Nail Clinic – Reaction to Trauma
According to Dr. Ella Toombs, a dermatologist in private practice in Washington, D.C., “The condition was originally thought to be a bacterial infection, but actually it’s a reaction pattern to some kind of trauma.” In other words, it’s something that happens after the skin has already been damaged or hurt in some way by something as simple as a cut on the cuticle or an ingrown nail. The skin responds with an overgrowth of blood vessels and tissue, also called hemangioma.
Pyogenic granuloma lesions often affect children and pregnant women. Lesions in pregnant women may disappear on their own after delivery, and sometimes waiting is the best strategy in those cases. Hormonal surges can increase the risk of developing this condition, so a woman can be more prone to develop it during her menstrual period. Those who take Accutane, a prescription acne medication, are also more vulnerable to pyogenic granuloma.
The treatment of pyogenic granuloma varies, as no solution is foolproof. Cutting off the hemangioma is a possibility, but may result in tissue damage. Also, simple cutting doesn’t usually reach the entire lesion, so recurrence rates can be high. “You need to have the area scraped out; after which, either silver nitrate is applied or electrodesiccation-a hot needle-is used to burn out whatever remains of the lesion,” says Toombs. “These are the methods that prevent regrowth.”
Dr. Joshua Fox, a New York dermatologist and official spokesperson for the American Academy of Dermatology and Dermatological Surgery, primarily uses lasers to treat the cases he sees. “I am a laser man,” he says with a chuckle. “Lasers leave fewer marks, minimize recurrence and are more specific. It may take more than one visit to get the whole lesion, but it’s an extremely effective method. Today about half of all dermatologists use lasers.”
In addition to regrowth at the same site, multiple sites or “satellites” can appear, validating the theory that pieces of pyogenic granuloma may spread through local blood vessels. Most cases are easily taken care of, although occasionally there are more challenging ones. “A lesion found near the nail fold is problematic,” says Toombs. “It can get under the nail plate and interrupt normal growth. That means a physician might have to take off the nail plate to treat the condition-but this is quite rare.
“Pyogenic granuloma can also mimic other conditions,” Toombs says. “Often the spots can look like melanoma or perhaps another form of skin cancer. You need to refer your clients to a dermatologist who can differentiate between the conditions.”
Fox adds that the condition can even resemble Kaposi’s sarcoma, a symptom of HIV. “Only someone with medical training can know what it truly is,” Fox warns.
Nail Tech Cautions
Pyogenic granuloma lesions aren’t usually painful but may bleed easily with very little contact-a tiny nudge or nick can do it. For this reason, nail techs need to use extra care. “Gloves are a must for a tech,” advises Patti Glick, R.N., “because of the greater possibility of blood contact and, therefore, blood-borne pathogens such as hepatitis.”
Fox advises that techs avoid performing any service near the sore. Glick adds, “Avoid that finger or area-no soaking, cuticle clipping, trimming or shaping. You might apply polish, provided the client brings her own or that any remaining polish is disposed of or given to the client after use.” The precaution wards against the possibility of blood contamination.
If your client has a red, raised spot on her finger or nail area, don’t ignore it. “Any client who has an open wound or bleeding lesions should be referred directly to a dermatologist,” Fox says. “People view nail techs as professionals and trust them for health information. Don’t break that trust by being afraid to refer your client to a doctor. Also, be smart and protect yourself by documenting your recommendations on that client’s record, just as we do in the medical field.”
“Make sure that you’re not the one to cause the initial trauma,” reminds Fox. “If you push too hard on the cuticle, for example, that can be enough to start the process. Also, if you have a client using Accutane or one who’s pregnant, tell her about your concerns and explain why you’re taking extra care. She’ll appreciate it. Lastly, make sure that your equipment is disinfected so you don’t increase the potential for infection.”
An ignored lesion can spawn a secondary infection that could, in turn, lead to further complications. If you notice a reddened or raised area on your client’s hand that wasn’t there the last time you saw her, refer her to a dermatologist or her own physician for a diagnosis. Not only will you be helping your client, but you’ll also increase the trust and confidence she has in you.