Keep clients suffering from Raynaud’s—a little-known condition that affects fingers and toes—comfortable during nail services.

The human body is a highly responsive instrument. When it’s overheated, it perspires; when it’s cold, it shivers; when it’s threatened, it releases adrenaline, which shifts the circulatory and nervous systems into overdrive. Although these responses are predictable, the fact is that not every body works the same. For some people, the physiological reaction to internal or external stimuli is exaggerated. Such is the case for individuals with Raynaud’s (ray-NODES) syndrome, a condition with which all nail technicians should become familiar. Primarily affecting fingers and toes, Raynaud’s causes these extremities to turn white or blue and become swollen, numb or tingly when exposed to certain “triggers”—typically cold temperatures or stress. While not disabling, Raynaud’s can cause pain that can be severe enough to affect quality of life, requiring sufferers to make lifestyle adjustments to limit exposure to their triggers. This is why it’s important for nail techs to know whether or not a client has Raynaud’s, and what to do—and what not to do—to keep that client comfortable throughout her nail service.

The Raynaud’s Mystery
First identified by French physician Maurice Raynaud in the mid-1800s, Raynaud’s is categorized into two types: primary, i.e., not associated with another underlying medical problem, and secondary, where symptoms of the condition are the first sign of an underlying autoimmune disease. The vast majority of Raynaud’s cases are the primary type, and thus what nail techs are most likely to see in the salon. According to Lynn Wunderman, chairman of the Raynaud’s Association, a national nonprofit organization that she founded in 1992, what occurs physiologically during a Raynaud’s attack can best be described in terms of the body’s “fight or flight” response. “When the body feels it’s in danger of extreme cold or stress, the blood vessels in the extremities shut down to send the blood supply to the body’s vital organs for protection,” she explains. “For a nonsufferer, this might occur at temperatures below 20 or 30 degrees Fahrenheit, or when someone puts a gun to their head. For a Raynaud’s sufferer, it can happen at 60 or 70 degrees, or after a really bad day at work.” At that point, the color changes and accompanying discomfort occurs. Although the primary signs and symptoms of Raynaud’s are easily identifiable, the syndrome’s origin remains a mystery. “Raynaud’s is considered a ‘phenomenon’ because the cause of the ailment remains unexplained,” says Wunderman, who herself has been diagnosed with the disorder. “We know that Raynaud’s occurs in all population groups, although it affects women much more often than men.” Wunderman reports that although researchers haven’t determined a specific genetic link for Raynaud’s, in many families more than one member has the condition. “It’s uncertain as to whether or not family connections are based on increased awareness of the condition among relatives or true heredity,” she adds.

Going on the Attack
Raynaud’s is not a well-known condition. Because of this, and the fact that it isn’t life-threatening and is rarely disabling, it goes largely undiagnosed. “Most people affected by the condition don’t even realize that their pain and discomfort have a medical explanation, so they don’t seek treatment,” says Wunderman. “Doctors often make the diagnosis based on the patient’s description of the color changes that occur suddenly after being exposed to cold temperatures.” It behooves anyone with symptoms of Raynaud’s to get a medical diagnosis. Although not common, complications stemming from Raynaud’s include digital ulcers and the potential for long-term damage to blood vessels. In extreme cases, “a sufferer may experience gangrene and lose a digit,” Wunderman warns. She notes that although there’s no medication to prevent or halt Raynaud’s attacks, certain calcium channel-blocking drugs have been clinically proven to decrease their severity and/or frequency, and topical antibiotics or nitroglycerin paste, gels or patches may help protect against infected skin ulcers. If Raynaud’s is suspected, a doctor will order a blood test to rule out a causative underlying disorder. If there is none, treatment consists mostly of lifestyle adjustments that involve avoiding exposure to cold temperatures, dressing warmly and managing stress. The Raynaud’s Association offers an additional piece of advice: Don’t smoke, as smoking narrows bloods vessels and can worsen Raynaud’s. Fortunately, the majority of Raynaud’s sufferers have a mild primary type, and commonsense measures are enough to keep them reasonably comfortable.

Nailcare That Comforts
Once you know that a client has Raynaud’s, there are several things you can do to help ward off an attack, so make sure to ask all new clients to fill out a health history questionnaire before their first service. But what if the client herself doesn’t know she has Raynaud’s? It isn’t the tech’s job to diagnose, but if you notice that your client has unusually cold hands, you should address it.“A technician needs to ask every client whose hands are freezing cold if she has asked her physician about them,” says Janet McCormick, MS, educator, author and co-owner of Nailcare Academy. She recalls a client with very cold hands who was frequently in pain, especially in the winter. “She thought it was arthritis,” says McCormick. “I continually gave her gentle suggestions about going to the doctor, and she finally went.” Sure enough, the client had Raynaud’s, and was grateful to McCormick for encouraging her to see her doctor.  According to Wunderman, there are a few things to consider when tailoring your nail service to someone with Raynaud’s. First and most obvious are the temperatures you introduce: Cold or cool soaks can trigger an attack, whereas paraffin treatments offer penetrating warmth. Also, think about safe ways to stimulate circulation. Wunderman suggests using products with ingredients containing L-arginine, a known vasodilator and circulatory stimulant, for example. Massage provides warmth, increases blood flow and promotes relaxation, but “gentle” is the operative word. “Do not massage the actual toes or fingers; rather, gently rub them—not between them—with lotion,” McCormick advises. Perhaps less obvious, but just as important, is supplying moisture to affected areas. “Keeping the skin moisturized can help avoid cracked skin, which can be tender and painful during and after a Raynaud’s attack,” Wunderman says. “Oil acts as a humectant that can help trap more heat in the skin, so oils could be beneficial.” McCormick always uses moist heat for these clients, even in the summer. McCormick has developed protocols for clients with Raynaud’s that she says have stood the test of time. “I always urge the client to run warm water over her hands for a few minutes while washing. Afterward, I wrap her hands in a wet washcloth and then lay a regular towel over them while they’re resting on a heating pad covered with a moist towel,” she says. “For both manicures and pedicures, I always perform a soak-less service, because water temperature is too hard to gauge. For pedicures, I clean the client’s feet with antibacterial gel using gentle massage and then place them on a heating pad covered with a moist towel, and then lay another towel over the feet. The service proceeds, with the hands and feet returned to the heating pad and covered between steps.” There aren’t any circumstances in particular in which you should turn away a client with Raynaud’s, but some concessions may be necessary. “If a sufferer has sensitive skin or ulcers, the process of cutting the nails or cuticles could be painful,” says Wunderman, though she adds that massage and paraffin does benefit sufferers.  At the end of the day, it comes down to nail techs using their instincts and experience to work with these clients. “If nail technicians are attuned to the symptoms, they can help by suggesting the best parts of the process and skipping some that might be troublesome,” says Wunderman. “That said, in general, most should be fine with the standard manicure.”

-Linda Kossoff

[Images: Courtesy of Getty Images]

This article was first published in the October 2018 issue of NAILPRO

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