Nail Disorders, Diseases, and Client Conditions
You are not diagnosing. The exam tests whether you can recognize a condition that requires referral, distinguish infectious from non-infectious problems, and adjust service rather than guess.
Infectious - refer, do not service
- Onychomycosis (tinea unguium): thickened, yellow-brown, crumbly plate that may separate from the bed.
- Tinea pedis: athlete's foot - itching, scaling, peeling between toes.
- Paronychia: red, swollen, painful fold, often with pus; bacterial.
- Pseudomonas (green nail): green-black stain from bacteria trapped under lifted product or a loose tip.
- Verruca: wart caused by human papillomavirus; contagious, often with disrupted skin lines.
Non-infectious - service with care
Onycholysis (plate separated from the bed, usually trauma), onychorrhexis (splitting), leuconychia (white spots from trauma), onychauxis (thickening), onychocryptosis (ingrown edge), onychophagy (bitten nails), koilonychia (spoon nails), Beau's lines (horizontal grooves after illness or trauma), pterygium, splinter hemorrhages, psoriasis and eczema of the nail unit. A dark streak or band under the plate (melanonychia) is referred - it can be a melanoma.
Contraindications
Contagious conditions, open wounds, burns, and unexplained inflammation stop the service. Systemic conditions - diabetes, neuropathy, circulatory disease, immune suppression - require physician clearance and gentler technique.
Worked example
Two clients present with a lifted nail. First: thick, crumbly, yellow-brown, with a crumbly edge and similar changes on other toes - refer for suspected onychomycosis and disinfect every tool. Second: a clear, clean separation after the client caught the nail in a drawer, plate otherwise healthy - onycholysis from trauma, service with short, gentle shaping and no product over the separated area.
Traps
- Labeling every green nail "fungus" - it is usually pseudomonas.
- Servicing a warty finger because it "looks like a callus."
- Assuming a dark streak is polish stain.
- Calling onycholysis contagious.