Recognising Contra-Indications

Let's chat about something important: nail abnormalities and infections. As a savvy nail tech, understanding these quirks isn't just about mastering your craft—it's about keeping your clients safe and healthy too. It’s important to understand these conditions and be able to recognise when a client's hands or condition is out of the norm. But it’s also important to note, we are not doctors and cannot diagnose.

Before we get started, let’s discuss two important terms when it comes to assessing the condition of your client's hands and nails.

Contra-indications: Factors which may prevent you from carrying out your treatment.
Contra-actions: Things which may occur as a result of treatment, either during or after said treatment.

For this blog post, we are focusing on contra-indications as this is what most hand and nail infections and abnormalities fall under.

What are examples of contra-indications in nail services?

Bacterial Infections

Infections of the nail and surrounding skin appear when bacteria have entered wounds or small cuts in the cuticles or surrounding skin. They may appear red and can be tender to the touch. In some cases, skin abscesses (a collection of pus under the skin) can develop. Bacterial infections can also appear as cellulitis - inflammation of the dermis and subcutaneous tissues which can appear red, warm to the touch and painful. It is not advised to carry out the service when a bacterial infection is suspected. Clients should be advised to visit their GP.

Fungal Infections (Greenies)

Pseudomonas, also known as "greenies," are a common bacterial infection found in moist environments like under lifted artificial nails. When moisture builds up between the natural nail plate and enhancements, it creates an ideal breeding ground for bacteria.

Greenies can develop on both enhanced and natural nails if there's any lifting or damage. Prevention is key: thorough hand washing and proper disinfection of tools can help avoid their appearance.

If greenies do show up, prompt removal of enhancements and keeping the nail dry are essential. While they may take some time to grow out, they typically clear up on their own without the need for treatment.

Tinea Versicolor

Tinea Versicolor is a benign fungal skin infection which creates pale areas of pigmentation on the skin. The fungus which causes this condition is present on healthy skin and only causes problems when it begins to overgrow. Tinea Versicolor is mainly harmless and can be treated with over-the-counter lotions or shampoos. It is not contagious and should not impact your service.

Eczema (Dermatitis)

Eczema (Dermatitis is often due to an overactive immune system and can cause skin inflammation, visible as a rash which can feel itchy. Eczema is not contagious, so is not likely to cause cross-contamination. However, you should be careful when using products which can dry out the skin like acetone or alcohol as this could worsen their symptoms.

Diabetes

If your client is diabetic, ensure you take extra care when offering a manicure treatment. Nails must be filed with a non-metal board and do not use nippers, scissors or metal tools to cut cuticles or nails. Diabetic clients are more prone to infections so sterilisation and hygiene are paramount. We would also avoid using metal tools as clients with diabetes are more prone to infection due to taking longer to heal if the skin is accidentally nipped.

Do not treat a diabetic client who is experiencing a lack of sensation in the area being treated. Refer them to a GP.

Warts

Warts are caused by a virus (HPV) which causes skin to grow excessively. As warts are contagious we would not recommend carrying out the service and would advise the client to visit a GP or pharmacy for treatment.

Verrucas

Verrucas are small rough lumps on the skin, usually on the feet, which are caused by a virus. However, verrucas are usually transmitted through broken or wet skin so there are precautions you can take, such as using a waterproof dressing and avoiding the area.

Basal Cell Carcinoma

This is the most common form of skin cancer and it often appears as a translucent raised mark on the skin although it can take different forms. As it is not infectious, it shouldn’t prevent the service from being carried out. If you think a client has a mark which could be basal cell carcinoma, refrain from trying to diagnose, and advise them to visit their GP.

Squamous Cell Carcinoma

This is also a type of skin cancer which may begin as a regular ulcer that won’t heal, or an abnormal growth, which usually appears in areas often exposed to the sun. If you see a mark on a client which looks like Squamous Cell Carcinoma advise them to see their GP.

Psoriasis

An autoimmune condition that can cause a variety of skin rashes, silver, scaly plaques are the most common form. Psoriasis isn’t contagious and people with the condition can still have manicures, although we would suggest asking the client how they are feeling and avoiding using drying chemicals like acetone/alcohol on flared-up areas.

Hives

These red, raised, itchy patches often arise suddenly and can be a result of an allergic reaction. Speak with your client about allergies to ensure the service doesn’t incorporate any of their known allergies. If they are unsure about what has been causing their hives, encourage them to speak to their GP.

Herpes

The Herpes Simplex Virus (HSV) can cause periodic blisters or skin irritations around the lips or genitals but it can also manifest on the hands and particularly around the fingertips. HSV is contagious and spreads through skin-to-skin contact. We recommend talking with your client if you suspect they have a herpes outbreak on their hands and advising them to visit a GP if they have not been diagnosed or wait until 2 weeks after their outbreak is no longer visible to return for a manicure.

Rash

Nearly any change in skin's appearance can be called a rash. Most rashes are from simple skin irritation, others result from a medical condition. Consult with your client if you’re concerned about apparent rashes.

Viral Exanthem (Measles)

Many viral infections can cause a red rash affecting large areas of skin, for example, measles. These conditions are very contagious and the client should be advised to leave and seek medical advice.

Scabies

Scabies are tiny microscopic mites that burrow down into the skin and cause incredibly itchy rashes (often appearing as small clusters of red dots), particularly in the webs of fingers, wrists and elbows. Scabies are very contagious and your client should be advised to seek medical advice.

What to do when you come across a contra-indication

When encountering a contra-indication, it's crucial to communicate openly with clients. We must explain that we've identified an abnormality and prioritise their well-being by refraining from proceeding with the treatment. Our aim is to avoid exacerbating any existing conditions. While we don't want to cause unnecessary concern, it's important for clients to understand that their health takes precedence over nail aesthetics. It’s also important to note that attempting to diagnose or prescribe medication beyond our scope of expertise could pose risks for both clients and nail technicians.

Working with allergies

For nail technicians, identifying potential nail allergies in clients is crucial for ensuring their safety and well-being. Here are some insights and advice to help you recognise signs of nail allergies:

• Familiarise yourself with common allergens: Learn about common allergens found in nail products, such as HEMA, HPMA, and IBOA. Be aware of the symptoms associated with allergic reactions to these substances.
• Observe client reactions: Pay attention to any adverse reactions or sensitivities your clients may experience during or after nail treatments. Look for signs like redness, itching, swelling, or irritation around the nail area.
• Have an in-depth consultation with new and existing clients re medical history and allergies
• Remove builder gel every 2-4 infills to check the health of the natural nail and ensure no contra actions are occurring
• Remove builder gel or gel enhancement if a client expresses any sign of change since their last appointment
• Ask about previous reactions: Inquire about any history of allergic reactions to nail products or other substances. Clients with a previous allergy may be more susceptible to developing reactions in the future.
• Educate clients: Provide information to clients about the potential risks of nail allergies and the importance of reporting any unusual symptoms or reactions. Encourage them to seek medical advice if they experience persistent or severe symptoms.

Please note: If someone is already experiencing an allergic reaction or has explained that they have in the past and they don’t know what they are allergic to, they could still react to HONA or any other hypoallergenic ingredient. Speak with your insurer for advice on patch testing someone who has an existing allergy.

By staying vigilant and proactive in identifying potential nail allergies, you can help ensure a safe and comfortable experience for your clients.

Read more about allergies in our dedicated section of the HONA Knowledge Hub.