Green Discolouration Under a Lifted Acrylic Nail
A 41-year-old woman comes for removal of acrylic enhancements and a manicure. She wants a gel overlay on all ten nails because she is a bridesmaid at the weekend. On the right thumbnail you see a 5 mm green-black discolouration under the lifted free edge, with separation of the nail plate from the nail bed. The surrounding skin is intact, there is no pus, and she reports no pain. She says she bumped the nail three weeks ago and has been covering it with polish. She has no diabetes, no immunosuppression, and no allergies. The acrylic was applied six weeks ago and has lifted on three other nails without discolouration. She asks you to just cover it with gel so it looks normal in the photos.
1. Interpret the nail finding and explain why covering it with gel is not appropriate.
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The green-black discolouration under a lifted nail plate is not normal and should not be covered. The combination of lifting, a warm moist space underneath and green-black colour suggests bacterial colonisation, commonly described as 'green nail' and often associated with Pseudomonas. A subungual haematoma from the bump is possible, but the nail plate separation and colour make bacterial involvement a real concern.
Covering it with gel would trap moisture and bacteria, reduce access for cleaning and assessment, and could make the problem worse. It would also hide a change that may need medical review. The judgement is therefore not to apply gel to the affected nail, not to seal the lifted edge, and not to treat it as a cosmetic discolouration.
2. State what you would and would not do in this appointment, including hygiene measures.
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I would not apply gel over the affected nail and would not attempt to clean under the nail with a sharp tool. I would explain the finding and advise her to see her GP or a podiatrist if the discolouration spreads, the nail becomes painful, pus appears or the surrounding skin becomes red and swollen.
For the other nails, I would only proceed if I could avoid cross-contamination. I would use fresh disposable files and buffers, disinfect reusable tools, keep the affected hand away from shared equipment and clean the workstation afterwards. I would avoid aggressive cuticle work on the affected finger. Removing the acrylic from the affected nail may itself require filing or soaking; if it cannot be done without trauma, I would refer rather than force removal. The priority is infection control and safe referral, not a perfect set of nails for the wedding.
3. What aftercare and record-keeping would you provide?
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I would advise her to keep the affected nail dry and uncovered where possible, not to apply polish or gel, and not to pick at the lifted edge. She should wash her hands normally and dry them well, and use separate nail tools at home. She should seek medical advice if the colour spreads, the nail lifts further, pain or pus develops, or the skin around the nail becomes inflamed.
I would record the exact location and size of the discolouration, the nail plate separation, the absence of pain and pus, the client's request to cover it, the refusal, the advice given and any service carried out on the other nails. I would also note that disposable items were used and reusable tools were disinfected. This record shows that I assessed the nail and made a safety-based decision rather than simply refusing a service.