Murgueytio, 40, a personal trainer from Clarksburg, Md., recovered after a 14-day course of antibiotics and took longer to heed his doctor’s warning that he was at risk of spreading the infection to other parts of his body. He learned his lesson. “I do my own toes now,” she says.
The cuticle is a thin layer of clear dead skin at the junction between the nail bed and the skin, and acts as a barrier against dirt or debris and infectious agents such as bacteria, yeast or fungus.
Nail salon technicians often trim or cut the cuticles, which can damage the skin and provide easy access to irritants and dangerous microbes. According to experts, an infection called paronychia can also occur in the fingernails after the nails.
As summer sets in, it’s often tempting to go barefoot, especially at the pool or beach. Experts say it can be dangerous after a pedicure if the cuticles have been recently cut or trimmed.
“I wouldn’t walk through the sand barefoot,” says Adam Friedman, M.D., professor and chair of dermatology at the George Washington University School of Medicine and Health Sciences. “Small sand particles get inside, causing irritation and inflammation, and introducing bacteria and other microbes.” (This applies not only to pedicels, but also to open cuts or wounds.)
After a pedicure or nail clipping, Friedman recommends applying a healing ointment like Aquaphor or Cetaphil to the fold — just below the cuticle at the base of the nail — as a waxy sealant. . “An important point: A little goes a long way,” Friedman says. “You don’t want to mess with it.”
Bacterial paronychia often causes redness, swelling and pain around the skin fold of the nail, sometimes with pus-like drainage, says Olabola Awosika, a dermatologist at Pinnacle Dermatology in Detroit. He treats such infections with oral antibiotics and recommends soaking fingers or toes in a water and white vinegar solution — one part vinegar to two parts water — for 10 to 15 minutes three times a day. The solution is both anti-inflammatory and antimicrobial.
Recurrent infections may require a topical steroid, he says. “In chronic regrowth, there can be complete loss of the cuticle and associated permanent damage to the nail, such as discoloration, nail plate and horizontal lines,” he says.
Sheldon Labs, a Washington, D.C., podiatrist, says he sees many nail injuries caused by “overzealous” nail technicians who “want to push the cutter back and tear the skin.” He, too, treats them with antibiotics and home soaks — he likes Epsom salts dissolved in warm water — twice a day for 10 minutes for five to seven days.
“In severe cases, we have to remove the toenail,” he says, which is usually done in the office.
These infections are especially dangerous for diabetics with peripheral neuropathy, which occurs when the nerves leading to the hands and feet are damaged. They can’t feel the pain in their legs caused by an infection, says Laups, assistant professor of surgery at GW Medical Faculty Associates. “They usually don’t come up as severe,” he says. “They see pus or redness or smell an infection.”
If the infection spreads to the bone under the toenail, called osteomyelitis, surgery may be needed, he says.
“The soft tissue of the toenail is directly above the bone,” Labs explains. “Occasionally, the bone becomes infected and we operate on the bone to clean it up. If that doesn’t work, we may have to amputate the toe. It’s rare, but it happens. That’s why we tell diabetics not to get pedicures.
How to Prevent Pedicure or Fingernail Infections? The Centers for Disease Control and Prevention recommends the following:
- Keep nails short and trim often.
- Scrub the base of the nail — the distance from the fingertip — with soap and water (or a nail brush) when washing hands.
- Clean manicure tools before use. In commercial settings such as nail salons, ensure that technicians disinfect manicure tools before using them.
- Avoid cutting and pushing cuts, as they act as barriers to infection.
- Do not bite or chew your nails as this can lead to bruising and infection.
- Never tear or bite the hangnail. Instead, clip it with a clean, sanitized nail trimmer that won’t injure the surrounding skin.
If your toenails are so thick or damaged that it’s difficult to cut them yourself, skip the nail and see a podiatrist, “it’s pretty safe,” says Friedman.
Friedman says she wishes people would avoid pedicures and manicures altogether, but realizes this is unrealistic. “You have to find a compromise,” he says. Saying, “Don’t do that” doesn’t work.” Instead, she says, “Make sure you go to a reputable place where they sterilize their equipment. Ask them to leave the cuts alone or gently trim them, don’t tear them.”
Awosika agrees, adding: “Always make sure your manicurist or nail technician uses clean tools and is gentle with your nails and surrounding skin,” she says. “If it hurts or is uncomfortable, it’s not normal, you should speak up. When skin conditions result from these procedures, patients are often uncomfortable during the procedure, but I thought it was normal – so listen to your skin.
