YOU & YOUR CLIENT

Your working environment, the preparation of the working area is very important for the comfort and safety of both the technician and their clients, and in order to comply with the legal requirements that ensure the working environment is a safe place for all. From a nail professional's point of view, it is important that every client is safe, but clients are in the environment for only a short period of time while technicians are exposed to many hazards during all their working hours. A thorough client consultation will help you to provide the best possible service for your client. 

Making a remedy into a poison

Here are two quotations for a very useful textbook that are relevant to this issue and are always worth remembering.
  • The Overexposure Principle. According to Doug Schoon this rule says, 'Every chemical substance has a safe and unsafe level of exposure. Simply touching, inhaling or smelling a potentially hazardous substance can't harm you. Exceeding the safe level of exposure is the danger you must learn to avoid.'
  • Paracelus, a famous 14th century physician, was the first to study and understand toxic substances. He said, "All substances are poisons; there is non which is not a poison. Only the right does differentiates a poison from a remedy." Over the last 500 years, the public has forgotten what Paracelus discovered. The Overexposure Principle is the modern-day interpretation of what he learned.' 
Paracelus is correct; everything is potentially a poison, therefore we must avoid the dose that makes the remedy into a poison. All products should have a Safety Data Sheet (SDS), available from the manufacturer or distributer. An SDS provides the information on things such as how to store the product, any specific hazardous ingredients, emergency first aid advice, possible routes of entry, how to deal with large spills, and similar advice. It is obvious that the chemicals that are considered a potential hazard on any SDS, or those that require a warning on their labels, are more likely to have a much lower does than other chemicals. But technicians are not in the position to know what the poisonous dose for each individual is for each of the chemicals. It is therefore far safer to assume that any dose is a potential poisonous dose to prevent any problems.
Further protection will be gained by following correct working practices, as described in this book, and also following the manufacturers' instructions on the use of the various products.
Safe working environment
Protecting you and your
clients and colleagues
Good working practices
Following manufacturers'
instructions
Safety
Good knowledge and
understanding

Allergies and overexposure

Two frequent queries or worries tend to be expressed by both experienced and new nail technicians. One of them concerns allergic reactions and the other is health and safety in the salon. There are some general rules that should be followed.
Allergies.
Allergic reactions and sensitivities can occur to anyone at any time. Unfortunately, this is a very common problem in an industry that uses a variety of chemicals every day. However, it need not be such a problem if good working practices are adhered to, such as practising strict hygiene and not letting artificial nail products touch any soft tissue.
  • Any individual, at any time, can become allergic to a particular product or food. It may be something that has been used for years or a few days but there is usually a warning that an allergy has developed, e.g. itchy skin, rash, headaches, etc. This happens when an individual has been exposed to too much of the product but every person's level of overexposure is different.
  • If a technician or client develops an unusual symptom. the most common one being an itchy rash on the hands or fingers, there is a likelihood that an allergy is starting. In the case of a technician, they must stop using the product or start wearing gloves and, in the case of a client, all the products must be removed immediately. Do not wait to see if it gets worse: it will!
  • If a client telephones you to tell you of a problem they have noticed ask them to come in to you as soon as possible. It is impossible to have a good idea of what the problem is without seeing it.
  • If these actions are taken quickly enough, the symptoms may go fairly rapidly. If not, the condition will worsen and the hands could become swollen and bleed, with the nail plate lifted and distorted. Obviously, the chance of infection at this stage is very high and will make the whole condition even worse. It is really not worth taking the chance of reaching this stage.
  • Once the product has been removed, the condition may disappear. If the client is willing, a different system could be tried, which may be successful. Top of the list is the liquid monomer in any acrylic system (or unreacted monomer that may be found in a sticky layer in a UV-cured system): an acid-based primer is corrosive so that could be the culprit if it has touched the skin; or sometimes it could be the nail adhesive. If a UV-cured coating was used it may be that the coating was uncured. Dust from shaping the product could be the culprit. Tis could also have an effect after removal of the coating where uncured product touches the skin.
  • If the condition does not go within a few days or if it seems worse after the removal of all products, the client or technician should get medical advice. It is important to remember that technicians are not medically qualified and should never diagnose any condition. Instant removal of products as soon as any reaction is noticed is the only safe course of action. Leaving it to see if it gets better is unacceptable and could result in legal action being taken against the technician and salon for negligence. To leave a product on a client knowing that it could be the cause of a reaction is negligent.
  • There is little point blaming the manufacturer or seeking recourse if timings go wrong. Correct labelling should have necessary warnings and a professional technician should be aware of how to use all products correctly amd safely. We know household bleach is corrosive and will burn skin and bleach clothes; whose fault is it when this happens with correctly labelled bottles?
Avoiding allergic reactions
Although allergies can be caused by just about any product, they are more common when providing nail enhancement services. Following simple working procedures will minimise the possibility for both the technician and their clients.
  • Keep the nail desk clean and free from dust.
  • Change the disposable towel between clients and several times during the service when dust is created.
  • Do NOT touch the liquid monomer on any skin:
       - Avoid the skin surrounding the nail during application.
       - Do not touch the brush with your fingers.
       - Do not have a patch wet with monomer where you have wiped your brush and then lean in it. 
  • Use ONLY the manufacturer's recommended lamp for all UV cured materials to ensure a proper cure. If the manufacturer says to use any lamp, they did not develop the product and do not know what creates a proper cure. Therefore any client is at risk in this situation.
  • When wiping away the inhibition layer on light-cured gels, start with the smallest finger and wipe from the cuticle to the free edge to avoid smearing uncured monomer onto the surrounding skin.
As nail specialists, it is important to be able to recognise various nail and skin conditions. There are many common conditions that do not prevent manicures or application of the nail enhancements, other that need special care and, less commonly, some that prevent any treatment altogether.
ALWAYS REMEMBER
Always remember the three key rules:
1. Nail professionals (manicurists, pedicurists and nail technicians) should only ever work on HEALTHY hands, feet and nails.
2. Professional technicians are not doctors or dermatologists and therefore should not diagnose a medical condition.
3. If there is any doubt about a condition, do not continue, but suggest the client sees a specialist. 
It is worth pointing out that if a client has an obvious medical condition of the skin or nails and is treated by a technician without an agreement from their GP or specialist, the technician's insurance can be void and he or she would be directly responsible for any claim against them should problems arise. Only work on healthy hands or feet unless you have been specific permission, in writing, from a medical practitioner.
Treatable nail conditions
These are conditions of the hands, feet and nails that do not prevent treatment, but an understanding of the condition is important as suitable care needs to be taken.
1. White spots: there are three common types.
   
  • Leukonychia: white spots in the nail plate. Some people are more prone to these than others and it can  depend on the client's occupation. If white spots are prevalent on most nails, there may be a systemic cause but, more commonly they are caused by minor  trauma injuries to the matrix, such as knocking. The spot is where inside the nail plate the cells are undeveloped or not fully keratinised in a small area. The spot will grow out but is likely to be a slight problem when it reaches the end of the nail, as it may peel.
  • White spots or areas on the surface of the nail plate. This is almost always due to some form of damage to the nail. It could be from over-filing weakening the nail, harsh removal of any coating, picking off nail coatings.
  • White superficial onychomycosis (WSO). This is more common on toes but can be seen on finger. It appears as a powdery looking or fuzzy surface. It is a fungal infection caused by a few different organisms. As suggested by the name, it is usually superficial and will grow out. It can be filed away if the nail is not thinned but any file that has been used on this condition is contaminated and should be thrown away.
2. Splinter haemorrhagee: tiny black streaks under the nail. Usually due to minor trauma and occasionally due to illness. They are splinter-shaped due to the forward growth of the nail plate. The will grow out.  
3. Beau's Lines: Horizontal ridges across the nail plate. These should not be confused with damage to the nail plate. They will noticeably be on all nails and are caused by internal health issue that continues around a month or more. The matrix will be forced to slow down for a period of time, creating interruption in the nail plate formation. They will return to normal when the client has recovered. 
4. Ridges: Beaded ridges are longitudinal lines with little bumps are usually associated with circulatory problems. Buffing them will thin the nail plate so should be avoided. You will also come across age related ridges usually noticed in older clients, again buffing cold thin the nail plate.
6. Lamellar dystrophy: This is peeling or flaking of the nail. This is normally caused by lack of moisture in the nail plate, chemical damage or minor trauma to the edge of the nail e.g. typing. It can be overcome by avoiding the above, regular use of cuticle oil, very gentle regular filing until the damaged area has grown out and keeping the edges sealed with a nail polish.
7. Onychophagy: This is nail biting. Frequent nail services can stop this problem, as the cuticle can be treated immediately to improve appearance and condition and that is often enough encouragement to stop the habit.
8. Furrows: These are longitudinal lines from matrix to free edge. A single furrow may be congenital or caused by injury to the matrix. Treat with care, as the furrow may be very thin. 
9. Blue Nails: Nails with a blueish tinge. Usually due to poor circulation or sometimes illness. The nails are often weak and thin. Hand massage and careful buffing will stimulate the circulation in the area. Artificial nails is not recommended if the nails are very thin as this will cause too much trauma to the nail.
10. Hangnail: A small tear in the cuticle or a sharp point on the side of the nail., usually due to neglect of cuticles or dryness. They can carefully be removed with a clean pair of nippers. The condition can be prevented by gently lifting the nail fold, when softened, from the nail bed and keeping it moisturised.
5. Onychorrhexis associated with a furrow: These are usually prone to splitting down from the free edge. This occurs when the matrix is permanently damaged at some stage. The nail plate grows slightly deformed and thinner in this area. If the damage is recent it may cure itself within a year. If the damaged part of the nail is prone to splitting, extreme care should be taken at the free edge as its very easy for infections to get into the nail bed. The best thing to do is keep this nail short with no free edge or it could be protected from splitting by a thin, light overlay.
12. Eggshell Nails: Thin, pale and fragile nails, usually curving under. Can be hereditary but can also be indicative of illness or medication. Treat very gently. 
13. Habit tic: A series of horizontal ridges down the centre of the nail. Caused by picking at the nail fold. Usually associated with a very large and exposed lunula. Advise the client of the damage being done, but do not try to buff out.
14. Koilonychia: Flat or spoon-shaped nails, which are thin and soft. Can be caused by an iron deficiency or excessive exposure to oils or soaps. Treat gently.
15. Pitting: Flat or spoon-shaped nails, which are thin and soft. Can be caused by an iron deficiency or excessive exposure to oils or soaps. Treat gently.
16. Pterygium: This is an abnormal condition where the skin adheres to the nail plate and is stretched by the nail growth. This usually happens as a result of damage to the area at the base of the nail and can also be seen under the free edge. Gently massaging oil into the area will help but never try to remove it. Avoid using solvent based products.
17. Psoriasis: A mild case of this condition is seen as pitting on the nail. The nail will be delicate and must be treated with care. A more severe condition can result in the destruction of the nail plate and should not be treated. 

1. Hyperhidrosis

This is an over activity of the sweat glands on the feet. If the condition is severe, then the client should be referred to a GP or chiropodist. The client should keep the feet clean and dry at all times and the use of a fungicidal foot powder may be helpful.  

2. Corns

This is a patch of hard skin often found on the side or top of the toes and usually caused by pressure from ill-fitting shoes. The surface of this can be removed during the hard removal stage of a pedicure, but if the corn is big and invading lower levels of the skin, the client should be referred to a chiropodist. 

3. Callus

These are similar to a corn, but over a larger area such as the heel or under the foot. 

4. Bunion

This is a misaligned toe joint. This can be really painful for your client so care must be taken when working in the area.

Treatable and untreatable conditions

11. Bruised Nail: Dark spots of blood under the nail plate. Avoid the area if painful, if there is pressure under the nail or the bruise covers more than a quarter of the nail. Otherwise treat gently, the blood will eventually grow out. 

1. Bacterial Infection

This is unfortunately a common condition seen during nail services. This is caused by an overlay lifting from the nail plate and bacteria entering. The warm, moist environment provides perfect conditions for the bacteria to grow. It is seen as an area that is discoloured. This starts as a faint yellow colour and can progress, if left untreated, to a very dark green. It will remain as a stain on the nail plate even after the bacteria has gone. If this is treated early it will not cause any long lasting problems. But, if left, it can eventually destroy the nail plate. This is caused by lifting of an overlay. To treat, remove nail products completely from the nail and throw away any buffers and files used. The dehydrate the nail. Now the environment does not support bacterial life. It is safe to reapply the overlay.

2. Onycholysis associated with nail services

Nail plates can be damaged by over-buffing and thinning the nail. They can also be damaged by improper removal of coatings and by the client picking off coatings e.g. gel polish. If the nail plate is thinned, Onycholysis can easily result. This opens up the bed to infection. This is easily avoidable by correct preparation, application and removal as well as good client education. 

Treatable and untreatable conditions

Skin conditions where restricted services can be offered