Spoon nails are a common nail abnormality that can be easily overlooked because the mildest cases are hard to recognize. But be observant; early detection can alert clients to the early stages of a more serious medical condition.
A poor diet can also cause spoon nails. When a person’s diet lacks iron, she becomes anemic. Anemia is a major cause of spoon nails. This is where the keen eye of the tech can help alert a client to a deeper problem. Techs who notice a normally healthy nail begin to pit in the middle or flare at the edges can gently ask clients if they’ve ever been tested for iron deficiency. If the client isn’t aware of an iron deficiency, but complains of being unusually tired, suggest she see her doctor to get her iron tested.
A final, though rare, cause of spoon nails could be a systemic problem, such as lung or heart problems, or even cancer.
The treatment for koilonychia varies for every patient. Doctors will evaluate the nail and get a patient’s history to determine the cause of the disorder — whether it’s hereditary, dietary, a result of trauma, or systemic. The doctor may opt for no treatment, knowing the deformed nail will grow out; she may recommend an iron supplement, or she may order more tests to determine if there is a deeper cause. Treatment can also include an emollient that softens the nail and the surrounding skin to prevent splitting and cracking.
WHAT’S A TECH TO DO?
Dr. Parker Gennett, a podiatrist in Vestal, N.Y., suggests techs have clients with spoon nails get a baseline exam. Be aware that when koilonychia is in the advanced stages, it is possible for bacteria to get lodged in the split nail or in the open, cracked skin. Sometimes trapped bacteria or fungus will turn the area yellow or green. Do not apply product over any compromised skin or over a spoon nail that is cracked in the middle, regardless of whether any discoloration is evident. Water can easily get trapped and bacteria can grow, even with careful preparation. Protect yourself and the client by refusing to apply product when a spoon nail and the surrounding skin is cracked.
Dr. Gennett warns against applying an enhancement to beautify a toenail affected with koilonychia. Because toenails are likely to be covered with shoes, and they are evaluated less frequently, they are at a greater risk to trap water and develop an infection.
Once the doctor has determined there is no risk involved in enhancements, techs can apply an overlay to even out and correct the concave nail. Be sure to prep the area that is indented carefully — it’s easy to miss a spot on an uneven nail, and that puts the client at risk for lifting. During the application step, be sure to press firmly on the concave area, filling in completely the small dips of the nail. When that area grows out to the free edge, you will notice the acrylic is thicker where the client’s nail was concave. With careful prep and application, techs can make wavy, uneven spoon nails look like they have beautiful natural curves.