Murgueytio, 40, a personal trainer from Clarksburg, Md., recovered after a 14-day course of antibiotics and a warning from his doctor about taking too long to be seen, risking an infection that could spread to the rest of his body. He learned his lesson. “I’m doing my own toes now,” he says.
The cuticle is a thin layer of clear dead skin at the intersection between the nail bed and skin, and serves as a barrier against dirt or debris and infectious agents such as bacteria, yeast or fungi.
Nail salon technicians often trim or cut cuticles, which can lacerate the skin and give easy access to irritants and dangerous microorganisms. The potential resulting infection, known as paronychia, also can occur in fingernails after a manicure, according to experts.
With summer underway, it’s often tempting to go barefoot, especially at the pool or beach. This can be risky after a pedicure if the cuticles have been recently cut or trimmed, experts say.
“I wouldn’t walk through the sand barefoot,” says Adam Friedman, professor and chair of dermatology at the George Washington University School of Medicine and Health Sciences. “Little particles of sand can get in, causing irritation and inflammation, and introducing bacteria and other microorganisms.” (This is true for any open cuts or wounds, not just from pedicures.)
After a pedicure or manicure where the cuticles have been cut or pushed, Friedman recommends applying a healing ointment, such as Aquaphor or Cetaphil, on the fold — the area below the cuticle at the base of the nail — to act as a sealant against germs. “An important point: A little goes a long way,” Friedman says. “You don’t want to be dripping with it.”
Bacterial paronychia often causes redness, swelling and pain around the skin fold of the nail, sometimes with puslike drainage, says Olabola Awosika, a dermatologist with Pinnacle Dermatology in Detroit. She treats such infections with oral antibiotics and recommends soaking the 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.
Repeated infections also may require a topical steroid, she says. “With chronic recurrence, there can be complete loss of the cuticle and potentially permanent damage to the associated nail, such as discoloration, lifting of the nail plate and horizontal lines,” she says.
Washington, D.C., podiatrist Sheldon Laps says he sees many nail injuries resulting from “overzealous” nail technicians “who want to push the cuticle back and end up lacerating the skin.” He, too, treats them with antibiotics and at-home soaks — he prefers 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 usually is done in the office.
These infections can be especially dangerous for diabetics with peripheral neuropathy, which occurs when nerves leading to the hands and feet are damaged. They can’t feel pain in their feet caused by an infection, says Laps, also assistant clinical professor of surgery at GW Medical Faculty Associates. “They usually don’t come in until it’s severe,” he says. “They either see pus or redness or smell an infection.”
If the infection manages to spread to the bone under the toenail, known as osteomyelitis, surgery may be necessary, he says.
“The soft tissue of the toenail is directly above the bone,” Laps explains. “Occasionally, the bone becomes infected and we do surgery on the bone to clean it out. If that doesn’t work, we may need to amputate the toe. It’s rare, but it happens. That’s why we tell diabetic patients not to have pedicures.”
How can you prevent infections resulting from pedicures or manicures? The Centers for Disease Control and Prevention recommends the following:
- Keep nails short, and trim them often.
- Scrub the underside of nails — the far end of the nail that juts out from the fingertip — with soap and water (or a nail brush) when you wash your hands.
- Clean any nail grooming tools before use. In commercial settings such as nail salons, make sure the technicians have sterilized nail grooming tools before using them on you.
- Avoid cutting and pushing cuticles, as they act as barriers to prevent infection.
- Don’t bite or chew your nails, which can lead to abrasions and infection.
- Never rip or bite a hangnail. Instead, clip it with a clean, sanitized nail trimmer that won’t cause any injury to the surrounding skin.
If your toenails are significantly thick or distorted, making them difficult to cut yourself, avoid nail salons and see a podiatrist, Friedman says, “which is much safer.”
Friedman says he wishes people would avoid pedicures and manicures entirely but realizes this is unrealistic. “You have to find a compromise,” he says. “To say ‘don’t do it’ doesn’t work.” Instead, he says, “make sure you go to a reputable place where they sterilize their tools. Tell them to leave the cuticles alone or gently trim them, don’t rip them.”
Awosika agrees, adding: “Always make sure your manicurist or nail technician is using clean tools, being gentle with your nails and surrounding skin,” she says. “If it hurts or is uncomfortable, that’s not normal and you should speak up. I find that when skin conditions result in relation to these practices, often patients were uncomfortable during the procedure but thought it was normal — so listen to your skin.”
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