Barrier Breach: How To Prevent Paronychia in Your Nail Salon

Apr 6th, 2022

As every nail tech knows, the cuticle serves as the security force protecting the nail, nail folds and underlying skin. When that secure barrier is breached, often due to picking or biting at dry skin around the nail, bacteria can sneak in and plant a flag of infection.

Although nail techs should never offer clients medical advice, here are health experts’ advice for people at risk for this type of infection:

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This infection is called paronychia, a very common salon client hazard that can make the area around a client’s nail red, swollen and painful to the touch. It is important to learn how to identify it, what to do when you see it, and especially crucial, how to avoid giving it to a client.

Infection ID

Paronychia is one of the most common infections of the hand, causing inflammation in the proximal nail fold (PNF). Acute paronychia can come on fast, showing symptoms within days or even hours, and last for up to six weeks.

Whereas the acute type is typically caused by a bacterial infection, chronic paronychia also can stem from a fungal, or much less commonly, viral infection. Chronic paronychia frequently occurs among people in certain occupations that require them to put their hands in water often, such as bartending or dishwashing. In addition to water, which over time can cause a break in the nail fold seal, housekeepers, florists, bakers and swimmers are commonly exposed to irritants such as acids and alkalis that can lead to the development of chronic paronychia, according to an article published In the journal American Family Physician. The chronic type of infection lasts six weeks or longer, and in addition to its occupational link, can develop from the use of certain medications or in people with immunity-related health problems such as diabetes or HIV infection.

“Acute paronychia is a bit more obvious,” says Philadelphia board-certified dermatologist Erum N. Ilyas, M.D., FAAD. “It presents as a painful, tender, swollen nail fold that may even start to seep or drain. The swelling can even apply pressure to the nail, resulting in flattening of the nail plate or separation from the nail bed.”

In addition, paronychia can cause horizontal ridges to form on the nail plate. Because the nail plate is growing through a chronic inflammatory state, it affects the strength of the nail plate, and therefore tends to break or peel easily, she says.

Causes and Prevention

Clients at higher risk for paronychia, such as people with diabetes or whose jobs require them to have their hands in water frequently, might have extremely dry skin and cuticles. Patients with paronychia commonly complain that it is hard to keep from peeling or picking the dry skin around their cuticles, Ilyas says. Trauma or manipulation of the skin around the nail fold opens the door to bacteria, leading to infection. Ingrown toenails can lead to paronychia on a toe.

Hazards lurk at the nail salon as well: Overzealous cuticle removal, snipping and pushing by nail techs can remove the barrier that keeps bacteria from getting in, setting the stage for infection. Inaccurate or poor filing down the side of a nail can leave a hangnail that can lead to infection if the client starts picking at it, says nail tech, educator and author Janet McCormick, co-founder of Nailcare Academy in Fort Myers, Florida.

If a client comes in with inflamed, red and irritated skin around the nails of the hands or feet, “Do not work on them,” McCormick says. The Environmental Protection Agency’s best practices for nail techs advises refusing service to clients with any signs of infection or broken, irritated skin.

If you suspect you might have cut or pushed a client’s cuticle back too far during a service, play it safe by cleaning the area and not applying product. Continuing the service could expose skin to dust or other irritants and cause an infection. Take extra care with clients who are chronic nail biters or pickers or have a job that can result in dry skin and hangnails, because they are more prone to developing paronychia.

Ilyas echoes McCormick’s advice.

“If the nail fold is tender to touch, swollen or draining, it is best to not treat a client and refer them to their doctor for treatment,” she says. “The risk of worsening the infection, spreading it to your workstation or contaminating your instruments make it important to ensure treatment occurs first.”

Plus, you do not want to be taken to small claims court for negligence if a client can persuasively tie their infection back to your service.

Treatment

Health professionals can diagnose paronychia by examining it, but they might send a sample of any pus present to a lab for analysis. If the infected area is inflamed, but there is no pocket of pus (called an abscess), warm compresses or soaks of 10 to 15 minutes long several times a day can help reduce swelling and pain.

“The best approach is to reduce the pressure building up in the digit from the nail pressing on the skin by decompressing it and/or draining it, as needed, and perhaps removing part or all of the nail,” says Bruce Pinker, M.D., a board-certified podiatrist and specialist in foot and ankle sports medicine and diabetic foot care in upstate New York.

“I find soaking the digit afterwards in Epsom salt soaks or Domeboro powder soaks is very helpful in helping the toe to heal properly.”

After soaking, Pinker also recommends applying antibiotic cream and taping gauze over the infected digit (finger or toe). Doctors might prescribe a topical or oral antibiotic if draining and soaking are not clearing up the issue.

Ilya’s go-to treatment for chronic paronychia is a combination of prescription topical steroids and antiyeast creams for three months, “the time it takes for the nail to grow beginning to end,” she says.

It can be difficult or even uncomfortable to turn away a client whom you suspect has paronychia or to stop a service if you fear you have breached the cuticle barrier. But, it is important to resist the urge to please—for your client’s safety and yours.

“Many of my patients seek nail treatments to mask the effects of the paronychia on their nails, sometimes without realizing they have this diagnosis in the first place,” she says.

Ilya recommends patients take a break from nail treatments for 90 days to let their nail and nail fold heal.

“Then a return to the nail salon is permitted with one caveat—do not remove the cuticle for treatments,” she says. “Leave the cuticle in place, and allow it to play its role to protect the nail fold.”

Tips for Paronychia Prevention
Although nail techs should never offer clients medical advice, here are health experts’ advice for people at risk for this type of infection:
Do not bite or pick at nails or cuticles.
Protect hands from exposure to water and chemicals on the job by wearing gloves, preferably with cotton lining.
Trim toenails straight across about once a month, and do not cut them too short.
Do not trim cuticles or use cuticle remover on clients prone to infections.
Source: Icahn School of Medicine at Mount Sinai, https://www.mountsinai.org/health-library/diseasesconditions/paronychia

About the Author

Virginia Pelley is a freelance writer and editor based in Tampa, Florida.