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As I started to write this, I started thinking—always a good thing. I have genetically good skin, but bad nails, hair and horrible teeth. Every single tooth in my mouth is a veneer. You really need teeth for 2 reasons; to fill out your lips and the area around the mouth, to reduce loss of bone structure around your mouth with aging, and longer teeth are associated with youth (teeth wear down and shorten with aging). But I digress—we will talk about teeth, and why you want to keep them, in another post.

Anyway, back to nails.

I use my hands all day long, every day. I really, really try to avoid housework, and as some of you know, I don’t cook. However, you will be glad to hear that when I am seeing patients I wash my hands before and after each patient and sometimes multiple times with a patient so up to 60 times a day. Contact with the numbing cream we use before Botox and filler injections, and with the various peel solutions discolor them. The powder in the gloves I wear when I am doing procedures dry the hands, cuticles, and nails and also discolor them. I am often on the computer, which wears them down as the nail hits the keyboard. Nails are meant to be tools to help your fingers accomplish various tasks, and I use them that way.

Nails thin over time with aging, and women’s nails thin worse than men’s. Both women and men tend to develop longitudinal splits which tear easily. And all the manicure/pedicure stuff women do to their nails damage them more. So I my nails are brittle, and break easily. They tend to discolor to yellow, and nail polish discolors them more. I do have one good nail trait—the free edge at the end of the nail is uniformly white so if i can ever get them grown out long enough, I can wear a light colored or sheer polish and it looks like a French manicure. That is a genetic trait, you can’t do anything to get your nails to do that if they don’t—:( sorry, bummer. I like them short, and need them short to practice medicine. Good thing, since I can’t grow them out anyway. I like them square, another good thing, since filing them round or oval makes them more prone to breakage.

My hands get dry, and my cuticles split and tear. Because, like many women, I am a “picker” (my husband says I went into dermatology so I could do it legally) when I have a torn cuticle it bugs me so I pick or bite at it until I have made it even worse. Because of that I carry a pair of cuticle nippers in my purse and have one at my desk and bedside. As soon as I have a torn cuticle, I clip it immediately. Because I fly frequently, during the time when the TSA was forbidding cuticle clippers as potentially lethal weapons, it was a problem. Thank you, Osama Bin Laden. Now however, I am back to carrying them with me everywhere, as part of my APM kit (Always Prepared Mom kit—cuticle nippers, tiny foldable scissors, nail file, safety pins, lip balm, small tape measure, tiny sewing kit, bandaids, topical steroid, antibiotic ointment, and kitchen sink) that is always in my purse.

I don’t allow my nursing staff to wear acrylic nails because they would be poking the patients, and because acrylic nails more much more likely to carry Staph bacteria. Luckily, my nurses and most nurses in general don’t want to have acrylic nails, but some in other settings do. It has been an issue in some surgical settings where investigations after a rash of post-operative Staph infections have occurred have shown the bacteria to be carried in acrylic nails of the operating room staff. In any event, I am the boss, so my nurses have short, natural, nails with light color polish.

For a long time I resisted going for a manicure and pedicure because of the health risks. But my youngest daughter and I started going as “mother-daughter time” and my nails do look better when a professional does them than when I do them one handed. But there is definitely a risk of infection, with wart virus, nail and foot fungus and mycobacteria. Some nail salons are better than others, but truthfully, none of them can really follow proper infection control procedures and stay in business at the low prices they are charging. The nail instruments can be contaminated, and although they clean some of them and “sterilize” them, the process they use doesn’t get rid of all contamination. And some things like the foam blocks and emery boards are never cleaned. The biggest risk is the pedicure tub. The proper procedure to disinfect is to drain the tub between each use, flush a treatment solution through it, drain that, take the filter out, clean the filter, rinse the system again, and let it dry for hours, before using it again. Have you ever seen that happen? Over the last several years I am seeing more and more nail salon clients coming in for pedicures that are not traditional pedicure type clients. They come in because their toenails are thick, they can’t care for them, and seeing a podiatrist for nail care is more expensive. Unfortunately the incidence of nail fungus increases with age, and many of these clients have nail fungus which is why their toenails are thick and they can’t care for them. And they are using the same tub right before you!!

And don’t even get me started about nail salons and double dipping into the waxing pot. I see it all the time.

I know, I know—the list of nail care products that a cosmetic dermatologist uses. I got a little long winded, and a touch off topic, something that does happen “on occasion.” But it is Friday, after all.

I promise, next post.


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