MAY NEWSLETTER

 

As promised the subject of this month’s newsletter is a surprise. People often take the skin on parts of the body for granted. The ISS staff feels it is important to take care of your entire skin including the specialized skin structures known as the nails. Skin on a healthy, glowing face can be easily defeated by a simple glance at old, tired hands.

 

The nails and their surrounding skin take abuse from environmental exposures including weather, sunlight, and chemicals. Chemical exposure can be lessened by wearing gloves. Sunlight exposure can be avoided by using sunscreens and/or wearing gloves. Moisturizers are the key for weather and soaps that cause dryness. We recommend a sunscreen with a moisturizer for daily wear. For severe conditions that cause chapped skin and hangnails we recommend a moisturizer at night with lightweight cotton gloves. For any work outdoors or with chemicals, gloves are a must.

 

Just the facts Jack- or Pay attention there will be a test at the end on this material!

 

The nail grows out from a specialized area called the matrix in a fold of skin on the finger. The end of the matrix is indicated by the white semi-lunar shaped area under the nail called the lunula. Injuries to the proximal matrix affect the top of the nail while injuries to the distal matrix affect the bottom of the nail. The purpose of the cuticle is to hold the nail in place and seal the pocket from which the nail arises. The nail bed is the pink portion underneath the nail. The nail bed serves the purpose of keeping the nail stuck to the fingertip. The nail plays an important protective role and is essential for tactile sensation of the fingertips. Injuries to the matrix will affect the growth of the nail while injuries to the nail bed will affect the attachment of the nail. Disease or illness can be reflected in the nail due to their effects on the matrix.

Fingernails grow faster than toenails. Fingernails grow at a rate of 0.1mm a day. It takes approximately 5.5 months to replace a fingernail and approximately 12 to 18 months to replace a large toenail. 

 

Now for the fluff followed by the real stuff

 

Aesthetic considerations

Nail beauty is determined by the shape of the nail, its texture, and its decoration. Nail shape is determined by personal preference in most cases. The current trend is to cut the tip of the nail square. Length of the nail creates the impression of thin, tapered and graceful fingers. Longer nails can predispose the individual to nail and nailbed injuries with the primary injury being separation of the nail from the nailbed or a cracked nail. Texture of the nail is variable and can be influenced by nail care and nail cosmetics. Decoration of the nail is as varied as one’s imagination. In general, painted nails are considered more attractive than plain nails.

 

Nail care

Items for nail care include the following:

- Clippers                       

- Scissors                       

- Emery board                

- Abrasive nail file

- Blocks                         

- Metal particle file         

- Acrylic nippers             

- Cobalt steel fiberglass/linen shears

- Cuticle pusher              

- Orange stick                

- Cuticle trimmer            

- Nail buffer

- Nail whitener   

 

Bacterial, fungal and certain viral (herpes virus/cold sores) infections can be transmitted easily by contaminated instruments and/or trauma. To avoid infection your nail care instruments should only be used on your nails (not your pet or your husband with athlete’s foot). To avoid infection when seeing a nail technician you have one of three options: bring  your own instruments, make sure the nail technician uses adequate sterilizing techniques or use single use disposable instruments. The risk of Hepatitis B or HIV transmission with nail care is zero unless there is an open wound or the instruments are contaminated with blood or serum. Keep in mind that artificial nails predispose an individual to infection. Trauma from using instruments too harshly or removing too much of the natural nail plate will predispose the nail and its surrounding skin to infection. It is better to shape a nail using an abrasive instrument than to cut the nail. The space between the nail and the tip of the finger is heavily colonized with bacteria and for this reason all healthcare personnel involved in patient care should have a maximum length of 3mm for the end of their fingernails.

 

Cosmetics used on nails

 

Nail polish, base coats and top coats are three products that have similar chemical compositions.

 

Nail varnish is also known as polish, enamel and lacquer. Reactions to this product can include dermatitis (from components of the product like formalin/formaldehyde or nickel metal mixing balls), hives, and nail plate staining. Staining can be removed by cleaning the nail with hydrogen peroxide (see Donetta’s comments below) or it can be avoided by using a base coat. The occlusive nature of the polish can lead to overhydration of the nail resulting in a thinner and weaker nail. Chipped nail polish is a potential bacterial reservoir.

 

Base coats improve adhesion and prevent staining of the nail. Base coats sacrifice gloss and scratch resistance. Certain base coat preparations can also harden the nail due to the coating.

 

Top coats improve gloss and scratch resistance.

 

Nail polish removers contain solvents and dehydrate the nail, reduce corneocyte adhesion, and remove lipids- all of which contribute to brittleness of the nail. The preferred product for polish removal is one that contains a significant amount of water (17%), contain solvents such as lactones or dimethyl esters (adipic, glutaric, or succinic) and/or skin conditioners. Nail polish removers should only be applied weekly.

 

Cuticle softeners and removers work to soften or destroy the keratin in the cuticle.

 

Cuticle removers are designed to destroy keratin. These products contain potassium/sodium hydroxide or an alpha-hydroxy acid. The nails are prepped by a soak in soapy water. The remover is applied and left in place for two minutes before being washed off. The softened cuticle is then pushed back by being rubbed gently using an orange stick covered with cotton. The cuticular ridge should not be removed but can be shaved down with a V-shaped cuticle trimmer.

 

Cuticle softeners are designed to treat the eponychium and lateral folds. These products contain urea or an alpha- hydroxy acid. Daily use will virtually eliminate hangnails.

 

Nail hardeners and treatments can harden the nail using a coating (see base coat above) or by chemically altering the nail structure. Formalin/Formaldehyde preparations cause cross linking of keratin. Excessive use of these products increases the cross linking density resulting in a brittle nail. Additional changes to the nail or fingertip can range from mild to severe. A newer hardening agent on the market called dimethyl urea limits the hardening to just the surface of the nail, avoiding the potential for overhardening and a brittleness.

 

Artificial nails can take on one of three forms including sculptured (60%), molded on an ABS plastic tip (30%), and thin overlay on the natural nail (10%). The nail, its bed, and surrounding skin should be healthy prior to using artificial nails. Meticulous preparation of the nail including cleansing and antiseptic solutions is critical to avoid complications. Three different chemical methods are used to create and/or attach the artificial nail. The methods include methacrylate (liquid and powder), acrylate (usually ultraviolet/UV gels) and cyanoacrylate (wraps). The last method is to repair a fractured or torn nail. All of these systems have their various advantages and disadvantages- some of which will be highlighted below.

 

Methacrylate systems are less likely to cause allergic reactions. Allergic reactions can occur anywhere from 2 to 16 months after the first application. This method has the strong odor of organic solvents when being applied. Methacrylic acid can produce third degree burns. Any area of burning should be rinsed immediately with water. Methacrylate systems are easier to remove and acetone is the primary solvent. The nail has to undergo filling every two to three weeks at the lunula due to nail growth. Damage to the natural nail after 2 to 4 months is not unusual. If the nail becomes yellow or crumbly it indicates that the nail was applied and maintained incorrectly. Get a new nail technician!

 

Acrylate systems are more likely to cause allergic reactions. This system can’t be used on individuals taking photosensitizing medications as an ultraviolet light source is used to cure the gel. This system is essentially odorless. Excessive shrinkage of the gel can be a problem with this system. Gels degrade with light exposure and have to be removed every 3 to 4 months. Acrylate systems are difficult to remove and require the nail to grow out and then be filed or ground off with heavy abrasives.

 

Cyanoacrylate systems are used to apply plastic preformed nails and repair torn or fractured nails. This method is not as durable as the methods listed above. Most of the cyanoacrylate systems contain hydroquinone, another source for allergic reactions.

 

Remember, you are at an increased risk of bacterial and fungal infections due to the nature of artificial nail systems.

 

Heck with the technical stuff- I want to hear what Donetta has to say!

 

Like the skin, nails change as we age, becoming dull, dry, cracked and ridged.  Adding moisture back to the nail bed becomes more important. There are some moisturizers like jojoba oil, vitamin E and olive oil that moisturize the nail plate as well as the cuticle.  There are also commercial preparations like Solar Oil from Creative Nail that you can apply daily. 

I also advise to clients not to over cut the cuticle.  This is an important part of good nail health.  Just by keeping the cuticle moist and pushing it back with a rubber tipped cuticle pusher the nail will look neat and healthy.

 

Over the years I have been asked my favorite nail strengthener to use.  By far my favorite is Nailtiques Formula No. 2.  It contains protein, keratin, gelatin, and calcium.  It bonds the nail layers together for a strong finish.  I have also recommended a nail supplement called Apperex (contains biotin.)  I think it does a good job and it really helps the nails grow.  It is also is a very tiny pill making it easy to swallow.

 

Lastly this is the season for a sexy nude nail and some nail polish colors stain the nail bed making neutral polish hard to wear.  My recommendation is to remove the polish and lightly buff the nail plate with a buffer.  You can follow this by soaking in a hydrogen peroxide and water soak to remove the yellow staining.  I just use a tablespoon of peroxide and sit and soak during TV time. 

 

This also works on your toes as well.  

 

Zoya Nail Lacquer is the longest wearing polish with a Toluene and formaldehyde free formula and it comes in a variety of colors.

 

Common nail injuries and conditions

 

Traumatic injuries

 

Traumatic injuries to the nails except for the very tip of the nail require removal of the entire nail, examination of the nail bed and matrix, meticulous repair of any wound, and replacement of the nail or a false nail to act as a splint to promote the best chance at returning the nail and fingertip to its pre-traumatic state.

 

Infections

 

Fungal infections of the nails result in a thickened and discolored yellow nail. Diagnosis should include a culture as other disease states can mimic the appearance of a nail infected with a fungus. Treatment is prolonged (up to six months) and cure rates can be disappointing. Antifungals can affect the liver and one must consider the benefit versus risk in a patient over age 35. Intermittent pulse therapy of antifungal agents can improve appearance and symptoms but not affect a  cure.

 

Paronychia

 

This condition is an infection between the nail fold and nail. It is usually the result of dry skin, hangnails, trauma or disrupted cuticle. Treatment involves improving the health of the skin and draining any pus by disrupting the adhesion between the nail fold and the nail.

 

Ingrown nail

 

This problem is caused by biting nails or cutting nails back shorter than the nail fold. This causes the nail to dig in to the nail fold as it grows out. This can result in inflammation and infection. Early treatment can be as simple as cutting a V in the middle of the nail to weaken its arch and placing a small piece of cotton under the edge of the ingrown nail. If improvement is not seen in one week, see your doctor.

 

(reference used:  Baran, R., & Maibach, H. (2005). Textbook of Cosmetic Dermatology; United Kingdom: Taylor & Francis Group.)

 

That concludes our discussion of the specialized skin structure known as the nail. We hope you enjoyed the information.

 

Sincerely,

 

The Staff at Integrated Skin Solutions- “Where looking good is understood!”

 

7424 NW River Park Drive (Hwy 9)

Parkville, MO 64152-5028

816.505.5550 Fax 816.505.4550

www.integratedskin.com

Questions or comments- info@integratedskin.com