Nail changes induced by application of a callus eliminator during a manicure

LETTER CASE NOTE Nail changes induced by application of a callus eliminator during a manicure To the Editor: A 51-year-old male presented with nail discoloration and koilonychia that developed after a manicure. The manicurist mistakenly applied a callus eliminator (containing potassium hydroxide [pH 14]) instead of a cuticle eliminator and placed his hands into hot mitts for several minutes. The material data safety sheet of the product used warns that heat and occlusion should be avoided.1 One week later, he presented to the office with periungual erythema and arrest of cuticle formation of all ten digits. The changes on his left hand (Fig 1) were slightly more pronounced than the right. Halfspooning was apparent of the lateral aspects of the fourth and fifth nails. The lunula lost its normal lunar curve, and there was distortion of the distal aspect of the lunar line. Longitudinal ridging and a variegation of erythema of the nailbed with blanching were present on all five digits. Hyponychial hyperkeratosis was noted on the fourth digit. Temovate solution—one drop to the base of each nail twice a day—was prescribed. A workup to check for systemic causes of koilonychia, such as iron deficiency anemia, hemochromatosis, Raynaud’s disease, and systemic lupus erythematosus2,3 was not done because of the rapid onset of nail changes after the manicure and the lack of systemic complaints. Five weeks later, the periungual erythema had diminished, and there were 5 mm of normal regrowth at the nail bases. This case demonstrates that a manicure, seemingly a harmless beauty ritual, does have its risks. Physicians should warn patients about the possibility of infection, mechanical nail damage, and allergic or irritant contact dermatitis.

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Fig 1. Periungual erythema and spooning.

Nicole C. Dombrowski, BAa Jenifer R. Lloyd, DOb Ohio University College of Osteopathic Medicinea Athens, Ohio Lloyd Dermatology and Laser Centerb Youngstown, Ohio Correspondence to: Jenifer R. Lloyd, DO Lloyd Dermatology and Laser Center 8060 Market Street Youngstown, OH 44512 REFERENCES 1. Be Natural Callus Eliminator (material safety data sheet). Mesa (AZ): ProLinc Cosmetics, Inc; 2003. 2. Fawcett RS, Linford S, Stulberg DL. Nail abnormalities: clues to systemic disease. Am Fam Phys 2004;69:1417-24. 3. Fawcett RS, Stulberg DL. The adult working years: common skin findings in systemic diseases. Clin Fam Pract 2003;5:667. Published online November 30, 2004. J Am Acad Dermatol 2005;52:e6. ª 2005 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2004.08.032