Navigating nail care after a breast cancer diagnosis

“A lot of the weight of the world is on Black women,” says Eboney Thompson, who was trained as a nail technician and is thriving with metastatic breast cancer. “We’re taking care of everyone else and constantly putting ourselves at the back of the line. When you sit down in the salon chair, that’s your time to yourself where you can feel beautiful. This is my serenity space, my peace.”

People of all races, genders, and ethnic backgrounds now use nail art as a form of self-expression, a source of well-being and self-care. However, for many thrivers and survivors, nail care goes even deeper than beauty or relaxation. It’s about reconnecting with a sense of self. “With cancer you’re trying to find your new normal, especially with stage IV,” says Eboney. “Wearing nails and having my toes done gives me a piece of my old life.”

Bold nails can be a banner of wellness. “When my nails are intact and right, it represents my health going the right way,” Eboney explains. “A lot of people ask me, ‘Let me see your fingernails’ because they can tell by the way my nails are decorated how I’m feeling.” Even losing her hair (after the first time), was not as difficult for her as the discoloration and drainage from her nails, side effects caused by chemotherapy. “I could cover my hair with a wig, but I couldn’t use acrylics or glue on my fingers, due to the risk of infection.”

The drainage that Eboney experienced (which she described as oozing) was a symptom of paronychia, a nail infection that can be a side effect of chemotherapy after two or more months into treatment. Nails may also become darker, develop white streaks or ridges, or become brittle, dry, and cracked. Sometimes they can lift up from the nailbed, which is the layer of living cells underneath the nail. Eboney’s children helped her wrap her fingers in protective gauze, and they started joking about her having mummy fingers. “We’re a big jokester family, so they helped me change the bandages on my fingers and came up with jokes to keep me laughing instead of crying,” she remembers.

Eboney Thompson and her family -- and her manicured nails

Read more about nail changes caused by breast cancer treatments here.

Find more information on general nail care during treatment here.

Multiple risks at nail salons

Lori Ranallo, RN, MSN, APRN-BC, CBCN, a board-certified breast oncology nurse practitioner who is also an LBBC Medical Advisory Board member, confirms that infection is the most important hazard of nail salons. “We really discourage anything that increases your risk of infection while your white blood cell count is depressed by treatment,” she says. In a salon you’re exposed to a lot of people in a small space for several hours, a possible source of germs. Then you have mechanical risks that come from cutting nails and cuticles. Even a tiny opening in the skin can allow infection to enter. Since some breast cancer treatments reduce the sensitivity of your hands and feet to hot, cold, and pain, you might not even realize it if you are injured.

It's also crucial that your medical team can inspect your nails and nailbeds. Colored polish, gel tips, acrylics, or press-ons prevent your team from seeing the condition of your actual nails. Glue-ons can also trap bacteria and breed infection. Ranallo says that when the nail is healthy, press-on products that don’t require glue or heat may be an option, as long as they can be removed easily for check-ups and your oncologist approves.

“If you notice anything different about your nails, go to your oncology team first,” Ranallo emphasizes. For example, if you went to a podiatrist about changes in your toenails, they might prescribe an antifungal medicine that could interfere with treatment or lead to liver problems. “When you see anything new or different about your nails, tell us (your oncology team) first.”

Different approaches for different cancer stages

Ranallo makes an important distinction between early-stage versus stage IV, metastatic disease. “With early-stage disease, the goal is a cure, and we’ve got one shot to do it.” Changes in your lifestyle–like avoiding manis/pedis–will only be a temporary sacrifice and can promote treatment success. An infection that interrupts your chemotherapy schedule, even for a week, can alter the outcome, especially in adjuvant therapy.

On the other hand, “if you have metastatic breast cancer, you will be on treatment for the rest of your life.” In that case, “if it makes you look and feel better, if the human touch—the caressing of your hands and taking time for yourself—is good for you, then let’s just modify it so you can continue to enjoy it.” But, she adds that there may be interruptions in what you can do safely, based on the type and timing of your treatment.

Timing and communication are essential

Ranallo explains that every treatment that lowers your white blood cell count has a specific nadir—the point at which your counts will be at their lowest and you are most vulnerable to infection. “Find out from your oncologist what is the strongest time in your treatment cycle and schedule your nail appointments then; avoid the nadir. If you are taking something like filgrastim (Neupogen) to boost your white cell count, then you have some added protection, and that’s also a good time for nail care.”

Communication with your oncology team is vital. “Have an open conversation with your oncologist. With each new treatment, ask what parts of your body could be impacted, and how. Then it’s your job to say what is important to you. If beautiful nails are part of your identity, say so, and work with your team to arrive at the best approach,” Ranallo advises. There are ways to have a salon experience but use precautions. For example, in a post-COVID world, it is much more acceptable to wear a mask at the salon—to avoid catching whatever is going around—without people thinking it is odd. Ranallo, herself, loves the nail salon experience. She urges you to get a good hand massage, have the cuticle softened and shaped gently without cutting, have the nails filed to the shape you prefer, and get some plain polish rather than gel tips or acrylics. Press-ons might be a way to achieve more glamour. Check with your oncology team about ways to manage salon safety.

Expressing “you” in the midst of change

“A lot of people have major body changes with breast cancer,” says Chelsea Schlepp, who was diagnosed with early-stage breast cancer almost two years ago. “I personally lost both my breasts, all my hair, my eyebrows, and my eyelashes. It's hard to feel feminine at all, or even like yourself, in that situation. Nail polish was one thing that I could still use to help feel better about the situation. It was also a way to express some individuality.” Chelsea now uses and sells Color Street nail strips, a nail appliqué made of nail polish that is dried, shaped and ready to press on. She enjoys the different designs and glitters that can help her feel festive for a special event.

Mary Mills, who also uses and sells Color Street, said that carboplatin (Paraplatin) burned her nail beds. About two months after treatment, her nails started falling off. She received a lot of support from her community. “I continue to live life every day and just be me. I refuse to let cancer win,” she says.

The joy of vacation nails

Ronda Carter of Winston Salem, NC, who is living with metastatic breast cancer, finds manicures almost a necessity. “My treatment makes my fingernails very thin, and without polish my nails are so painful I can’t do anything with my hands. Ronda has built a 12-year relationship with her current manicurist. They know about each other’s lives and families and Ronda trusts this woman to be gentle and understand what she needs. “When I go on vacation, I like to take pictures of my ‘vacation nails,’ and I look at them when I don’t feel good. They cheer me up.”

To get started (or to restart) with manicures, Ronda suggests that you visit a salon when it’s not busy (e.g., on a weekday) before making an appointment. “It’s easy to look around and know if the salon is well taken care of. Do they sterilize their instruments in an autoclave? Do they display a license on the wall?” Is there good air ventilation and adequate space between stations? If you see someone rocking great nails at a breast cancer event, in a Facebook group, or in your physician’s office, ask what salon and which technician they use.

Which products are safe?

There is rising concern about many beauty products used for hair, skin, and nails, both at home and in salons. In particular, the hair relaxers traditionally used by many Black girls and women may be associated with a higher risk of some types of cancers. Several websites and phone apps have been developed to help women of color learn more about a wide range of beauty products and specific ingredients to avoid.  For more details read 6 tips to empower your beauty choices.