A Podiatrist’s Guide to Nail Polish Use

An Article Written By Cecilia Brennan
Podiatrist – New Step Podiatry.

Podiatrists and nail polish don’t always go together. Podiatrists don’t apply nail polish after they provide footcare like nail salons do. At the same time, we understand that people do like to wear toenail polish particularly in summer and for special occasions.

This blog article explores nail polish wear considerations for people with fungal or dry & brittle toenails, diabetes, a history of skin cancers and those receiving chemotherapy. Nail polish application tips are also included.

Podiatry advice on nail polish wear for people with fungal toenails

In fungal nails the fungus usually lives underneath the nail plate on the nail bed. Good access to the nail bed is required to effectively treat fungal infections with topical antifungal paints.

Antifungal topical paints are made to penetrate the nail plate to reach the nail bed. Thinning the nail and applying the treatment at the free end of the toenail and edges is also helpful at getting more antifungal active ingredient to the fungal infection. Therefore, if you are wearing nail polish and you are using a paint to treat a fungal infection you will be reducing the amount of antifungal paint getting to the infection. Additionally, occluding the nail with nail polish may be favourable to fungal growth.

Extended nail polish wear also means you aren’t able to regularly inspect the progress of the infection regardless of how you are treating the fungal infection.

When it comes to wearing nail polish, consider a more ‘breathable’ nail polish which are usually the non-toxic nail polishes such as the Sienna and Dr.’s Remedy range. When wearing nail polish consider applying the topical antifungal at the nail edges or as per advice from your podiatrist or doctor.

If you have a fungal nail and choice to wear nail polish, keep reading this blog article to see how long you should wear nail polish for.

If you would like to know more about fungal infections of the toenails and skin, read this article written by Bonnie McNab, Podiatrist at New Step Podiatry.

Yellow streaks in a toenail are a sign of toenail fungus

 

Podiatry advice on nail polish wear for people with Diabetes

People with diabetes are at increased risk of skin infections including bacterial and fungal infections. It has been found that the skin’s natural defence against infections is different in people with diabetes compared with the rest of the population.

Attending a nail salon may increase the risk of infection as the space and equipment is shared with others that may already have an infection. Hopefully the nail salon has good hygiene practices such as sterilising all nail trimming and filing instruments (podiatrist do this as standard practice). The baths that a foot soak are done in need a replaceable liner or need to be really wiped out with appropriate cleaning products.

People with diabetes may choose to instead attend a podiatrist for toenail care and apply nail polish at home to reduce the risk of infections.

When it comes to nail polish application, keep reading this blog article to read how best to apply nail polish.

 

Podiatry advice on nail polish wear for those with a history or concern for skin cancers

Skin cancer can occur under nails! This includes melanomas which will cause a brown-black streak which doesn’t grow out. The nail can also separate from the nail bed, split easily and feel bumpy under the nail. Skin cancer on or under your nail is a rare occurrence, but it does happen.

It’s super important to remove nail polish when you go get your skin checks done by your doctor. Make sure your doctor also checks between the toes. If you are concerned about a potential skin cancer under your nail, have a look at the resources at the bottom of this article and see your doctor.

To prevent melanomas under the nails, wear opaque nail polishes because the colour will reduce the sun’s rays reaching the nail bed where skin cancers can form.

Also look for nail polishes that are labelled as UV protected so the colour is protected and lasts longer. Some clear nail polishes and nail base coats can also be UV protected which may offer your nail beds UV protection, however, the degree of UV protection is unknown. Maybe in the future nail polishes will have SPF testing and labelling like sunscreens. These clear or light coloured nail polishes might be a good option for people who don’t want to wear nail polish but want some UV protection i.e. most of my male patients but also me as I don’t like wearing nail polish, have light coloured skin and go out in the sun in summer!

Melanoma affecting toenails

What about nail salon UV lamps?

Man­i­cures and pedicures with shel­lac or gel nails use lamps to dry the pol­ished nails. These lamps are called UV lamps or LED lamps and both emit UV radiation, predominantly UVA rays which have been linked to increased risk of skin cancer. It’s the same rays from the sun that cause skin cancer.

There is mixed research about the link between nail salon lamps and skin cancers. As the Cancer Council says, “we have good evidence of the level of risk from the sun and sources such as solariums (commercial use was banned in Australia in 2016) but we don’t have strong research about devices used in nail salons”.

One option is to have non-toxic nail polish that doesn’t require a UV lamp applied instead of shellac or gel.

Everyone’s risk is different. Those with fair skin, who are older or take medications that make them sensitive to light should be more careful. Those who attend nail salons more frequently are also at increased risk.

To reduce your risk wear SPF 50+ sunscreen prior to attending nail salons. For the hands, you can wear dark, opaque gloves with a small cut out at the fingertips. For the feet, it’s not as easy but could wear a snipped sock.

In saying all this, these actions will not protect you against melanomas under the nails.

 

Podiatry advice on nail polish wear for people receiving cancer treatment

Just like your hair can be affected by certain chemotherapy drugs so can nails. Chemo can affect new cell growth which can cause dry, brittle and discoloured toenails.

The main drugs that cause nail changes are Taxanes, Anthracyclines (Doxorubicin and Epirubicin) and Capeitabine (Xeloda).

Damaged nails and damaged skin around nails such as torn cuticles can allow bacteria in causing an infection. Given the immune system is already compromised due to chemo drugs a small skin infection can be a big issue. So, it’s important to reduce the risk of nail damage.

Here are some nail polish tips that can help reduce nail damage during chemotherapy:

  • Avoid acetone-based nail polish remover, it is harsh on nails. Use acetone-free nail polish instead.
  • Use non-toxic nail polishes if your cancer treatment teams allows nail polish wear.
  • Use nail strengthening products, there are heaps are out such as Dr.’s Remedy Restore Ridge Repair Enriched Nail Polish or Hydration Clear Moisturising Nail Treatment. Pharmacies are a good place to look for these products too. Clear nail treatments are a good option for those who may not want colour on their nails.
  • Use cuticle oil to make the skin around the nail more resilient against breaks and infection.
  • Check out the resources at the bottom of this blog article for more information and care for your nail during chemo treatment.

Sometimes people get told to wear black nail polish when they are getting chemotherapy. I have 2 things to say when it comes to wearing black nail polish during chemo to prevent nail changes. One, I really feel for people who need chemo because there is so much conflicting advice out there and two, it’s best to talk to your oncologist or cancer nurses as they will be most up to date on the evidence on this one.

It seems the medical reason behind wearing dark nail polish during treatment is that some research has found that chemo treatments increases nail sensitivity to UV light and with increased UV exposure comes increased risk of nail damage. Dark nail polish blocks UV to protect the nail from the sun. When researching there was advice that said dark nail polish is just to hide nail damage and others linked less nail damage due to chemo drugs due to nail polish wear directly. This research wasn’t as strong as the increased UV light sensitivity research.

Unfortunately, with dark nail polish it is difficult to assess the nail and surrounding skin for damage, infection and inflammation which the cancer treatment staff may want to do regularly. Therefore, clear nail polishes that are UV protected may be preferred. Again, it’s best to talk to your cancer treatment team.

Fingernail changes that can occur with certain chemo drugs. Picture from https://www.cancerpal.co.uk/post/looking-after-nails-during-chemotherapy-treatment

 

Podiatry advice on nail polish wear for people with dry, brittle toenails

Nails can get dry, brittle and easily break as we age but also with certain medical conditions such as hypothyroidism, anaemia and deficiencies in certain vitamins and minerals.

When it comes to nail polish, consider the following tips:

  • Avoid artificial/acrylic nails and to a lesser degree shellac and gel
  • Use a non-toxic nail polishes such as Sienna or Dr.’s Remedy products
  • If not using a non-toxic nail polish, avoid really bright shades such as yellow, orange, blue greens as these are more likely to stain already weak nails.
  • Consider nail hydration treatment such as Dr.’s Remedy Hydration which is a clear moisturising treatment. This helps to moisturise, strengthen and protect the nail. It can be worn alone or as a base coat under nail polish. If wearing alone, apply 1-2 weekly. If a thick layer is forming on top of the nail, you can remove with acetone free nail polish remover and reapplied a day later.
  • Consider cuticle oil such as Dr.’s Remedy Caress Cuticle Oil which is a lightweight oil that helps to prevent cuticle breaks. It is best applied at night so you are less likely to ‘wash it off’ with regular handwashing that occurs during the day. Apply one drop to each cuticle and massage into the nail region. It is safe to massage excess oil into the hands.

Follow the below advice on how to apply nail polish.

 

A Podiatrist’s view on how to safely apply nail polish

If you are going to wear toenail polish read through these steps to see if you can improve your technique.

  1. The right position

Make sure you are in a comfortable position that will avoid excess strain on your body particularly to your neck and back. Ensure there is enough light and if you require glasses for your eyes make sure you are wearing them!

  1. Prep the nail: remove any existing nail polish and lotion build up

There are many nail polish removers out there on the market. They can be divided into acetone based and acetone free. My preference is acetone free as acetone is a strong chemical that can irritate your skin. If using an acetone-based nail polish, consider applying Vaseline on the skin around the nail to protect the skin.

Do not apply nail polish over the top of existing nail polish. Excessive layers of nail polish are more likely to stain and damage nails.

Even if you don’t have nail polish on it’s a good idea to use a little nail polish remover to remove any cream, lotion or moisturiser residue. This will help the nail polish stay on.

The Dr.’s Remedy range has a nail polish remover. It is free from acetone, formaldehyde, toluene and phthalates. It is infused with tea tree oil and vitamin E to help nourish the nail.

If you have had gel or acrylic nails applied, it’s best to get the people who applied these to your nail to remove it. That way they are using the right product to effectively remove it.

  1. Prep the nail: trim and file

To keep your nail polish in good condition, trim and file your nails to prevent nail damage from snagging and catching. To cut your nail, follow the natural contour of the nail shape. When filing do try to only file in one direction, i.e. don’t go back and forth as this action is more likely to damage the nail.

If you like you can buff the face of the nail which is particularly useful if you have ridges in your nails.

These nail buffers can be purchased from pharmacies and supermarkets
  1. Prep the nail: Base coat

Please consider applying a base coat before the coloured nail polish is applied. Base coats help the nail polish adhere which will keep the nail polish looking good for longer. Base coats can also protect the nail from damage from extended nail polish wear and staining from darker coloured nail polish (which is less likely to occur with non-toxic nail polish so please do consider these polishes). See heading below for how long you should wear nail polish for.

The Dr.’s Remedy range has several base coat options including Basic Base Coat, Restore Ridge Repair, Healing Hydration for dry, brittle nails and our favourite the Total Two-in-One which is a base and top-coat in one!

New Step podiatry stocks the Total Two in One (base coat and top coat in one!)
  1. Applying nail polish

If you need, now is a good time to apply toe separators to prevent nail polish getting on your skin. If you have a wobbly/shaky hand, consider applying Vaseline or cuticle oil to the cuticles and skin around the nail.

When you start painting, it best to not start right on the edge. Also don’t start right against the base cuticle. Once you have done the middle you can do the edges but don’t redip or saturate the brush because the edges don’t need as much polish.

We don’t recommend polish with glitter in it as this can get stuck in the nail edges and cause irritation. Glitter is also harder to remove with nail polish remover.

To prevent streaking, apply a thin first coat and then a thicker second coat. Make sure you allow a good amount of time between coats to allow the nail polish to dry.

Lastly, as always, use the product as directed and avoid excessive inhalation.

 

  1. Top coat

After the nail polish is dry, apply a top coat. This will help protect the nail polish colour from our sunny Australian days and keep the nail polish lasting longer. Plus a top coat provides a glossy top to make your nail shine. Again, we love Dr.’s Remedy Total Two-in-One base coat and top coat.

  1. Cuticle care

Consider applying a cuticle oil to protect against dry, cracked, peeling and irritated cuticles. This will make your nails look even better! Dr.’s Remedy has a Caress Cuticle Oil which is great at hydrating dry nails and comes with 10% undecylenic acid which has antifungal properties. As fungus enters the nail from the edges, having this antifungal action around the nail edges helps to reduce the risk of fungal infections.

Speaking of cuticles…

Should you push back your cuticles?

The cuticle at the base of the toenail is there to create a barrier to prevent bacteria and fungus from entering the nail structure. By removing excessive cuticle, you are removing the body’s natural defence to infection. Loose cuticle skin can be removed as this skin isn’t reducing the risk of infection. Feet are more at risk of fungal infections which means you really want to consider whether to push back the cuticles on toenails with fingernails being more tolerant.

 

A podiatrist’s view on how long you can wear nail polish

If you have fungal toenails, try to limit nail polish wear time to special occasions i.e. applying the day before and removing the day after. This way you can keep a close eye on the infection. A nail free of nail polish is required to effectively apply a topical solution/antifungal paint.

For healthy toenails, I like to tell my patients 2 weeks maximum, then take the nail polish off to allow the toenail to ‘breathe’ and to inspect the nails. After 2-4 days you can apply again. This advice is based on using nail polish free of nasty chemicals. Wearing nail polish for longer than 2 weeks particularly ones with the nasty chemicals will increase your risk of nail staining.

 

Final thoughts

I don’t wear nail polish so writing this blog has been very informative, particularly around UV protection. So I think I’ll start wearing UV protected nail polish in summer. As I get older, my nails may dry and break easily, in this case I will need to consider a hydration treatment. There are only three brands of nail polish I would apply to my nails, they are Sienna, Smith & Cult and Dr.’s Remedy.

What hasn’t changed with writing this article are my thoughts on nail salons. I still won’t attend them given the risk of skin infections and risk from UV lamps.

 

References and Further Information Resources

 

Further info on skin cancers on nails

https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/nail-melanoma

https://www.skinrepair.net.au/have-you-checked-your-nails-lately/

 

Further info on nail salon UV lamps

https://www.cancer.org.au/iheard/do-the-uv-lights-used-in-nail-salons-for-shellac-and-other-nail-polishes-cause-skin-cancer

https://www.molemap.net.au/skin-cancer-prevention/manicure-putting-you-at-risk

https://www.skincare.com/body-care/hands/skin-cancer-on-your-nails

 

Further info on nail changes during chemo

https://www.bcna.org.au/resource-hub/articles/nail-changes/

https://www.cancerpal.co.uk/post/looking-after-nails-during-chemotherapy-treatment

 

Further info on the difference between non-toxic nail polish, regular nail polish, gel, shellac and acrylic

https://sienna.co/blogs/news/nail-polish-acrylic-gel-explained

 

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