Contra Indications to Manicures

What is a Contra Indication?

- It is something that prevents or restricts the way in which the treatment is carried out.

- Very important to recognise in order to prevent cross infection 

- Sometimes you may need a medical referral before you can go ahead

Examples of Contra Indications:

Fungal Infection - Ringworm of the Skin 

Fungal Infection of the Nail - Ringworm known as Onychomychosis

Bacterial Infection - Paronychia and Impetigo 

Viral Infection - Warts

Parasitic Infestation - Scabbies

Severe Nail Seperation - Onycholysis

Sever Eczema

Severe Psoriasis

Psoriasis of the Nail 

Severe Bruising 

Contra Indications that RESTRICT the way in which you apply the Manicure Treatment

- You would avoid the affected area and adapt

- It is important to explain to the client why you are doing this

Examples of Contra Indications that RESTRICT:

Nail Separation or Lifting of the Nail - Onycholysis

Severely Bitten Nails - Onychophagy

Damaged or Weak Nails

Bruised Nail 

Broken Bones 

Dermatitis

Manicure:

- Carry out verbal consultation, checking for contra indications whilst disinfecting their hands

- Ask client to remove jewellery and choose enamel colour 

- Wash your hands and collect tools from steriliser

- Remove enamel from clients nails

- Starting on right hand file nails and cut to shape

- Apply cuticle cream, massage in and soak nails 

- Repeat on other hand 

- Remove right hand, dry and start cuticle work

- Repeat on other hand 

- Massage hand and arm 

- Apply buffing past and buff nails

- Squeak clean nails with nail polish remover

- x1 base coat 

- x2 colour 

- x1 topcoat

- Quick dry/cuticle oil

- Aftercare advice

Pedicure:

- Consultation from/signature

- Spritz foot and look for contra indications 

- Remove polish and hard skin 

- Start with left foot - apply cuticle cream and soak foot

- Repeat on other foot 

- Exfoliate feet

- Remove left foot, cut and file nail, carry out cuticle work

- Repeat on right foot

- Foot massage on lower leg and foot 

- Buff nails with buffing paste 

- Squeak clean nails 

- x1 base coat

- x2 colour 

- x1 topoat

- Quick dry/cuticle oil

Luxury Pedicure - apply foot mask and booties or hot oil massage

Massage Routine:

- Apply massage cream/oil

- x3 Effleurage up the arm/shin and down

- x3 Petrisage (circular motions) massage one side of arm/leg then the other

- x3 Effleurage the hand/foot

- Circle each finger/toe and lightly pull

- Knead in circles base of hand/foot

- circle around wrist/ankle

- Effleurage hand/foot

- Rotate hand/foot clockwise and then anti-clockwise x3 extend and relax x3

Nail Painting Procedure:

- Varnish should be applied in 3 strokes, starting with centre then to the right and far left

- Before applying polish ask client to re-apply their jewellery and check colour choice

- Start by applying base coat- start with thumb on right hand, finishing with little finger on left

- Apply 2 coats of chosen polish 

- Finish with 1 coat of top coat

* REMEMBER TO SEAL THE ENDS *

French Manicure Application:

- Apply 1 coat of base coat

- Apply french manicure base colour 

- Apply the white colour to free edge only and then apply x1 top coat all over nail

Different Nail Types

- Normal/Healthy

- Dry

- Britle 

- Damaged/Weak

- Ageing/Mature

Normal/Healthy:

Healthy pink colour, feels smooth to touch, no splits or ridges and has good amount of flexibility and oil content.

They should have regular manicures to keep nails in perfect condition and use cuticle oil daily.

Dry Nails:

Peeling, flaking, slightly rough to touch, lacks shine, ridges and white spots (Leuconychia)

Weekly warm oil manicures, avoiding the use of chemicals, regularly massing cuitcle oil into nails

Brittle Nails:

Inflexible, shatters easily, vertical ridges, splits very low and nail plate may be curved

Weekly manicures, keep nails at manageable length, massage oil will increase circulation to area which will help prevent ridges, buffing will also minimise ridges.

Weak/Damaged Nails:

Papery thin, bend easily, very short in length, layers often split and rough to the touch

Weekly warm oil manicures, regular application of cuticle oil, avoid picking or biting the area and keep nails short and manageable until healthy.

Ageing/Mature Nails:

A combination of dry and brittle nails, prone to curving, dryness with peeling or flaking, ridges and discoloration

Regular manicures with warm oil, specific top coat for ageing nails, daily massage of hand and nail cream and cuticle oils, keep nails at a manageable length.

Hangnail or Agnail:

Also known as a Stepmother's Blessing

Small torn piece of skin next to a fingernail or toenail

Important to keep the skin hydrated and not let it dry out, reccomend a good hand cream and rub cuticle oil into the cuticles dayily to keep soft

Nail Functions

- Aid manipulation 

- Heighten the sense of touch 

- Provide rigid support at the end of the finger

- Protect the end of the finger bone 

- Scratch and groom

Nail Structures - made up of many different ones:

A) The Matrix

Found right below the cuticle and before main body of the nail

Used to reproduce cells that continue to divide and form the nail plate itself. If the matrix is damaged the whole nail will be lost.

B) The Nail Bed

Situated under the nail plate

It is well supplied with nerves, blood and lymph vessels from the underlying dermis

The nail bed and its bloody supply gives the nail its pink colour. Its function is to supply nourishment

C) Nail Grooves

There are 2 types - a) at either side of the nail plate and b) on the underside of the nail plate           which interlock with the grooves of the nail bed

They provide a surface upon which the nail plate moves as it grows, guiding the nail and helping  it to grow straight.

They also help to anchor the nail in place

D) The Hyponychium

The piece of skin under the free edge of the nail 

It acts as a protective seal that defends against infection to the nail bed

E) The Free Edge

Part of the nail which extends beyond the fingertip

Protects the fingertip and Hyponychium 

F) The Nail Plate

The main visible part of the nail which rests on the nail bed

Made up of translucent, dead, keratinised cells to make it hard and strong

Made function is to protect the nail bed

G) The Nail Walls

These are the folds of skin at the sides of the nail plate

They hold the nail in place and give some stability 

Help protect the nail from external damage

H) The Lunula

The white crescent found towards the base of the nail and is situated between the matrix and the nail plate

This is where nails start to harden and it bridges the gap between the living cells of the matrix and the dead cells of the nail plate.

Does not have a known function

I) Lateral Nail Folds

These are the folds of skin at the corner side of the nail plate

They hold the nail in place and give some stability 

They help to protect the nail from external damage

J) The Eponychium

This is the overlapping skin at the base of the nail plate, underneath the cuticle

This is to protect the matrix from infection

K) The Cuticle

This surrounds the base of the nail and is an extension of the horny layer of the epidermis

It protrudes a short way onto the bottom of the nail plate

Protects the matrix against bacterial infection as it provides a protective seal.

Nail Formation

The nail forms its structure from the epidermis

This process beigns as the embryo develops at around week 10

a) Cell Division in the Matrix

This is the first part of the nail plate development

Known as the Germinating Area

Newly formed cells are soft and plump

b) Keratinisation 

New cells develop in the matrix, they are pushed forward becoming flatter and harder

Their Nuclei disintegrates as keratinisation takes place, the cells stick together as a cementing ingredient is secreted into the spaces surrounding the cells 

c) The Lunula 

Appears differently to rest of the nail plate

the pale appearance is caused by 3 factors:

- The Germinal Matriz (underneath) is thicker than under the other areas thus it does not allow the pinkness of the blood underneath to show through

- The partial Keratinisation of the cells give a cloudy/opaque appearance

- The nail plate attachment to the nail bed is less firm therefore more light is reflected in this area

d) The Layers of the Nail Plate

Consits of 3 layers bonded together

Each layer developing from a different origin of the epidermis

e) The Fat Content of the Nail Plate

There is very lipid (fat) between the cells of the nail plate

This could acount for the fact that nails are 10 times more permeable in water, than the skin

f) The Nail Bed - comprises of:

The Lower Epidermis - (only th Prickle Cell Layer and Germinating Layer)

And an Inner Dermis

The upper cells of the epidermis are firmly attached to the underside of the nail and move towards the tip of the finger

Medical research shows that the nail bed can pass materials including mineral salts

This explains why changes in the nails can be seen over short periods

g) Attachment of the Nail Plate

As nail grows it runs along furrows called Nail Grooves which run along the sides and the underside of the naill

The grooves are protected by folds of skin called the Nail Walls and Lateral Nail Folds

This gives extra adhesion at the end of the nail plate

4) Nail Growth

The rate of growth is about 3-5mm per month

Taking about 4-6 months for cells to travel from the Lunula to the tip of the free edge

This process takes approximately twice as long in the toenails

a) Factors Affecting Nail Growth

Seasons

Age

Health

Trauma

Medication 

Temperature

b) Damaged Nails

The nail growing out is the only way that damage to the nail plate can be repaired

As the nail itself is a dead structure, this will only occur if the matrix remains undamaged

If the matrix is damaged, the nail will never re-grow normally again

Base Coat

Provides a smooth base for enamels to stick to and protects the nail from discolouration

Different types of base coats:

- Strengthener - used to improve weak or damaged nails 

- Base coat for dry nails - re-hydrates nail and prevents peeling

- Base coat brittle nails - helps nails to become more pliable

- Base coat for mature nails - re-hydrates, prevents peeling and improves flexibility

- Ridge filling base coat - flows into grooves of nail, providing smooth finish

Coloured Enamel

2 types - Cream and Pearlised

a) Cream

Usually used on dry nails and most suitable for short nails 

Contain high oil content and produce a more matt finish, a top coat is essential to give a gloss finish

b) Pearlised

Contains normal enamel ingredients with addition of fish scales or chopped silk

Draw attention to nails so should not be used on short or ridged nails 

Top coat is not usually required as pearlised enamel dries to a gloss finish 

Top Coat

Protects the nail enamel and provides gloss finish

some top coats contain ingredients that speed up drying process

Enamelling Procedure

a) before enamel is applied ask client to replace their jewellery 

b) ensure nail plate is grease free 

c) start with thumb and apply enamel in 3 strokes, starting at cuticle and working towards free edge

d) apply 1 base coat, 2 cream enamel/3 coats of pearl enamel and 1 top coat for cream enamel and none is required for pearlised enamel 

e) advise the client to wait 20 minutes for nails to become touch dry but they will not be fully dry until up to 2 hours time

Nail Shapes

Oval

Square

Short Oval or Round

Pointed Oval

Squoval 

Pointed or Stiletto

Fan

Hooked

Convex or Ski Slope

Pedicures, History and Information

Pedicures been around for more than 4000 years

The use of fingernail polish can be traced back even further

Originating in China in 3,000 BC nail colour indicated one's social status

Ancient Egyptions have been manicuring all the way back to 2,300 BC

Carved into Pharoah's tombs 

A pedicure is a way to improve the appearance of the feet and the nails

Pedicures are done for cosmetic, theraputic and medical purposes

Pedicures are not just limited to nails, usually dead skin cells on the bottom of feet are rubbed off using a pumice stone

1) Assessment of Client's Hands

Pay attention to shape of the nail 

Look closely at the nail condition 

Decide the condition of the skin

Precautions to a manicure and pedicure

Never work over a contra indication 

Request doctor's permissiion to work before proceeding if in doubt when performing manicures/pedicures on diabetics

All equipment must be steralised

Never apply undue pressure or probe deeply around the cuticle/underneath the nail

Never cut live cuticle

Contra Indications

Diseases - infectious/non infectious 

Disorders

Sepsis

Cuts, abrasions or open wounds

Rashes, allergic reactions 

Bruising

Swelling, inflamation 

Burns, scolds

Warts, verruca's

Systemic desease e.g. arthritis

Filing 

Use a fine emery board 

Hold emery board at 45 degree angle sloping under the nail 

Go from side to centre - avoid sawing action 

Bevel down the nail - check under tha nail to make sure the edge is smooth

Buffing

Apply small amount of buffing paste to each nail, massage buffing past in to nail 

Use buffer in downwards motion, from half moon to free edge (about 6-10 times)

Buffing is used to produce a hine on nails not having varnish application and to reduce ridging

Always lift buffer at the free edge to avoid heat build up

Avoid getting paste under the cuticles as this could cause irritation

Damage caused due to incorrect use of tools

Filing sides of nail too far down causing splitting and ingrown nails 

Passing on infections by not steralising instruments

Using sharp instruments under the free edge which can lift the nail plate, allowing bacteria to enter and cause infection

Using sharp instruments - may scratch the nail plate or snag the cuticle

Cutting the skin when trimming cuticles - infection can start

Too much pressure whilst buffing, damages the lunula

irritating exsiting nail disorders/diseases by ignoring contra indications

Exfoliators

These are mild abrasive creams that can be masaged over the skin with concentration over areas of dryness

These aid desquamation (removal of dead skin cells)

Increases circulation, bringing oxygen and nutrients to the surface

Improves the texture of the skin

By removing the dead skin cells it will help the massage medium or parafin wax to penetrate the skin

Reasons for buffing the nail

Increases the blood circulation to the nail bed

Reduces the appearance of any ridges in the nail plate and produces sheen to the plate

Contra Actions

Contra Actions to manicures are:

Excessive Erythema

Cuts

Inflamed Cuticles

Thinning of the Nail Plate

Allergic reaction

What would you do if the client developed an allergic reaction?

Remove product

Avoid contact, record and seek advice

Aftercare Advice

Allow the varnish to dry for at least 20 minutes before client leaves - be careful for 2 hours

Nails do not fully set for 24 hours

Excessive use of enamel remover damages the nail 

Always wear gloves, when outside in the cold and using chemicals 

Always wear rubber gloves when clenaing and washing up 

Do not use nail varnish remover that contains accetone 

Weekly manicures are recommended for best results 

Apply hand cream regularly 

Use cuticle oil daily to keep hydrated 

Client can use a top coat to keep the shine lasting longer on their manicure

Contra Actions:

Excess urination 

Headache

Thirst

Energised 

Fatigue/Drowsy 

Emotional changes

Diziness/faint

Aches and Pains

Nausea

Aftercare:

Rest

Modification of lifestyle - add more relaxation

Healthy eating and exercise/stretching advice - only eat light food before and after a massage

Suitable home care products - e.g. dry skin use extra hydrating moisturiser 

Future treatments - advice to come back for regular treatments 

Muscles and Bones of the Arms and Legs

The skeleton has 3 main functions:

- Protects the internal organs

- Gives the body its shape

- Used for muscle attachment

Bones of the Arms and Hands (in exam need to label diagram)

Ulna, Lunate

Triquetra, Pisiform, Hamate - Carpal Bones

Phalanges, Metacarpals, Capitate

Trapezoid, Trapezium, Scaphoid and Radius

The forearm consists of 2 bones - Radius and Ulna

Radius - lateral bone of the forearm and is found on the thumb side

Ulna - the medial bone and is found on the little finger side

They form a Hinge Joint with the Humerus, which allows flexion and extension

The wrist cosists of 8 small short bones

These bones form a Gilding Joint and glide over one another to allow movement

There are 5 metacarpal bones which form the palm of the hand

The long bones of the fingers are called the phalanges - made of 3 bones in the fingers and 2 bones in the thumb

Muscles are made of elastic fibres that:

- Have the ability to contract or relax returning back to their original form after contraction

- Stretch when relaxed

- Respond to stimuli provided by nerve impulses

a) The Deltoid Muscles

- Cap the shoulder joint 

- Allow abduction, flexion, extension etc.

b) The Biceps 

- Found at the Brachii of the upper arm

- Flexes the forearm and turns palms upwards 

c) The Triceps

- Found at the back of the upper arm

- Extends the forearm

d) The Wrist Flexors

- Found at the anterior of the forearm (front)

- Comprises of 3 muscles 

- Flexes the wrist drawing it towards the forearm

e) Wrist Extension 

- Found at the posterior of forearm (back)

- Comprises of 3 muscles and extends and straightens the wrist and hand

f) The Brachioradialis

- Found at the front of the lower part of the upper arm, crossing the elbow

- Allows flexion of the elbow

g) The Brachialis

- Found on the radial side of the forearm and helps flex the forearm

Muscles of the arm (as stated above) - (would label diagram in exam)

Deltiod                                   Biceps

Brachioradialis                      Thenar Muscles

Hypothenar Muscles             Wrist Flexors

Brachialis                               Triceps

h) Thenar Muscles

- Found in the palm of the hand below the thumb

- Flexes and moves the thumb

i) Hypothenar Muscles

- Found below the little finger, in the palm of the hand 

- Flexes and moves the little finger

j) Flexor Carpi Radialis

- Found at the Medial Epicondyle Humerus and posterior to the proximal ulna

- Flexes the wrist joint, drawing the palm closer to the forearm

k) Palmaris Longus

- Found at the Epicondyle of the Humerus to the Palmer Aponeurosis of the 2, 3, 4 and 5th Metacarpals

- Allows flexion of the wrist

l) Flexor Carpi Ulnaris

- Found in the Medial Epicondyle Humerus, proximal to the posterior of the Ulna, to the base of 5th MT, Pisiform and Hamate

- Allows flexion and adduction of the wrist and weak flexion of the elbow

m) Extensor Carpi Ulnaris

- Found lateral to the Epicondyle Humerus to the Dorsal surface 5th MT

- Allows extension and adduction of the wrist and weak extension of the forearm

n) Extensor Carpi Radialis Brevis and Longus

- Found lateral to the Epicondyle of the Humerus, to the base 2nd/3rd MT Dorsal surface

- Allows extension/adduction of the wrist and weak extension of the forearm

O) Flexor Digitorum Superficialis

- Found at the medial Epicondyle Humerus Coronoid process Ulna and radial head

- Flexes the fingers, pulling them in towards the palm

p) Flexor Digitorum Profundas

- Found proximal to the 3rd and 4th anterior Medial Ulna to the base of the Distal Phalanges of the 4 fingers

- Allows flexion of the 4 fingers and flexion of the wrist

q) Flexor Pollicis Longus 

r) Extensor Digitorum

s) Extensor Indicis

t) Extensor Digiti Minimi

u) Extensor Pollicis Longus Brevis

v) Adductor Pollicis Longus

w) Anconeus

x) Supinator

y) Pronator Teres

z) Pronator Quadratus

Bones of the foot:

- Distal, Medial and Proximal - The Phalanges

- Meta Tarsals

- Cuniforms 

- Cuboid 

- Calcaneous 

- Talus

- Navicular

Muscles of the leg:

- Abductor 

- Adductors: Adductor Longus, Adducor Brevis, Adductor Magnus and Gracilis

- Tibialis Anterior

- Quadriceps: Rectus Femoris, Vastus Lateralis, Vastus Intermedialis and Vastus Medialis

- Gluteals

- Hamstrings: Biceps Femoris, Semitendinosus and Semimembranosus 

- Gastrocnemius

- Soleus

Muscles of the Ankle and Foot:

a) Flexor Digitorum Longus

b) Flexor Hallucis Longus

c) Peroneus Longus 

d) Peroneus Brevis

e) Peroneus Tertius

f) Extensor Hallucis Longus

1) Blood Vessels 

a) Arteries

- Carry oxygenated blood from the heart, to the rest of the body

b) Capillaries

- The smallest vessels and carry both oxygenated and de-oxygenated blood

c) Veins

- Carry de-oxygenated blood from the body, back to the heart

Arteries of the Arm and Hand:

Radial Artery, Ulna Artery, Deep Palmar Artery, Superficial Palmar Artery and Digital Arteries

The main arteries of the arm are the Ulna and radial Arteries 

a) The Ulna Artery

Supplies the little finger side of the arm

b) The Radial Artery

Supplies the thumb side of the arm

2 loops that feed the hand: The Superficial Palmer Arch and The Deep Palmar Arch - these then divide to form the digital arteries 

Veins

- A surface network of veins carry waste products and de-oxygenated blood away from the hand and back to the heart

- Veins contain small valves which forces the blood to flow in one direction only back to the heart

Veins of the forearm and hand

- The blood in the digital veins located in the fingers drains back to the Dorsal Arches in the back of the hand

- From here the blood drains into the Basillic Vein and upwards on its journey back to the heart

- 2 deeper Palmar Venous Arches carry blood away from the palm and link into the Median Antibrachial Vein in the arm

Veins in the arm: Basillic Vein, Branch of Brachial Vein, Median AntiBrachial Vein, Branch of Brachial Vein, Deep Dorsal Arch, Superficial Dorsal Arch and Digital Veins

Functions of blood

Transport

Defence

Clotting

Heat Temparature Regulator

- In the head, the Common Carotid Artery divides to form:

- The Internal Carotid Artery- which supplies the brain

- An External Carotid Artery - which supplies the neck and face

- The Brachiocephalic Artery provides blood to the right upper chest, right arm, the neck and head

Manicure Revision

- using air filtration devices will help prevent respiratory conditions

- skin condition over exposure to water, chemicals is Dermatitis

- green discolouration between enhancement and natural nail is Pseudomonas

- Onychomycosis prevents nail enhancements and is yellow or white patches at the free edge

- white spots on nail plate are Leuchoychia

- an effective method of gel removal is buffing and soaking off

- correct posture will help avoid RSI

- maintenece of enhancements involves shortening and redefining side walls of the nail 

- vapours can irritate the eyes if this happens to a client you should stop and flush eyes

- trauma to an extension may cause it to crack 

- maintenance should be done every 2-3 weeks

- Monomer and Polymer are used together - Polymerise

- nail grooves keep the nail plate attached to the finger

- important to carry out nail and skin analysis to identify any nail or skin problems and to use products to suit the client skin type 

- Psoriasis of the nail - pitting and discolouration of the nail 

- a bruised nail would affect the treatment as it would be tender and would need to avoid area

- severe nail separation can result in a fungal infection 

Describe how to remove nail enhancements:

- either soak nails for 20 minutes in acetone then use orange stick to gently ease off

OR

- wrap individually with cotton wool soaked in acetone and wrap in foil

- then buff and give manicure

- four nail shapes a client might want is oval, sqaure, round or pointed

- hangnails are splitting of the cuticle area 

- circulation problems can change the nail integrity or increase chance of infection 

- trauma to the whole nail can cause bruising or the whole nail to fall off

- white areas appear under the nail plate

- white areas under the nail plate are air bubbles marking spots where the nail plate is becoming detached from the nail bed 

- onycholysis

- psoriasis is when the nail plate crumbles in yellowish patches 

- Onychomycosis is the medical name for fungal nail infection

- dry nails can be recognised as dull, with a flaking free edge 

- flexible with thickened nail plate common for fungal infections and trauma

- thickened toenails may be caused by:

- ill-fitting and tight footwear

- some medical conditions 

- ageing and poor circulation etc.

- concave appearance of the nail is other wise knwon as:

- Ski jump 

- the best nail shape for large square hands would be:

- round