Fungal nails?

[Planky1]

I had a client this morning where I had to not do her pedicure as I suspect quite a bad case of fungal nail infection. This is the first time I've actually ever had to refuse to do a treatment and I suggested to her to go to her GP to get it checked out.

But I guess I'm just after some reassurance that I did the right thing and my suspicions could be correct?

All her toes were quite yellow but both big toes even more so. I have yellowish big toes so I know this can be down to trauma or not using base coats with polish etc.
But in particular her left big toe nail is almost completely detached from the nail bed and if you tap on the nail it sounds hollow.

Also with this nail, if you are looking at the underside of the nail, the only way I can describe it, is there looked to be scrolls of flesh I guess, so lines of curled up soft tissue if that makes any sense? Sorry, struggling to describe it.

I couldn't take a picture and can't find an image of anything like it online to give as an example either.

She was adamant that her toes were fine, they've been like it for years but I stood my ground and said once she's been to her GP and had it checked out, if all was ok then we could re-arrange her appointment.

Was I right do you think?

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[ChicUnique]

Hi planky, I've never actually seen a fungal nail so I'm not sure, I just wanted to say that my big toe sounded similar to that, hanging off and yellow and mine were caused by ingrown nails being removed and grew back funny, my right toenail was disgusting to look at but according to my gp there was no fungal there (I've since had it removed),
But I think you did right in sticking to your guns and referring her to her gp when you weren't sure, I would of done the same xxx

 

[Papillion]

I think you did the right thing. Hard to tell someone you cant do a treatment though.

My mother and gran have both had it. They went to their GP's who diagnosed it.

It looked crumbley and was sort of splitting. The nail was very soft and yellow/browny and lifted off the nail bed. The general photos on google images look a bit extreme to what it actually looked like on them.

 

[Planky1]

Her nails were not soft or splitting but brittle and like I say, the worst one sounded hollow.
She was adamant there's no fungal infection and that they've been this way for years but something has caused them to go this way? Could it just be trauma from ill fitting shoes as she insists?

Having only seen example images in my training years ago of fungal infections and online, it's very hard in practice to know whether it is or isn't, well, when you're not used to it that is. I'm sure longer serving geeks could spot whether it is or isn't just by looking but I've never had someone with one to see.

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[StephR]

Yes most definitely did the right think honey. It is hard telling clients no and referring them to the doctor but it's the best thing to do.

It sounds very much like a fungal infection to me even if she did say she it's been like it years.

Xx

 

[vickieg29]

I think it sounds like you did the right thing..

I had a lady who normally has waxing enquire about having UV gel polish done next week, but she said she normally has problems with lifting when she has it done elsewhere due to her one "fungal nail" :s
Should she text me and want them doing, I think i'll have to politely refuse until it's checked out....

better to be safe than sorry x

 

[user 65838]

Sounds a lot like my Husband big toe nail he has had an ingrown toe nail removed and the nail has now got fungal infection its yellowy thickened and layering

 

[elainel]

Fungal nails can present in a few different ways depending upon the micro-organism, commonly a coffee/yellowy coloured discolouration spreading downwards from the free edge, the nail tends to be thickened and in extreme cases can be crumbly. It can also be white superficial discolouration which spreads over the whole nail plate, and tend to be thickened and crumbly.

Currently the GP's in my area tend to do very little about a fungal nail because it is seen as a 'cosmetic issue' rather than a medical one, even in the case of diabetics. It is notoriously difficult to treat.

The treatment options are:

a) see the GP anyway, they might get lucky with a prescription for an oral tablet or a topical medication.

b) do nothing, there is a risk it may spread to other nails but ultimately it is not life threatening.

c) use a topical medication to paint onto the nail, expect to do this DAILY for at least a year. (some medications are now weekly). Expect to pay around £20 for a 3 month supply.

d) consider using tea tree oil on the nail (with the usual precautions against essential oil use, eg pregnancy), considered by some to be absolutely useless and others a miracle cure, again a daily application for at least a year, but a darn sight cheaper.

Elaine

 

[Planky1]

Fungal nails can present in a few different ways depending upon the micro-organism, commonly a coffee/yellowy coloured discolouration spreading downwards from the free edge, the nail tends to be thickened and in extreme cases can be crumbly. It can also be white superficial discolouration which spreads over the whole nail plate, and tend to be thickened and crumbly.

Currently the GP's in my area tend to do very little about a fungal nail because it is seen as a 'cosmetic issue' rather than a medical one, even in the case of diabetics. It is notoriously difficult to treat.

The treatment options are:

a) see the GP anyway, they might get lucky with a prescription for an oral tablet or a topical medication.

b) do nothing, there is a risk it may spread to other nails but ultimately it is not life threatening.

c) use a topical medication to paint onto the nail, expect to do this DAILY for at least a year. (some medications are now weekly). Expect to pay around £20 for a 3 month supply.

d) consider using tea tree oil on the nail (with the usual precautions against essential oil use, eg pregnancy), considered by some to be absolutely useless and others a miracle cure, again a daily application for at least a year, but a darn sight cheaper.

Elaine

Oh my word, so she wouldn't be able to have anything done to her feet for a year? That will go down well......

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['chelle]

I think you did the right thing. From the symptoms you described I would have suspected fungal nail infection too.

I had a fungal nail infection in one of my toenails for a very long time that wouldnt go away with the paint on remedies, and the doctor prescribed me oral medication which worked extremely well. It does take a long time to go though, it was about 10 months before my nail was completely clear

 

[StephR]

Oh my word, so she wouldn't be able to have anything done to her feet for a year? That will go down well......

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Ive had a fungal nail infection which was on both my little toes, big toe on the one foot approx 1/4-2/4 of the nail and a few other nails. I had it for a long time before I got fed up and went to the doctors. They put me on antibiotics. Took me 6 months for it to grow out and doctors then decided to take me off of it because it had gone. Unfortunately my little toe nails are now very thick and bumpy but doctor has assured me that there is no sign of fungal infection there anymore. She seems to think wearing shoes that rub is what is actually causing my little toe nails to look like this. I wore open toe shoes as much as possible (went to doctors in early spring so was easy) and was told not to wear polish etc.

Your client may be lucky and she may get rid of the infection very quickly if her nails grow fast. You did the right thing refusing to treat her so dont feel badly about it. xxx

 

[Planky1]

Thank you for all your replies. This has got me thinking about different scenarios so just putting them out there....

1) If a client had a nail as described but had told me she had already had it checked and it was fine, would you go ahead? If not, what would you say, that you want written proof? Or would you take the clients word? (Am thinking of a scenario where this client may come back saying all is well but how will I know if she is telling the truth?)

2) You saw the nail but felt it wasn't fungal and was merely from ill fitting shoes and went ahead with the treatment. Would you? How do you know the difference when sometimes yellowing/lifting of nail from nail bed can be caused by trauma? Is it a case that we should ALWAYS refuse to do a Pedi/Mani if we see yellowing of the nail until we get the all clear from their GP?

This is one of the reasons why I would have loved for there to be a contra-indication Science topic, I have seen pictures in my training and online as stated in my original post, of general examples but I want to feel confident when assessing feet in the future that yes, it's highly probable that IS a fungal infection or no, she just has awful nails caused from years of wearing shoes too tight or trauma caused from injury etc

I hate not knowing!!

 

[Envy]

I've actually ever had to refuse to do a treatment and I suggested to her to go to her GP to get it checked out.

All her toes were quite yellow but both big toes even more so. I have yellowish big toes so I know this can be down to trauma or not using base coats with polish etc.
But in particular her left big toe nail is almost completely detached from the nail bed and if you tap on the nail it sounds hollow.

Also with this nail, if you are looking at the underside of the nail, the only way I can describe it, is there looked to be scrolls of flesh I guess, so lines of curled up soft tissue if that makes any sense? Sorry, struggling to describe it.

Hi Planky - sorry I didn't have time to reply earlier - as mentioned there are many reasons for yellowing of toes nails - most are 'safe' to work over.. Especially as they can grow so slowly..

What you have described sound to me more like very unloved nails that have indeed been traumatised - the skin you describe underneath sounds like a lot of sole horn - when onycholysis occurs the bed epithilium stays stuck to the plate and can also plump up on the nail bed - this is usually due to all the moisture trapped inside shoes...

Fungal infections are actually quite rare ... I have personally only ever seen a handfull of cases that were diagnosed as fungal infection..

The general 'tell' for infection is the nail becomes very thick, layered, crumbly and often a milky colour
Of course there are many other types of infection that may be present (as mentioned in an earlier post where the surface becomes white and mottled - but again, this is rare..)

I would always say, if you think it looks suspect - get a second opinion from someone who is qualified to identify it - and even better is having a culture done to pinpoint the exact cause pathogen.
If a culture is not done, the chance of actually dealing with it properly is very slim...
Topical medication is limited in it's effectiveness and if the infection is actually 'in' the plate then topical will NOT get rid of it - the client will need targeted medication for the particular strain or type of infection...

Personally I am confident with most near any condition nail - because I have researched and worked alongside many doctors over nail conditions - I would ALWAYS treat anything suspisious looking as though it was a risk and not use the same tools/files on any other toe or clients and ALWAYS thoroughly disinfect every surface after the client...

Please see disclaimer at bottom of this post regarding liability

Thank you for all your replies. This has got me thinking about different scenarios so just putting them out there....

This is one of the reasons why I would have loved for there to be a contra-indication Science topic, I have seen pictures in my training and online as stated in my original post, of general examples but I want to feel confident when assessing feet in the future that yes, it's highly probable that IS a fungal infection or no, she just has awful nails caused from years of wearing shoes too tight or trauma caused from injury etc

I've done a lot of consideration on writing this topic: the problem I have is contra indictions are not legally binding in my country... We effectively are allowed to work on virtually all situations & problems (except open wounds) without the fear of being sued... so what is right for me could very well land you in hot water...

The best suggestion I could ever make is buy a copy of Doug Schoon's book, nail structure & product chemistry, it offers a common sense and safe reply/description to all the major nail conditions you may come across ... (the second edition has lots of colour photos too...)

Hope that helps..
Allen

 

[Planky1]

Hi Planky - sorry I didn't have time to reply earlier - as mentioned there are many reasons for yellowing of toes nails - most are 'safe' to work over.. Especially as they can grow so slowly..

What you have described sound to me more like very unloved nails that have indeed been traumatised - the skin you describe underneath sounds like a lot of sole horn - when onycholysis occurs the bed epithilium stays stuck to the plate and can also plump up on the nail bed - this is usually due to all the moisture trapped inside shoes...

Fungal infections are actually quite rare ... I have personally only ever seen a handfull of cases that were diagnosed as fungal infection..

The general 'tell' for infection is the nail becomes very thick, layered, crumbly and often a milky colour
Of course there are many other types of infection that may be present (as mentioned in an earlier post where the surface becomes white and mottled - but again, this is rare..)

I would always say, if you think it looks suspect - get a second opinion from someone who is qualified to identify it - and even better is having a culture done to pinpoint the exact cause pathogen.
If a culture is not done, the chance of actually dealing with it properly is very slim...
Topical medication is limited in it's effectiveness and if the infection is actually 'in' the plate then topical will NOT get rid of it - the client will need targeted medication for the particular strain or type of infection...

Personally I am confident with most near any condition nail - because I have researched and worked alongside many doctors over nail conditions - I would ALWAYS treat anything suspisious looking as though it was a risk and not use the same tools/files on any other toe or clients and ALWAYS thoroughly disinfect every surface after the client...

Please see disclaimer at bottom of this post regarding liability


I've done a lot of consideration on writing this topic: the problem I have is contra indictions are not legally binding in my country... We effectively are allowed to work on virtually all situations & problems (except open wounds) without the fear of being sued... so what is right for me could very well land you in hot water...

The best suggestion I could ever make is buy a copy of Doug Schoon's book, nail structure & product chemistry, it offers a common sense and safe reply/description to all the major nail conditions you may come across ... (the second edition has lots of colour photos too...)

Hope that helps..
Allen

Thanks so much Allen. Her nails were very thick on those 2 big toes but not that thick that I couldn't cut with clippers if I'd done them I don't think. And definitely weren't milky but very yellow. And then like I say, that one big toe in particular sounded hollow and had the tube/scroll like tissue underneath. Was very unpleasant looking if that helps my description of it at all? :lol:

She did say that she never does anything with her feet and that they are the last thing she thinks about, so yes, definitely unloved.

So if she comes back to me saying all is ok, do I trust that and go ahead? If you say that it's quite rare for fungal infections to actually occur and my description doesn't sound like how you describe it to be?

Obviously using Shellac, I can't have completely separate polishes for her.

Claire

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[Envy]

If I personally was in doubt I would still be super cautious (even if doc says all clear) and make sure I had an old file or two I can use and then dispose of, same with orange wood stick for cuticle work...

Nail polish/ shellac etc will not support pathogen growth so no need to worry about them
Hths

 

[busybee32]

I did a blog a couple of years ago with a client with severe onychomycosis.
Even consulted with Doug who confirmed my suspicions were correct.
We had samples sent off but the doctors kept losing them, and due to his circulation problems he ended up with gangrene which the hospital said the fungal infection got into his soft tissue as they hadn't ever been treated, he has had to have major surgery and thankfully now is in recovery but was so ill.
You should be able to find it on my blogs if not here is the link, http://www.salongeek.com/blogs/busybee32/16026-worst-fungal-infection-i-have-ever-seen.htmlthe pics are quite graphic, but in the blog there is also a link to a thread that Bev rose did with a link which is interesting
You did the right thing better to get a second opinion if in doubt an all that.
Jen xxx

 

[mini4mum]

Fantastic thread!

 

[mini4mum]

Just found a few pics for delectation is this sort of infection is very common

 

[Jocie]

I for sure think you did the right thing. I had to refuse service one time before I felt bad at first but now im ok with it. A girl had mold underneith her nails form a discount in and out salon yuuucckkk.

 

[Crystal colleen]

I did a blog a couple of years ago with a client with severe onychomycosis.
Even consulted with Doug who confirmed my suspicions were correct.
We had samples sent off but the doctors kept losing them, and due to his circulation problems he ended up with gangrene which the hospital said the fungal infection got into his soft tissue as they hadn't ever been treated, he has had to have major surgery and thankfully now is in recovery but was so ill.
You should be able to find it on my blogs if not here is the link, http://www.salongeek.com/blogs/busybee32/16026-worst-fungal-infection-i-have-ever-seen.htmlthe pics are quite graphic, but in the blog there is also a link to a thread that Bev rose did with a link which is interesting
You did the right thing better to get a second opinion if in doubt an all that.
Jen xxx

Jeepers that poor man and to be fobbed off like that from a doctor makes me sad :0( xx