Cosmetics available for nail treatment include:
• nail varnish and stick-on nail dressing
• preformed artificial nails
• sculptured artificial nails
• nail wrapping
• adaptable nail prostheses
• abrader.

Nail varnish
Nail varnish may hide any type of chromonychia in women (or even girls) if the surface
of the nail plate is smooth, or if it can be rendered so by fine sandpaper. The hue
resulting from Pseudomonas nail infection is often hidden by nail varnish, which may be
kept on during the treatment with sodium hypochlorite and is a helpful therapy for this
condition. Psoriasis may benefit from the use of nail varnish under some circumstances.

Stick-on nail dressing
Also known as ‘press-on nails’, this consists of a very thin, coloured synthetic film with
an adhesive which fixes it firmly to the nail.
Press-on nails may be used to hide nail discolouration or mild dystrophies. They may
cause side effects that vary considerably in intensity from patient to patient: flaking,
roughness, ridging, onycholysis, disappearance of the lunula and disorganization of the
nail plate which may be delaminated and broken off. Mild paronychial inflammation
with loss of the cuticle may be seen.
In some instances 9–12 months will pass before the nails entirely return to normal. The
effect on the nail is simply traumatic, not allergic, a combination of the impermeability
of the adhering film and the cumulative trauma to the nail plate when the film is
repeatedly pulled off.

Preformed artificial nails
Any dystrophy may be hidden by preformed artificial nails, providing that some natural
nail plate surface is still present to allow adequate adhesion. It is obvious that a severe
dystrophy will prevent this and the usefulness of such a prosthetic nail is then limited.
Local complications may appear when preformed artificial nails remain on for 3–4 days.
Distant allergic eczematous contact dermatitis may occur, more often due to the glue
than to the prosthetic nail itself.

Sculptured artificial nails
Some natural nail keratin must be present for sculptured artificial nails to be used. The
natural nail is first roughened with a burr, then painted with the acrylic resins which
harden at room temperature and become moulded on to the nail. The prosthesis can be
filed and manicured to shape. As the nail grows out, further applications of the self-
curing acrylic resins can be made to maintain a regular contour.
Allergic contact dermatitis may appear, generally after 2–4 months of application, as
distant sensitization (face, eyelids) or local reactions (onychial and paronychial tissues).
On patch testing, the patient may react strongly to the acrylic liquid monomer.

Nail wrapping
In nail wrapping the free edge of each nail is splinted with layers of a fibrous substance
such as cotton wool, paper or plastic film affixed with a variety of glues; after drying, the
edge is fashioned to requirements and the nail is coated with enamel. The entire
procedure is repeated every 2 weeks. Nail wrapping is useful but can do significant harm
if the entire nail is covered because of the occlusive nature of the material used. Allergic
reactions to cyanoacrylate nail preparations (painful paronychia, onychodystrophy,
discoloration and even exceptional permanent nail loss) are rare, but may persist for
more than a year.

Adaptable nail prosthesis
In a wide variety of conditions, ranging from deformed nails to complete loss of the
distal phalanx, and in women particularly, a silicone rubber thimble-shaped finger cover
may be employed. The fixation is excellent. The device is easy to clean (plain soap),
flame-resistant, and the formed nail takes varnish well.

Nail abrasion
Thick nails caused by diseases such as psoriasis, pityriasis rubra pilaris and
pachyonychia congenita can be abraded. Hyperkeratosis is prone to be associated with
onychomycosis of the toes. Nail abrasion helps to expose the nail bed to antifungal
chemicals, especially in elderly people in whom systemic treatment is not advisable.
Abrasion is a good way to improve the contour of an abnormal nail, for example in
onychogryphosis. In selected cases of ingrowing toe nail, repeated thinning of the nail
plate may be a useful conservative method in association with appropriate definitive
treatment.
There are many products, implements and devices for maintaining clean, well-
groomed nails to satisfy individual needs. These benefits are obtained with small risk.
The physician can and should be well versed in nail care and adornment to aid patients in
achieving an improved, positive self-image: when specific medical cure is shown to be
impossible, the physician will then be in a good position to judge the value of cosmetic,
chiropody or podiatry treatments.