1. Chapter 10 Nail Disorders and Diseases
Nail Disorders & Diseases 1

2. Learning Objectives
List and describe the various disorders and irregularities of the nails.
Recognize diseases of the nails that should not be treated in the salon.
Perform a hand, nail, and skin analysis on a client.
WHY STUDY NAIL DISORDERS AND DISEASES?
You must be able to identify those conditions on a client’s nails and determine if they should or should not be treated in the salon.
You must acknowledge infectious conditions that may be present so you can take the appropriate steps to protect yourself and your clients from the spread of disease.
You need to be able to recognize conditions that may signal mild to serious health problems that warrant the attention of a doctor. 2

3. Introduction
Nails are an interesting and surprising part of the human body.
The nail is a mirror into an individual’s general health.
Certain health conditions may first be revealed by a change in the nails.
Some conditions are easily treated in the salon but some are infectious and cannot be treated by salon professionals.
Carefully studying this chapter will vastly improve your knowledge and expertise in caring for nails.
INTRODUCTION
To perform professional and responsible service and care, you need to learn about the structure and growth of the nail, as you did in Chapter 9, Nail Structure and Growth. Now you must learn about the disorders and diseases of nails so that you will know when it is safe to work on a client.
Nails are an interesting and surprising part of the human body.
The nail is a small mirror into an individual’s general health.
Certain health conditions may first be revealed by a change in the nails, a visible disorder, or poor nail growth.
Some conditions are easily treated in the salon—hangnails, for instance, or bruised nail beds that need camouflage—but some are infectious and cannot be treated by salon professionals.
Carefully studying this chapter will vastly improve your knowledge and expertise in caring for nails. 3

4. Pinpoint Common and Uncommon Nail Disorders
Nail disorders are caused by injury, heredity, or disease.
Disorders must be referred to a physician.
Only cosmetic problems can be treated by a licensed cosmetologist or nail technician.
PINPOINT COMMON AND UNCOMMON NAIL DISORDERS
A nail disorder is a condition caused by injury, heredity, or previous disease of the nail unit.
A cosmetologist should recognize common or normal disorders as well as abnormal nail conditions, understand what to do, and be able to help a client with a nail disorder in one of two ways:
You can tell clients that they may have a disorder and refer them to a physician if required.
You can cosmetically improve certain nail plate conditions if the problem is cosmetic and not a medical condition.
It is your professional responsibility and a requirement of your license to know which option to choose.
A client whose nail or skin is infected, inflamed, broken, or swollen should not receive services and should be referred to a physician to determine the type of treatment that is required. 4

5. Common Nail Disorders Beau’s lines Blue fingernails Bruised nail beds
Beau’s lines: Sometimes called furrows or corrugations, are visible depressions running across the width of the natural nail plate; result from major illness or injury that has traumatized the body.
Blue fingernails: Usually caused by a lack of circulating oxygen in the red blood cells.; may also represent a high level of an abnormal form of hemoglobin in the circulation.
Bruised nail beds: A condition in which a blood clot forms under the nail plate, causing a dark purplish spot; usually due to small injuries to the nail bed.
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6. Common Nail Disorders (continued)
Discolored nails
Eggshell nails
Hangnail
COMMON NAIL DISORDERS (continued)
Discolored nails: Nails that turn a variety of colors; caused by surface stains from nail polish, foods, dyes, or smoking. Could also be caused by an internal discoloration of the nail plate due to biological, medical, or even pharmaceutical reasons.
Eggshell nails: Noticeably thin, white nail plates that are more flexible than normal; normally weaker and can curve over the free edge. Usually caused by improper diet, hereditary factors, internal disease, or medication. Be very careful when manicuring these nails because they are fragile and can break easily.
Hangnail: A condition in which the living skin around the nail plate splits and tears. Never cut the living skin around the natural nail plate, even if it is dry and rough looking.
© FCG/Sutterstock.com
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7. Common Nail Disorders (continued)
Koilonychia
Leukonychia spots
Melanonychia
COMMON NAIL DISORDERS (continued)
Koilonychia: Soft spoon nails with a concave shape that appear scooped out. The depression is usually large enough to hold a drop of liquid. Often spoon nails are a sign of iron deficiency, anemia, or a liver condition known as hemochromatosis, in which your body absorbs too much iron from the food you eat. Spoon nails can also be associated with heart disease and hypothyroidism or other long-term illness.
Leukonychia spots: Also known as white spots, are whitish discolorations of the nails, usually caused by minor injury to the nail matrix. It is a myth that these are caused by a vitamin or mineral deficiency. They appear frequently in the nails but do not indicate disease. As the nail continues to grow, the white spots eventually grow off and disappear.
Melanonychia: Darkening of the fingernails or toenails. May be seen as a black band within the nail plate extending from the base to the free edge. In some cases, it may affect the entire nail plate. This is a fairly common occurrence and considered normal in people of color, but could be indicative of a disease condition in Caucasians.
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8. Common Nail Disorders (continued)
Onychophagy
Onychorrhexis
Plicatured nail
COMMON NAIL DISORDERS (continued)
Onychophagy: Bitten nails, is the result of a habit of chewing the nail or the hardened, damaged skin surrounding the nail plate. Bitten, damaged skin should not be treated by a cosmetologist. If the skin is broken or infected, no services can be provided until the area is healed.
Onychorrhexis: Split or brittle nails with lengthwise ridges; caused by injury to matrix, excessive use of cuticle solvents, harsh cleaning agents, polish removers, aggressive filing, or hereditary causes. Nail services can be performed only if nail is not split and exposing nail bed.
Plicatured nail: Highly curved nail plate often caused by injury to the matrix, but may be inherited. Often leads to ingrown nails.
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9. Common Nail Disorders (continued)
Ridges
Splinter hemorrhages
COMMON NAIL DISORDERS (continued)
Ridges: Vertical lines running down the length of the natural nail plate that are caused by uneven growth of the nails, usually the result of normal aging. When manicuring a client with this condition, carefully buff the nail plate or use ridge filler to minimize the appearance of these ridges.
Splinter hemorrage: Caused by physical trauma or injury to the nail bed that damages the capillaries and allows small amounts of blood flow. This blood oxidizes and turns brown or black, giving the appearance of a small splinter underneath the nail plate. These are normal and usually associated with some type of hard impact or other physical trauma to the fingernail or toenail. 9

10. Uncommon or Abnormal Nail Disorders
Onychauxis
Onychogryposis
Nail pterygium
Pincer nail
UNCOMMON OR ABNORMAL NAIL DISORDERS
Onychauxis: Refers to the thickening of nails. May be toenails and the fingernails and may present in a number of different ways.
Onychogryposis: Also known as ram’s horn or claw nails, is an enlargement of the fingernails or toenails accompanied by increased thickening and curvature.
Nail pterygium: Abnormal condition that occurs when skin is stretched by the nail plate. Caused by serious injury, such as burns, or an adverse skin reaction. Do NOT push extension of skin back with an instrument as it may cause injury and worsen the condition.
Pincer nail: Also known as trumpet nail. Nail plates with a deep or sharp curvature at the free edge have this shape because of the matrix; the greater the curvature of the matrix, the greater the curvature of the free edge. Increased curvature can range from mild to severe pinching of the soft tissue at the free edge. In some cases, the free edge pinches the sidewalls into a deep curve. 10

11. Recognize Nail Diseases
Onychosis
Infectious nail diseases
Any nail disease that shows signs of infection or inflammation should not be diagnosed or treated in the salon.
Medical examination is required for all nail diseases and treatment will be determined by the physician.
RECOGNIZE NAIL DISEASES
Any nail disease that shows signs of infection or inflammation (redness, pain, swelling, or pus) should not be diagnosed or treated in the salon.
Medical examination is required for all nail diseases and treatment will be determined by the physician. 11

12. Infectious Nail Diseases
Onychia
Onychomycosis
Fungi
Paronychia
INFECTIOUS NAIL DISEASES
Onychia: Inflammation of the nail matrix followed by shedding of the nail.
Onychomycosis: A fungal infection of the natural nail plate. A common form is whitish patches that can be scraped off the surface of the nail. Another common form of this infection shows long whitish or pale yellowish streaks within the nail plate.
Fungi: Parasites which may cause infections on the hands and fee; are contagious and can be transmitted through contaminated implements.
Paronychia: A bacterial inflammation of the tissues surrounding the nail.
© Courtesy of Robert Baran, MD (France)
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13. Infectious Nail Diseases (continued)
Pseudomonas aeruginosa
Pyogenic granuloma
Tinea pedis
INFECTIOUS NAIL DISEASES (continued)
Pseudomonas aeruginosa: Common bacteria that can lead to a bacterial infection that appears as a green, yellow, or black discoloration on the nail bed.
Pyogenic granuloma: Severe inflammation of the nail in which a lump of red tissue grows up from the nail bed to the nail plate.
Tinea pedis: Also known as athlete’s foot; red, itchy rash on the skin on the bottom of feet and/or between the toes, usually between the fourth or fifth toe.
© murat5234/Shutterstock.com 13

14. Noninfectious Nail Diseases
Nail psoriasis
Onychocryptosis
Onycholysis
Onychomadesis
NONINFECTIOUS NAIL DISEASES
Nail psoriasis: A noninfectious condition that affects the surface of the natural nail plate causing tiny pits or severe roughness on the surface of the nail plate.
Onychocryptosis: Also known as ingrown nails, can affect either the fingers or toes. In this condition, the nail grows into the sides of the living tissue around the nail.
Onycholysis: The lifting of the nail plate from the bed without shedding, usually beginning at the free edge and continuing toward the lunula area. This is usually the result of physical injury, trauma, or allergic reaction of the nail bed and less often related to a health disorder.
Onychomadesis: The separation and falling off of a nail plate from the nail bed. It can affect fingernails and toenails. In most cases, the cause can be traced to a localized infection, injuries to the matrix, or a severe systemic illness. Drastic medical procedures, such as chemotherapy, may also be the cause. 14

15. [INSERT ICON4 HERE] LESSON ACTIVITY 1
Conduct a term pronunciation activity. Ask students to pronounce one term properly.
Be prepared to work with them on correct pronunciation.
After you have confirmed the proper pronunciation, have the entire class pronounce each term. 15

16. Perform Hand, Nail, and Skin Analysis
Allows a cosmetologist to identify disease, disorders, and conditions
Cleanse the hands of the cosmetologist and client
PERFORM HAND, NAIL, AND SKIN ANALYSIS
This examination will allow a cosmetologist to identify disorders, diseases, and conditions including signs of infection which may be identified through pain, redness, swelling, throbbing, and pus.
Cleanse: Always begin a hand, skin, and nail analysis by cleaning the hands of both the cosmetologist and the client.
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17. Perform Hand, Nail, and Skin Analysis (continued)
Observe the moisture, temperature, condition, tenderness of skin and length of nails.
Share with your client.
PERFORM HAND, NAIL, AND SKIN ANALYSIS (continued)
Observe:
– The moisture level of the skin.
– The temperature of the skin.
– The condition of the skin.
– Tenderness to the touch of the skin.
– Examine the condition and length of the nails including the shape of the free edge and cuticle and the thickness of the nail plate.
Share: After performing the nail examination, share your findings with your client:
– Identify any form of onychosis—disease, disorder, or condition.
– Note the apparent cause—systemic, environmental, etc.
– Suggest the proper service or refer to a physician.
– Discuss home maintenance and a future service plan. 17

18. Summary and Review
Well-manicured nails have always been recognized as an indication of good grooming.
Nails originate in the epidermal layer of the skin and, like hair, their condition is dependent upon the individual’s overall health.
You will want to identify and help correct any unhealthy nail conditions and advise clients on when they need to see a physician.
Your creativity in providing quality nail services must be grounded in a thorough knowledge and awareness of the structure and physiology of the nails.
Working on unhealthy nails can be dangerous to both you and your clients.
SUMMARY AND REVIEW
• Well-manicured nails have always been recognized as an indication of good grooming.
• Nails originate in the epidermal layer of the skin and, like hair, their condition is dependent upon the individual’s overall health.
• You will want to identify and help correct any unhealthy nail conditions and advise clients on when they need to see a physician.
• Your creativity in providing quality nail services must be grounded in a thorough knowledge and awareness of the structure and physiology of the nails.
• Working on unhealthy nails can be dangerous to both you and your clients.

19. Chapter Review Questions
In what situation should a nail service not be performed?
Name at least eight common nail disorders and describe their appearance.
CHAPTER REVIEW QUESTIONS
1. In what situation should a nail service not be performed?
Answer: If the skin to be worked on is red, inflamed, broken, or swollen or shows signs of infection, you should not service the client but rather refer the client to a physician.
2. Name at least eight common nail disorders and describe their appearance.
Answer:
Bruised nail beds: dark purplish spots under nail plate
Ridged nails: vertical ridges down length of nail plate
Eggshell nails: thin, white nail plate that is more flexible than normal
Beau’s lines: visible depressions running across width of nail plate
Hangnail: living skin splits around the nail
Leukonychia: white spots on the nail
Melanonychia: darkening of fingernails and toenails
Onychophagy: bitten nails
Onychorrhexis: split or brittle nails that have a series of lengthwise ridges
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20. Chapter Review Questions (continued)
3. What conditions do fungal organisms favor for growth? 4. What is Pseudomonas aeruginosa? Why is it important to learn about it?
CHAPTER REVIEW QUESTIONS (continued)
3. What conditions do fungal organisms favor for growth?
Answer: They need dark, warm, and moist conditions to grow. 
4. What is Pseudomonas aeruginosa? Why is it important to learn about it?
Answer: It is a naturally occurring bacteria on the skin that can grow out of control and cause an infection under certain conditions, especially through a lack of oxygen. Bacterial infections are of concern in the salon because they are contagious and can be transmitted from one client to another through unclean implements and working conditions.
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21. Chapter Review Questions (continued)
What is the most effective way to avoid transferring infections among your clients?
Can a cosmetologist offer treatment advice for a client who has developed a nail infection?
Can a cosmetologist treat an ingrown toenail if there is no sign of pus or discharge? Why?
Name two common causes of onycholysis.
CHAPTER REVIEW QUESTIONS (continued)
5. What is the most effective way to avoid transferring infections among your clients?
Answer: Practicing strict cleaning and disinfection procedures during every nail service with every client will reduce the risk of transferring infections.
6. Can a cosmetologist offer treatment advice for a client who has developed a nail infection?
Answer: No, cosmetologists can only recommend to the client that he or she see a physician and they cannot perform services on the client until the condition has been successfully treated.
7. Can a cosmetologist treat an ingrown toenail if there is no sign of pus or discharge? Why?
Answer: No, an ingrown toenail is a medical condition that can only be treated by a qualified medical professional.
8. Name two common causes of onycholysis.
Answer: Injury and allergic reactions cause onycholysis. 21