PORTLAND, ORE. — Cosmetic nails are here to stay, so physicians would do well to learn about the glittery accessories driving a $6.8 billion a year industry, Dr. Phoebe Rich said at the Pacific Northwest Dermatological annual scientific conference.
“Nail cosmetics are not inherently dangerous,” the Portland, Ore.-based dermatologist stressed. “They're used by millions of women who really don't have any trouble at all with them.” However, when trouble does brew beneath the bright, rock-hard surfaces of acrylic nails, it can be nasty.
Dr. Rich offered these tips on nail cosmetics complications:
▸ Allergic reactions. Many allergens are involved in the process of creating artificial nails, but the site of the reaction will often reveal the source of the problem, she said.
Patients whose itching and burning is centered in the periungual and subungual regions probably have an acrylic allergy. “This material polymerizes very quickly, in less than a minute,” she said.
The allergen is basically trapped at the site where it is applied.
Enamel nail polish, on the other hand, may continue to induce dermatitis until the substance fully dries, which may take up to 48 hours. You may see reactions anywhere the patient's fingers touched: on the face, neck, or eyelids, for example.
Dr. Rich noted that a host of sensitizing agents are available in nail products that can be purchased at the local drugstore, not just in professional salons. An example is formaldehyde, an ingredient in Nail Magic, a nail hardening product that is not supposed to come in contact with the skin, but does, of course.
Many upscale nail salons are replacing highly allergenic materials with more expensive, less durable alternatives in response to customer allergies, she said.
▸ Irritant reactions. Nail polish remover containing acetone or acetate is the No. 1 culprit in drying out the nails, causing brittleness, fragility, onycholysis, paronychia, and friable keratin granulations.
There is a new alternative available over the Internet for sensitive patients: a water-based nail enamel that avoids the need for nail polish remover, since it peels off the nails or can be taken off using ethyl alcohol.
The nail colors sold at www.naturellacosmetics.com
▸ Trauma. “Women who are the most successful at using acrylic nails keep them short,” Dr. Rich explained.
“A long nail acts as a lever,” prying the rigid artificial nail off the nail bed, just as it did when one of Dr. Rich's patients caught her nail in the hinge of a lawn chair.
A natural nail, by contrast, is flexible, and would bend or break in such a scenario.
▸ Infection. The vivid, nearly impenetrable nail colors painted on cosmetic nails can hide all manner of infections, from “red-hot staph infections,” to onychomycosis “teeming with yeast.”
One problem is disruption of the cuticle with “clippers, drills, and all these little implements that they use to poke and prod and scrape.”
A word to patients to “nurture your cuticles” could help to avoid problems that arise because when aggressive cuticle trimming provides access to organisms that thrive in the moist, dark, warm place underneath the nail.
Infection sources in nail salons are reused files (which cannot be easily sterilized) and improperly cleaned pedicure tubs, which can incubate bacteria that find hospitable hosts in each pair of newly shaved legs that dip into the warm water baths they contain.