Acute Paronychia and Onychomadesis after a “Russian” Manicure: A New, Aggressive, and Destructive Form of Manicure for Dermatologists to Recognize

Abstract

Introduction

Cuticle reduction and removal techniques are commonly performed by nail technicians for nail cosmesis. However, manipulation of the nail cuticle can lead to localized infection and nail dystrophy.

Case Presentation

In this case, a 20-year-old woman from the Philadelphia area in the USA presented with onychomadesis secondary to acute paronychia following a “Russian” manicure. In this technique, an electronic filer is used to completely remove the cuticle, leaving the proximal nail fold exposed and vulnerable.

Conclusion

As this style of manicure is being inaccurately publicized as safe, it is important that dermatologists are aware of this technique and educate our patients about its potential for harm.

Established Facts

• The cuticle is an extension of the proximal nail fold that adheres to the nail plate and serves a physical barrier to prevent pathogen entry.

• Cuticle manipulation is a well-established risk factor for acute paronychia, which can lead to both temporary and permanent nail dystrophy.

Novel Insights

• The “Russian” manicure is a newly introduced popular technique in which an electronic filer is used to completely remove the cuticle.

• This style of manicure is being inaccurately publicized as a safe method for cuticle care.

• Dermatologists need to be aware of this aggressive form of manicure to counsel patients appropriately and inquire appropriately when evaluating patients with paronychia.

Introduction/Literature Review

The nail cuticle is a band of keratinized skin cells that extends from the proximal nail fold and adheres to the proximal nail plate. It serves as a physical barrier to prevent pathogen entry. Cuticle removal and reduction techniques are often utilized by nail technicians to improve the aesthetic appearance of the nail unit. Unfortunately, these techniques can introduce bacteria and cause acute paronychia, which can subsequently result in nail dystrophy. Herein, we report a newly introduced cosmetic procedure of cuticle removal being performed in salons, called the “Russian” manicure, which is inaccurately touted as a safe.

Case

A 20-year-old woman developed pain and swelling of the perionychium of her left fourth digit 1 week after a manicure. Her symptoms progressed over the next month until she developed periungual purulent discharge. She subsequently visited the emergency department and was diagnosed with acute paronychia (shown in Fig. 1). She presented to the dermatology clinic with onychomadesis 2 weeks after starting a 7-day course of cephalexin. The patient stated that the initial erythema, pain, and swelling had resolved with antibiotic treatment, but in the last week, the proximal aspect of her nail plate had lifted from her nail bed. She was informed that onychomadesis is secondary to a temporary arrest of nail matrix growth and reassured that her nail plate was likely to regrow. In reviewing the risk factors associated with paronychia, such as cuticle manipulation, onychophagia, and water immersion, our patient informed us that her nail technician had performed the specialized “Russian” manicure, in which her cuticle was complete removed. Of note, our patient had the “Russian” manicure on all fingers, but the cuticles did appear to regrow on unaffected nails (Fig. 1). Her manicure was performed with classic nail polish (i.e., not gel or powder), which chips easily with minor trauma. We recommended that the patient avoid this style of manicure in the future and exercise caution with any nail cosmetic procedures.

Fig. 1.

a Acute paronychia with evidence of early onychomadesis. b The cuticle has been completely removed.

Discussion

To our knowledge, there are no published reports of the “Russian” manicure in the dermatologic literature. In a “Russian” manicure, which is also called a “dry” manicure, the nail technician uses an electronic filer to completely remove the cuticle. The lifestyle website, HelloGiggles.com, published an article about these manicures in January 2021, explaining: “With this technique, each nail gets a cuticle massage and gets perfectly trimmed. Think of it as a cuticle exfoliation and treatment… While there is a dubious belief that cutting your cuticles damages the nail bed, in reality, Russian manicures and pedicures can make your nails shinier and improve nail growth… Russian manicures can actually be safer than other cuticle-trimming techniques, as cutting cuticles with a nipper can lead to uneven results and cause irritation if cuts are too deep” [1].

The authors identified multiple articles, blogs, and Instagram posts relaying a similar message to the lay public. The message that cuticles are unattractive and that their removal is not only safe, but aesthetically pleasing, is frankly dangerous. Cuticles are a critical part of the nail unit and serve as a physical barrier to prevent infection [2]. We know of no data suggesting that e-filers induce less irritation or inflammation than nippers. Rather, there is ample evidence that cuticle manipulation can damage the nail unit and increase risk of paronychia [2]. Though often assumed to be secondary to bacterial infection, paronychias are commonly caused by fungal or viral infection and may even be due to contact dermatitis or trauma-induced inflammation. Any of these insults may lead to a temporary arrest of the nail matrix and subsequent onychomadesis. We urge all dermatologists to educate their patients about the risks of cuticle cutting and removal.

Statement of Ethics

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Per institutional policy at the University of Pennsylvania, the publication of case reports is not considered human research and does not require IRB review or approval.

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

Funding Sources

No funding sources to declare.

Author Contributions

H.C.M. and A.K.F. diagnosed and treated the patient. H.C.M. and A.I.R. conceptualized the case report and novel insight regarding the “Russian Manicure” technique. H.C.M. prepared the initial manuscript. All authors reviewed the final manuscript.

Data Availability Statement

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Funding Statement

No funding sources to declare.