Nail Diseases, Disorders, and Conditions
This domain tests whether you can separate a cosmetic condition you may service from a medical condition you must refer, and whether you can describe what you see without diagnosing.
Vocabulary that decides the answer
- Disease: pathological and requires medical attention - fungal, bacterial, viral, or systemic.
- Disorder: a non-infectious condition that may be served if the skin is intact and not inflamed, such as ridges or brittleness.
- Condition: a descriptive term for appearance, such as leukonychia.
Refer, do not treat
- Onychomycosis: thick, crumbly, yellow-brown plate with subungual debris and lifting. Do not file across it; refer, then discard or disinfect everything used.
- Paronychia: red, swollen, painful nail fold, often with pus - bacterial; refer.
- Onychocryptosis (ingrown nail), onychia, felon/furuncle: inflamed or infected; refer.
- Melanonychia: a new dark longitudinal band, especially with pigment spreading onto the fold (Hutchinson sign) - urgent dermatology referral; never file over it or hide it under opaque product.
- Subungual hematoma: dark, painful, post-traumatic; a physician may need to relieve pressure.
- Verruca (wart) near the nail: viral and contagious - never file, cut, or treat.
- Herpes whitlow: grouped painful blisters - highly contagious; do not service.
- Psoriasis and lichen planus: pitting, ridging, and plate changes; refer if undiagnosed.
- Also recognize onycholysis, onychomadesis, Beau's lines, koilonychia, onychorrhexis, lamellar splitting, pincer nail, and hangnail (agnail).
Servicing rules
Wash hands, wear gloves, never share a file between clients, never cut living tissue, never apply product over broken or inflamed skin, and refer with neutral language. Document what you observed and what you advised.
Worked example
A 55-year-old client has a single brown-black streak on one thumbnail that has widened over three months. It is not a bruise: bruising grows out and fades, while this is stable and darkening. Correct action is to decline product on that nail, explain that pigment streaks need a dermatologist's evaluation, and document the referral - not to buff the surface or cover it with acrylic.
Traps that cost marks
Calling every discoloration "fungus"; buffing ridges on a suspected fungal nail; nipping a wart; and concealing discoloration under enhancement product.