking once the nail is healthy.
3. What in the previous application and her lifestyle contributed to this, and what do you advise to prevent recurrence?
Read the worked answer
Application factors: lifting within days suggests poor preparation and sealing - cuticle left on the plate, insufficient dehydration, over-thinning or over-filing creating a scored surface, product not capped at the free edge, or a gel cured unevenly. Once the seal breaks, water enters and cannot escape. Picking widened the pocket.
Lifestyle factors: five days a week in chlorinated water means prolonged wet-dry cycling; nails stay hydrated under the enhancement, which is exactly the environment Pseudomonas needs. Chlorine does not sterilise under a lifted product.
Prevention advice:
- Proper prep: push back and remove cuticle from the plate, dehydrate, avoid over-filing, and cap the free edge; check the seal at every rebalance.
- Rebalance at 2–3 weeks rather than leaving 3+ weeks with lifting.
- Wear gloves for pool sessions where practical, dry hands thoroughly afterwards, and use cuticle oil on the surrounding skin (not under the product).
- Never pick or peel product - book a removal instead.
- Rest the nails between sets if they are thin and scored; a conditioning treatment and short, natural nails until the plate recovers.
- Book with a technician who uses a consistent, documented prep protocol, and ask for the enhancements to be checked if any lifting appears in the first week.
Record the advice given and the two-week review in her client notes.