NAIL CONDITIONS: to treat or to refer?

LILLY DELMAGE explores how to manage common nail conditions, when to treat them & when to refer clients for medical advice

Have clients presented you with natural nail concerns, but you’ve felt unsure about whether you should continue their appointments? Read on to freshen up your initial training and note the conditions that require medical intervention.

While nail professionals should refrain from making medical diagnoses, it’s important to be aware of common nail conditions. “Knowledge of these will help you perform professional and safe services, as well as advise and inform clients,” explains Lucy Price-Marshall, Scratch Stars Natural Nail Specialist of the Year 2023 & 2024. “This will help build trust and encourage them to return.”

We’ve rounded up some of the most common natural nail conditions, explaining why they occur and providing information on best practice when faced with them at the consultation stage.

Consultations: healthy hands & nails or the need for referral?

“It is crucial that you allow time for a thorough consultation and observation of a client’s nails before any service,” notes Lucy Price-Marshall. “If you notice that a client’s nail is changing condition, you need to troubleshoot the cause and symptoms.”

Scratch Stars Natural Nail Specialist of the Year finalist 2024, Tanya Jeskins, reiterates this: “If you miss a condition, you could damage a nail, spread infection and bacteria, or give the wrong advice. This could lead to service breakdown and future nail issues for the client.” Education book, Milady’s Art & Science of Nail Technology, highlights the ‘golden rule’: “If the nail or skin to be worked on is infected, inflamed, broken or swollen, a nail tech should not service the client.”

Look out for:

Infection: signs of pus or weeping.

Inflammation: red areas that are sore or tender.

Broken skin or nail tissue: cuts or tears that reveal deeper layers of the skin or nail.

Raised or swollen skin: skin that appears higher and/or larger than usual.

If you miss a condition, you could damage a nail, spread infection and bacteria, or give the wrong advice. This could lead to service breakdown and future nail issues for the client.”

Treatable conditions at the nail desk

If you spot the below concerns, and there are no signs of infection, inflammation, broken or swollen nails or skin, you can safely perform the client’s treatment. In fact, nail techs can often improve these conditions, while cosmetically enhancing the appearance of nails.

Bitten nails

What is it? With new year’s resolutions in full swing, expect nail-biting clients to pay your business a visit, as a fresh manicure can be an incentive to break the habit. Education platform, NailKnowledge, shares that bitten nails can not only affect the nail plate, but the cuticles, free edge, hyponychium, nail beds and nail folds.

Lucy Price-Marshall explains: “The habit can cause soreness, and can pose risks of infection and onycholysis due to clients biting skin, cuticle and the free edge of the nail.” The natural nail specialist establishes the importance of getting to the root of the habit: “Clients may need to identify nail biting triggers, such as stress or anxiety, and try to minimise them.”

Treatment: Begin by tending to the cuticle area: clip off any hangnails, file rough edges and smooth the surface of the nail. NailKnowledge explains the power of nail enhancements, suggesting that you apply a gel, L&P acrylic or acrygel overlay to prevent the natural nail from being bitten. Sensitivity is also key, notes Hannah Beth Clayton, Scratch Stars Natural Nail Specialist of the Year finalist 2024 & CND™ UK ambassador. She says: “Rather than shaming nail-biting clients about the habit, it’s best to educate them about the importance of hydration, in the form of retail-friendly cuticle oils.”

Fight the biting

“My client went through a tough period in her life, and her nails and surrounding skin took the brunt,” says Hannah Beth. “Over 12 months, her treatment plan included daily homecare, two weekly cuticle care appointments and nail health checks, and the results were phenomenal.”

Leukonychia

What is it? This refers to discolouration, which often appears as white dots or lines on the nail. According to Milady’s Art & Science Nail Technology, the cause of this is typically due to trauma and injury to the nail matrix, sometimes from nail biting. However, underlying health conditions or the use of certain medications, such as antibiotics, can also trigger this condition.

Treatment: You can reassure clients that the white areas will grow out with the nail. While you cannot correct the white spots, you can safely continue with services and mask with a nail colour of your client’s choice.

NailKnowledge recommends avoiding aggressive manicure techniques and prioritising warm procedures, such as hot paraffin and oil manicures. When the discoloured areas reach the tip of the nail, handle with extra care, as they can be more prone to peeling. To avoid this condition and prevent reoccurrence, Tanya Jeskins suggests regular manicures or pedicures, daily cuticle oil use and a plan to prevent nail biting, if applicable.

Beau’s lines

What is it? Beau’s lines are horizontal ridges or dents on the nail plate, caused by a slowing in the production of nail cells by the nail matrix. These can be caused by trauma to the matrix, reactions to medications, or underlying health factors including illness, stress, nutrient deficiencies and skin disorders, such as eczema and psoriasis.

Treatment: Take extra care when performing a service, as affected nails are likely to be weak and fragile. Refrain from performing aggressive manicure techniques around the cuticles, as this can increase the likelihood of infection. Instead, focus on moisturising and hydrating the cuticle area with oil and lotion.

Scratch Stars Natural Nail Specialist of the Year 2019 & CND™ education ambassador, Helen Burton-Ward, advises: “Do not attempt to buff the ridge out, as this will thin the nail plate further.”

Opt for a ridge-filling base coat or primer to even out minor grooves. Reassure clients that the ridges should eventually grow out and advise them to consult a medical professional if the condition persists or recurs.

Hangnails

What is it? A hangnail refers to torn skin around the cuticle area. NailKnowledge notes that the common causes of hangnails are cuticle neglect, dehydration, incorrect use of nail products and aggressive or abrasive manicure techniques.

Treatment: Carefully remove any torn skin with a clean pair of nippers. Advise clients to apply creams, oils and lotions regularly to prevent dryness. If you spot signs of infection, such as redness, swelling or pus, or if the condition recurs, encourage clients to seek medical attention.

Product pick

“For clients that want to protect their natural nails in between treatments, I suggest CND’s RescueRXx™,” shares Hannah Beth Clayton. “This is a daily keratin treatment that helps to strengthen damaged and weak nails, while softening the skin around the nail plate. This is ideal for reducing the likelihood of hangnails, peeling and leukonychia.”

“Famous Names Dadi’Oil is a phenomenal product for clients wanting to see a big improvement in the health of their natural nails,” says Kay Kirsop, Artistic Nail Design and Famous Names brand ambassador.

“Refrain from performing aggressive manicure techniques around the cuticles, as this can increase the likelihood of infection. Instead, focus on moisturising and hydrating the cuticle area with oil and lotion.”

Hooked nails

What is it? A hooked nail presents a claw-like appearance, with a downward bend. This condition is often caused by trauma to the finger or nail area.

Treatment: You can reconstruct the structure and shape of the nail by filing and/or using L&P acrylic, gel or acrygel overlays. Scan the QR code to see how product and social development manager at Katie Barnes Tool Range, Erin Searle, uses the brand’s products to lift a hooked nail.

Nail delamination (peeling nails)

What is it? Peeling nails, or nail delamination, can be triggered by frequent hand washing. NailKnowledge shares: “When exposed to water, your nails absorb it, causing them to swell. As a result, the nails become soft and vulnerable to damage. When they harden again, they compress, which can create small cracks in the nail plate.” The process repeats, increasing the likelihood of fractures, peeling and splitting. Symptoms can also be triggered by external factors, such as fluctuating temperatures, nail trauma, using nails as tools and nutritional deficiencies.

Treatment: Award-winning nail tech & OPI Nail Boss, Emma Brock, explains how she caters to clients presenting this condition: “Keep the nails short and opt for a rounded shape. Encourage the client to moisturise their hands and oil their cuticles regularly, and recommend that they wear gloves when cleaning, as chemicals and water can weaken nails over time.”

Product pick

Repair Mode™ is a bond building brush-on nail serum from OPI, designed for damaged nails. Ulti-Plex Technology™ mimics the natural nail’s protein structure to help restore it to its optimal condition from within.

Jessica Price, OPI Nail Boss & Scratch Stars Natural Nail Specialist of the Year finalist 2024, explains why this is one of her favourite nail products: “It doesn’t add time to my services, because while the product penetrates, I work on the client’s cuticles.”

Product pick

IBX is a two-part system from Famous Names, which penetrates the nail plate to strengthen from within. First, use IBX Repair to treat areas of damage or weakness. Next, apply IBX Strengthen to fuse together the nail’s top layers for additional strength.

Kay Kirsop shares: “IBX is incredible, as it works by penetrating into tiny gaps in the nail, then cures to form a tough network that strengthens within the nail.”

Brittle nails (onychoschizia)

What is it? According to Health.com, onychoschizia affects roughly one in five people and presents with split, peeling, cracked or broken nails. NailKnowledge notes that the leading cause of brittle nails is dehydration, through nutrient deficiencies and exposure to harsh chemicals. Ageing and underlying heath conditions are also notable triggers.

Treatment: Nail enhancements can add a layer of protection to help nails grow, but ensure clients are using oils and lotions to increase hydration and maintain flexibility in their natural nails. Advise clients to replenish the moisture and oil lost through hand washing by applying cream or oil.

Sara Pinto, nail product director at Andreia Professional, offers her product recommendation: “For brittle and peeling nails, regular use of Andreia Professional’s Lab: Hydro Calcium helps restore hydration and repair the nail surface.”

Hydrated nails in two steps

Gelish master educator, Rhiannon Gilfillan, shares her go-to steps and products for treating dehydrated nails:

“I use the Morgan Taylor Bare Luxury range to treat dry nails. The Scrub helps detox and cleanse the hands and nails, and the Massage Butter moisturises, as it contains oils and plant extracts.

“I finish the treatment by applying Gelish Foundation Flex. Featuring vitamin A and biotin, this product nourishes and flexes with the nail to ensure longer-lasting protection against continuous washing.”

Toenail troubles

What is it? Toenail issues include the complete absence or partial loss of toenails. The Foot & Ankle Clinic, Darlington, shares on its website (www.thefootandankle.clinic) that this is often caused by trauma to the toes, inflicted during sports, by stubbing, via nail surgery, or as a result of fungal nail infections. The condition can leave individuals feeling embarrassed and seeking cosmetic solutions.

Treatment: Toenail reconstruction or toenail replacement is often an effective solution. However, the procedures should only be performed by nail techs who have completed a relevant qualification in cosmetic reconstruction.

Infection: how it spreads & handy solutions

According to Milady’s Art & Science of Nail Technology, there are a number of ways that infections often breed in salon spaces:

• Contaminated tools and equipment: such as dirty nail files, cuticle nippers and towels.

• Clients’ nails, hands and feet: each client that enters the salon exposes the premises to new bacteria.

• Open wounds: if you, or a client, has an open would, infected fluids can travel between individuals.

• Salon surfaces and objects: pathogens live on all furniture and objects.

Delicate deliveries

While you may need to refuse a nail service, you still have a duty to treat clients with care. “It’s crucial to approach such situations with empathy and professionalism,” says Sara Pinto. “Start by explaining that the client’s health & safety are your priority. Emphasise that certain conditions require medical attention, and postponing the service will ensure the best results in the long term.”

Hannah Beth Clayton adds: “Aftercare is crucial. Stay in touch with the client, checking in once a week and asking for nail photo updates. Think of how it would feel for you to be in the situation – how would you like to be treated?”

“While you may not be able to continue with the planned service, you can offer your client alternatives, such as a hand and arm or leg and foot massage,” suggests Tanya Jeskins.

Untreatable conditions at the nail desk

“As a qualified professional, you should be aware of when you cannot work on a client’s natural nails,” says Hannah Beth Clayton. “Remember: you are not medically qualified to diagnose or treat, so if in doubt, refer to a medical professional. When doing this, I maintain contact with the client to support them, alleviate embarrassment and encourage future bookings.”

Onychocryptosis (ingrown nails)

What is it? This condition occurs when the edge of a nail embeds into the skin. While ingrown nails are most commonly associated with toenails due to their harder, sharper structure and the constraints of wearing shoes, they can also present on fingers. The causes are varied, but can include cutting nails too short or in a curved shape, having more exaggerated curves in the nails and wearing improperly fitted shoes.

When the nail embeds, clients may experience pain, and you may see inflammation, redness and swelling around the impacted area, which can indicate an infection. To prevent ingrown nails in clients, avoid cutting nails too short, and be sure to cut nails straight across – rather than in a curved shape. Additionally, avoid cutting nails too short.

Pseudomonas (greenies)

What is it? Pseudomonas, also commonly referred to as ‘greenies’, is an infection often caused by bacteria getting trapped between the nail plate and an overlay. Lucy Price-Marshall comments: “Your client may have left too long between maintenance appointments, causing their enhancements to lift and allowing infection to breed. Therefore, you must remind them to book an appointment before this risk arises.”

The infection often starts as yellow or brown in colour, gradually becoming greener, and can eventually lead to a black discolouration of the nail. NailKnowledge details that greenies can destroy the nail plate, exposing the keratin in the nail and potentially leading to the need for surgical removal.

Onychomycosis (nail fungus)

What is it? This is a fungal infection that often begins at the free edge or the hyponychium, and works its way towards the cuticle area and nail bed. Milady’s Art & Science Nail Knowledge adds that the condition can take numerous forms, including white patches that can be scraped off, yellow streaks and peeling. Fungal infections require treatment from a medical professional.

Onycholysis

What is it? This occurs when the nail plate separates from the nail bed and turns white. As the nail plate loosens, a pocket forms, making it susceptible to infection. This condition can be caused by several factors, such as trauma to the nail, an infection or an allergic reaction. The ACESO™ system from Famous Names can aid this condition and nail techs can help by trimming the nail. However, if an allergy is suspected, the client should be tested to identify its cause and prevent reoccurrences.

Paronychia

What is it? This is a bacterial infection that targets the tissue around the nail. It can occur at the base of the nail, surrounding the nail, the surrounds of the nail plate, or on the fingertip. The client may report tenderness in the area, and you may observe redness and swelling. Common causes include the use of unsanitary implements, as well as the aggressive pushing or cutting of cuticles.

Reducing risks

Milady’s Art & Science of Nail Technology offers advice on preventative measures to reduce the presence, build-up and transfer of pathogens within the nail environment:

• Educate yourself on proper sanitation and disinfection procedures.

• Refuse clients with contagious conditions.

• Do not work near an open wound – instead, refer the client to a physician and request a written statement from the professional before working on the client.

• Implement practices that prevent causing cuts and bleeding in services.