Nail Diseases, Disorders, and Conditions
Expect to distinguish what you may work over from what you must refer, and to use the correct vocabulary. The exam does not ask you to diagnose - it asks you to recognize and refer.
Disorders (not infectious)
- Onychorrhexis - longitudinal splitting and ridging.
- Onychauxis - thickened nail.
- Leukonychia - white spots, usually minor trauma.
- Koilonychia - spoon nail.
- Pterygium - forward growth of cuticle onto the plate.
- Onychophagy - bitten nails.
- Beau's lines, furrows, splinter hemorrhages.
Diseases (infectious or systemic)
- Paronychia - red, swollen, painful nail fold; bacterial or fungal.
- Onychomycosis - fungal plate infection: yellow-brown, thick, crumbly.
- Pseudomonas - green-black discoloration under a lifted plate; bacterial.
- Verruca (HPV) around the nail.
- Tinea pedis - athlete's foot.
Refer, do not treat
Swelling, pus, pain, heat, a dark streak (melanonychia), sudden change in one nail, clubbing, or a lifted plate with debris - all require a physician.
Worked example. A client has a green-black spot on one nail under a lifted acrylic. Reasoning: the color plus lifting points to Pseudomonas, which thrives in the dark, damp space under the product. You do not file it off and recoat. You remove the product gently, apply no new enhancement, advise the client to see a doctor, disinfect every tool, and document.
Traps: calling a green nail "mold" and covering it with polish; working over paronychia because it "isn't the nail"; diagnosing onychomycosis; treating an ingrown toenail.