Related Terms

• Ablation, acrylic nails, cotton balls, cuticle, cuticle oil, cuticle remover, emery board, finger brush, fingernails, fungus, hand lotion, hand towels, hot oil manicure, ingrown toenail, manicure, massage lotion, nail clipper, nail fungus, nail polish, nail polish remover, nail scissors, nails, paraffin, pedicure, podiatrist, tinea unguium, trimming.

Background

• Nail treatments are defined as the deliberate altering of the appearance or shape of the nails, typically for the purpose of cosmetic enhancement.

• Nails are the hard, horn like piece at the end of human fingers and toes. Deliberate alteration of the touch, feel, or appearance of the nail is called a treatment. Nails are often the subject of many types of treatments, including coloring, reshaping, dipping, and moisturizing. An individual who performs nail treatments is called a manicurist.

• The word manicure, defined as a treatment to improve the appearance of fingernails, derives from the Latin word manus meaning hand, and cura meaning care. Centuries ago in India, henna (a type of dye) was used for manicures. The word pedicure comes form the Latin words pes, which means foot, and cura, which means care. Pedicures - treatments to improve the appearance of toenails- have been traced back to ancient Egypt where a carving of a pharaoh's official was noted as representing pedicures and manicures.

• Other services for nails include the application of artificial nails such as nail tips, acrylics and artificial nail gels. A manicurist may also apply treatments to real nails, such as filing, polishing and painting. Nail treatment sometimes may involve cutting the cuticle, the small line of raised skin surrounding three of the nail's edges.

• Nail treatments do not appear to affect the physiological functioning of the people. However, nail treatments remain popular because of their cosmetic appeal.

Technique

• Trimming (adult): A nail clipper or a pair of nail scissors may be used. To smooth jagged edges, a nail file or emery board may be used. Fingernails are often trimmed straight across and slightly rounded at the top. Toenails do not need to be trimmed as often, and can be trimmed straight across. An individual can trim at home or go to a manicurist in a salon.

• Trimming (infant): Baby's nails are generally soft. Nail clippers or manicure scissors designed for infants are preferred to trim infants' nails, as the tips are rounded for safety. Using one hand to hold the baby's finger or toe and pressing the skin under the nail down and out of the way reduces the likelihood of a pinch or cut. Then, the other hand can be used to trim the nail and round off any sharp edges. For fingernails, it is typically recommended to follow the nail's natural shape. Toenails are most often trimmed straight across. When all nails are trimmed, any rough edges can be smoothed with a soft emery board.

• Manicures: In a salon, a manicurist prepares for a customer by ensuring that the working area and tools are sanitized and conveniently located. This might include sanitizing the tabletop, placing clean metal implements into a jar with sanitizing liquid and having sanitized towels available. Some tools, such as emery boards, are not reused. Soaking liquids are not reused, and all water used can be boiled or otherwise sanitized. These preparations prevent the possible spread of disease. Proper lighting is also important. There are a wide variety of services available from manicurists and each manicurist might have a specialty. A manicurist's tools generally include nail clippers, cuticle clippers, a cuticle pusher, nail file/emery board, nail polishing board, nail scissors and finger brush. Supplies used may include a cuticle remover, cuticle oil, massage lotion, nail polish (base coat, color polish, top coat or sealant), nail polish remover or nail polish remover wipes, hand lotion, sanitizing spray/towels, cotton balls/pads and hand towels. A standard manicure usually includes filing and shaping of the nails and the application of polish. Some specialty manicures, such as the French manicure, may also be offered. Other manicures may include painting pictures or designs on the nails or applying small decals (decorations) or imitation jewels. Manicures usually take no more than an hour and may cost $10 - $60. Manicures can also be performed at home.

• Pedicure: Pedicures are nail treatments to improve the appearance of toenails. The tools used in a pedicure include towels, cotton balls, toenail clippers, lotion, cuticle cream, cuticle pusher, acetone, antibacterial soap, footbaths and white block buffer. Most pedicures include cuticle nipping, washing nails in a footbath with warm, soapy water, shaping the nails, and polishing the nails. Pedicures can be performed at home.

• Hot oil manicure: Hot oils are a unique treatment, which cleans, neatens, and softens the cuticles. The procedure generally lasts an hour. During the treatment, the hands are soaked in oils designed to moisturize the cuticles, nail beds, and fingers. After this nail treatment, most individuals receive a manicure.

• Paraffin treatments: In this method, the hands may be dipped in melted paraffin or wax as a proposed way to draw out toxins and smooth skin. Practitioners apply heat to relax the skin and make it more able to absorb lotion, which is sometimes rubbed on the hand before being placed in the paraffin. The hand is usually dipped more than once to allow a thicker wax coat to form in order to make the coating stay warm for longer and less likely to break or tear too soon. After the hands have been dipped in the wax, they are wrapped in either plastic or tin foil and then covered with cloth to retain warmth. The hands remain covered in paraffin until the substance returns to body temperature. The paraffin is then peeled off.

• Fungal nails: Nail polish, nail wax, and artificial nails may all trap fungus. Toenails are more likely than fingernails to harbor fungus because this organism thrives in dark, warm environments. Nail fungus may have a yellowish, greenish, or even brownish appearance. Whitish spots on the nails may indicate a fungal infection. Often, the nails are brittle and have uneven edges. The nails may have an irregular surface or edges. The nails may appear unusually thick. The skin around the nails may be red. The most common type of fungus that infects human nails is called tinea unguium. Treatments may vary, depending on the nature and severity of the infection. A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid anti-fungal agent. A podiatric physician can detect a fungal infection early, culture the nail, determine the cause and suggest a treatment plan, which may include prescribing topical or oral medication and debridement (removal of diseased nail matter and debris) of an infected nail. Newer oral antifungals approved by the Food and Drug Administration (FDA) may be the most effective treatment. These medications include Itraconazole (Sporanox®), Ketoconazole (Nizoral®), Fluconazole (Diflucan®), and Voriconazole (IVfend®). They offer a shorter treatment regimen of approximately three months and improved effectiveness compared to topical products. Tea tree oil has also been used as an antifungal agent, however more well-designed trials are needed to make any recommendation regarding its efficacy. In some cases, surgical treatment may be required. Nail treatments such as manicures, are not recommended for nails with fungal infections.

• Ingrown nail: When the problem is mild, soaking the affected hand or foot in warm water for 15 to 20 minutes and placing a dry cotton ball under the corner of the nail is recommended. Signs that an ingrown toenail is not healing include increased pain, swelling and drainage of the area. Sometimes minor surgery may be needed to remove the part of the nail that is growing into the skin. A qualified doctor will first numb the toe by injecting it with an anesthetic. Then he or she will cut the toenail along the edge that is growing into the skin and pull out the piece of nail. A small electrical charge or a liquid solution may be applied to the exposed part of the nail bed. This keeps the toenail from growing into the skin again. This part of the surgery is called ablation and is done at the discretion of a qualified doctor. Following surgery, soaking the foot in warm water daily is recommend along with applying an antibiotic ointment to the affected area at least twice a day and keeping a bandage over it until it heals. Nail treatments are not recommended for individuals with ingrown nails.

• Most manicurists go through a training program, and must receive certification from the local municipal government. Qualified healthcare professionals typically treat fungal infections of the nail or ingrown nails. However, there are products on the market that consumers can purchase for treatment of mild fungal infections at home.

Theory/Evidence

• Living skin cells within the fingers and toes produce nails, which are primarily composed of keratin, a hardened protein also found in skin and hair. The nail consists of several different parts including the nail plate, nail bed, matrix (hidden area under the cuticle), lunula (part of the matrix at the base of nail), cuticle (tissue that overlaps the nail) and the nail folds (skin framing the nail). In addition to having a cosmetic appeal, nails provide several important functions. Fingernails and toenails protect the sensitive skin underneath. Fingernails aid in the gripping of objects, and they also scratch.

• The average growth rate for nails is 0.1mm each day; individual rates depend on age, time of year, activity level and heredity. On average, nails grow about one tenth of an inch (2.5mm) each month. At that rate, it can take from three to six months to completely replace a nail. Fingernails grow faster than toenails. Nails also grow more rapidly in the summer than in the winter. Nails on a person's dominant hand (right vs. left) grow faster. Men's nails typically grow more quickly than women's nails. Disease, hormone imbalance (caused by pregnancy or other conditions), and the aging process may affect nail growth. For example, yellow or green discoloration in nails may result from a respiratory condition such as chronic bronchitis or from swelling of hands (lymphedema). Indentations that run across nails, called Beau's lines, appear when growth at the area under cuticle is interrupted. This might occur because of an injury or severe illness, such as a heart attack.

• Manicures and pedicures are most often recommended for primarily cosmetic purposes. Currently, available research regarding the safety and efficacy of nail treatments is lacking, most likely because such treatments are not considered necessary to keep nails healthy, and are not thought to treat any nail condition. Most nail treatments deal with only the most external portion of the nail and surrounding skin.

Safety

• Allergic reactions are the most common complication from nail cosmetics. Symptoms may include burning, stinging or itching. A person may have an allergic reaction (contact dermatitis) to components of acrylic nails or the adhesives used to apply them. This usually results in some redness and peeling of the skin around the nail. If peeling is excessive or persists despite the use of moisturizer on the affected skin, consult a dermatologist. The most common allergens in nail cosmetics are methacrylate (MMA) compounds in acrylic nails, toluene sulfonamide formaldehyde resin in nail lacquers, and formaldehyde in some nail hardeners.

• Most experts do not recommend cutting the cuticles.

• In many areas, manicurists are regulated and must be licensed.

• There is a risk of infection when tools are used on multiple people and not properly sanitized. Disinfect instruments used to cut nails or perform home manicures and pedicures.

• Sometimes a gap develops between the acrylic nail and the natural nail. For example, if the acrylic nail is bumped or jarred, it may separate from the natural nail. This gap provides a moist, warm environment in which bacteria and fungus can grow. If such an infection occurs, the natural nail may become thickened and discolored and should be evaluated by a dermatologist or qualified health professional.

• Some nail conditions may be harmless. These may include vertical ridges, which may become more pronounced with age. White lines or spots may indicate fungal infection, or they may simply result from injury to the nail plate or nail bed. Consult with a qualified healthcare professional and dermatologist before making any decisions about health conditions.

• Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails.

• Avoid application of polish to nails suspected of infection. Such areas may appear red, discolored, or swollen.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. American Academy of Dermatology. 7 June 2006. www.aad.org

2. American Podiatric Medical Association. 9 June 2006. www.apma.org

3. Dombrowski NC, Lloyd JR. Nail changes induced by application of a callus eliminator during a manicure. J Am Acad Dermatol. 2005 Jan;52(1):E4. View Abstract

4. Johnson IL, Dwyer JJ, Rusen ID, et al. Survey of infection control procedures at manicure and pedicure establishments in North York. Can J Public Health 2001;92(2):134-137. View Abstract

5. Karabagli Y, Kose AA, Cetin C. Toe necrosis due to a neglected tourniquet. Plast Reconstr Surg. 2005 Dec;116(7):2036-7; author reply 2037-8. View Abstract

6. Labreche F, Forest J, Trottier M, et al. Characterization of chemical exposures in hairdressing salons. Appl Occup Environ Hyg. 2003 Dec;18(12):1014-21. View Abstract

7. Mriano A, Mele A, Tosti ME, et al. Role of beauty treatment in the spread of parenterally transmitted hepatitis viruses in Italy. J Med Virol. 2004 Oct;74(2):216-20. View Abstract

8. Vugia DJ, Jang Y, Zizek C, et al. Mycobacteria in nail salon whirlpool footbaths, California. Emerg Infect Dis. 2005 Apr;11(4):616-8. View Abstract

9. Winthrop KL, Abrams M, Yakrus M, et al. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med. 2002 May 2;346(18):1366-71. View Abstract