Cosmetically Induced Nail Diseases - Identification and Management

Introduction:

In ancient times, nail cosmetics were made from natural ingredients like henna, flowers, and wax. But the cosmetics used in our daily life have a lot of chemicals added to improve the product consistency and esthetic appearance. These chemicals are usually checked for quality and safety before marketing, however, sometimes they may lead to some diseases affecting the nails. Not only the chemicals in cosmetics but also the other nail grooming procedures lead to certain nail diseases.

What Are the Chemical Components Causing Nail Disorders?

Each nail cosmetic contains different chemical components leading to some adverse effects. They are,

• Nail polish contains nitrocellulose, formaldehyde, butyl stearate, and dibutyl phthalate.

• Nail polish remover contains gamma-butyrolactone.

• Nail adhesive contains methyl acrylate.

• Acrylic nails contain methacrylate and benzoyl peroxide.

• Gel nails are cured using ultraviolet light, which can also lead to adverse effects.

How Are Nails Affected Due to These Chemical Components?

• Contact Dermatitis of the Nails: It occurs mainly due to nitrocellulose and formaldehyde content in nail polish. It is also due to methacrylates in nail adhesives and acrylic nails. It commonly involves the proximal nail fold and the hyponychium. Since the proximal nail fold is involved, it leads to onycholysis which means detachment of the nail plate from the nail bed. The involvement of hyponychium may further lead to splinter hemorrhages below the nail bed. Since nail polish removers contain a high solvent concentration, they cause stripping of the nail enamel from the nail plate.

• Paronychia: It is an inflammation of the skin around the fingernails. It is characterized by a painful swelling around the nails which is due to abscess formation in the nail fold. Paronychia is found to be followed by contact dermatitis. This is the bacterial build-up after dermatitis actually leads to the infection which on further progression forms an abscess around the nail bed. This is mainly due to formaldehyde in the nail polish.

• Nail Dystrophy: It is characterized by distortion and discoloration of the nail. It involves mostly the nail bed, nail matrix, and the surrounding skin. It is found to be due to methacrylates and acrylates in nail cosmetics.

• Brittle Nails: They may be due to excessive exposure of the nails to the solvents and chemicals in the cosmetics such as nail polish removers and cuticle removers, leading to dehydration.

• Paraesthesia and Nail Loss: The sculptured nails contain acrylates which cause paraesthesia and eventually lead to nail loss.

• Allergic Reaction: The adhesive used to place the artificial nails also contains some chemicals which often lead to allergic reactions characterized by redness, swelling, and pus discharge around the fingernails.

How Are Nails Affected Due to the Nail Grooming Procedures?

• Cuticle Trimming: Cuticles are cut and hanging nails can occur which are very painful. A cuticle is a part that seals the space below the proximal nail fold. If the cuticle gets damaged, it paves the way for infectious pathogens to enter thereby causing paronychia.

• Cuticle Softener: Using these cuticular softeners can lead to chemical burns around the proximal paronychial fold.

• Clipping Nails: If nails are being clipped when dry, it leads to onychoschizia where the nails split horizontally including the keratin layer.

• Non-sterile Instruments: The use of such instruments can lead to bacterial, fungal, and viral infections.

• Unclean Pedicure Tubs: This also may lead to contamination of the infectious organisms in the tubs and cause entry into the nail leading to abnormalities.

• Long Nail Extensions: This may lead to fracture of the nail plate and tearing of the nail bed.

• Repeated Use of Nail Polish and Nail Polish Remover: This practice leads to the staining of fingernails and onycholysis. This also leads to keratin granulations on the nails which simulates onychomycosis which is a fungal infection of the nail characterized by thickening and discoloration of the nail bed. These keratin granules are due to repeated application of nail polish without removal of the previous coatings.

• Buffing of the Nail Plate: Over buffing of the nail plates usually leads to the weakening of the nails representing hapalonychia which is the thinning of the nail plate.

• Repeated Manicure: This can lead to brittle nails and follow by cracking.

How to Identify Allergy to Nail Cosmetics?

To identify the compatibility of the individual to the cosmetics, a patch test will be conducted with the different products that are going to be used by the individual. The patch test involves the application of the product on the elbow or on the back and leaving it for 24 to 48 hours and checking for any reaction. If any reaction redness or irritation occurs, then the individual is advised not to use the product.

How to Manage Nail Cosmetics Problems?

• For paronychia characterized by swollen nail folds, use topical corticosteroids.

• Avoid cutting cuticles and if any yeast formation is noticed, apply antifungal ointment.

• Check whether the tools used for manicure and pedicure are sterilized before use or take sterile instruments to the salon.

• Keep nail extensions short to prevent fracture of the nail plate.

• Do not over file the nails.

• Avoid using nail cosmetic products with harsh chemicals.

• Do not use nail polish remover often because it may lead to fragile nails.

• Avoid applying nail polish over the previous coating because it may lead to keratin granulations on the nail bed.

• Do not have long nails or long artificial extensions as they may house some pathogens.

• Do not bite the nails to prevent the entry of pathogens into the systemic circulation.

Conclusion:

As nail cosmetics, besides providing attractive nails, also have some adverse effects. These effects are usually noticed in technicians working with these products on a regular basis. It is important that they take patch tests for the ingredients in the products and then start using on the customers. To be on the safer side, a patch test can be performed on every individual visiting the salon to overcome the invisible harmful effects behind those attractive nails.