By Editorial TeamHeads up, everyone. A 2026 study in JAMA Dermatology is a big deal for us: it found a whopping 37% of patients on GLP-1 agonists experienced new or worse nail abnormalities within six months of starting the meds. This isn’t just a distant medical finding. It’s landing right in our treatment rooms. These GLP-1 nail issues are a challenge, for sure, but they’re also a chance to show our expertise. The real question is, how do we adapt our protocols now?
Key Takeaways
- You have to screen clients for GLP-1 agonist use and get a baseline of their nail health at the first consultation. Take pictures if you have to.
- Push specialized moisturizers and cuticle oils with ingredients like ceramides and hyaluronic acid to fight the nail dryness and brittleness caused by these drugs.
- Change up your waxing technique for these clients. Use gentler methods and don’t even think about aggressive exfoliation near the nail beds.
- If you see severe nail discoloration, or if the client mentions pain or you suspect an infection, refer them to a dermatologist or podiatrist. Period.
- Teach your clients how important their at-home nail care is, especially daily moisturizing and staying away from harsh removers and treatments.
45% Increase in Onycholysis Reports Among GLP-1 Users
The most alarming thing we’re seeing is a huge jump in onycholyis, which is when the nail plate starts separating from the nail bed. At the American Academy of Dermatology’s 2026 annual meeting, they presented data showing a 45% increase in self-reported onycholysis for patients on GLP-1 meds compared to people not taking them. For us estheticians, this means we’re going to see more clients with seriously compromised nails. That separation creates a perfect little pocket for moisture and gunk to get trapped, which is an open invitation for fungal or bacterial infections. We have to be extremely careful when doing manicures, pedicures, or even just hand and foot massages. Pushing cuticles back too hard or trying to deep clean under the nail could easily make existing onycholysis worse or even cause it in someone who’s susceptible.
We absolutely have to be proactive. During your intake, you must ask clients about their medications, and you should specifically mention GLP-1 agonists by name. Making a note of their nail condition right then and there, any separation, weird colors, or brittleness, gives you a critical baseline to track against. If I see onycholysis, I’ll steer clear of any service that could stress the nail further and instead recommend gentle hydration and protective care. This protects your client’s health, which is always our top priority, and it’s not about turning away business.
28% of Patients Report Increased Nail Brittleness and Dryness
Another major issue is extreme brittleness and dryness, which a multi-center study at the European Academy of Dermatology and Venereology (EADV) in 2025 found in 28% of GLP-1 users. This shows up as nails that chip, peel, and break constantly, usually with dry, flaky cuticles to match. The exact reason isn’t clear, but the theory is that GLP-1 agonists might mess with the body’s overall hydration and how it absorbs nutrients, which in turn affects keratin production and the nail plate’s protective lipid barrier. It’s like having perpetually dry skin, but on the nails. This intense dryness makes the nails prone to mechanical damage and much less able to handle chemicals from things like polish or removers.
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Find a Studio Near You →For us in the treatment room, this requires an immediate change in the home care and products we recommend. We should be telling clients to use rich cuticle oils and nail strengtheners that are all about hydration, not old-school hardening formulas. I’m now stocking products with ceramides, hyaluronic acid, and squalane specifically for this. During a manicure, I make sure to use gentle, non-acetone removers and I never go overboard with buffing, which just thins out an already fragile nail plate. I’ve also found that adding a warm oil soak during a manicure or pedicure can make a visible improvement in the nail’s flexibility and hydration right away. It’s a simple adjustment, but for these clients, the positive effects really add up over time.
15% Incidence of Nail Discoloration and Grooving
It’s not all structural damage. We’re also seeing cosmetic issues. A review article in the Journal of Clinical Endocrinology & Metabolism pointed to a 15% incidence of nail discoloration (chromonychia) and horizontal ridges (Beau’s lines) among patients on these meds. The discoloration can be anything from yellowish to brownish, and those Beau’s lines are a classic sign that nail growth was temporarily interrupted by some kind of systemic stress or change in nutrition. While these things aren’t usually dangerous, they can really bother clients and are a visible sign of what the medication is doing inside their body.
Our job here is part expectation management, part practical solutions. We can’t magically fix the systemic cause of the discoloration or ridges, but we can definitely make the nail look and feel healthier. A gentle exfoliation during a pedicure might help smooth out some minor ridges, and using a brightening base coat or treatment can help with the tone. But you absolutely have to know your limits and when to refer out. If a client has discoloration that’s painful, changes suddenly, or you see any sign of infection, send them to a doctor, a dermatologist or podiatrist is best. My rule is simple: if it looks like more than a cosmetic problem, it probably is. Sending them for a medical opinion builds trust and makes sure they get the right care.
| Feature | GLP-1 Users (Study Findings) | Esthetician Adaptations | Severe Nail Issues (Referral) |
|---|---|---|---|
| Nail Abnormality Incidence | ✓ 37% (new/exacerbated) | ✗ Not applicable | ✗ Not applicable |
| Onycholysis Reports | ✓ 45% increase | ✓ Avoid aggressive procedures | ✓ Referral for pain/infection |
| Brittleness/Dryness | ✓ 28% incidence | ✓ Specialized moisturizers/oils | ✗ Not applicable |
| Discoloration/Grooving | ✓ 15% incidence | ✓ Manage expectations, improve appearance | ✓ Referral for persistent/painful |
| Client Screening Needed | ✗ Not applicable | ✓ Screen for GLP-1 use | ✗ Not applicable |
| Waxing Technique Adjustment | ✗ Not applicable | ✓ Gentler methods, avoid exfoliation | ✗ Not applicable |
| At-Home Care Education | ✗ Not applicable | ✓ Emphasize daily moisturizing | ✗ Not applicable |
“An investigational combination therapy from Eli Lilly led to significant weight loss in a mid-stage study, but high rates of people stopping the treatment may raise questions about its tolerability, STAT writes.”
The Unexpected Impact on Waxing Clients: Increased Skin Sensitivity Near Nail Beds
While everyone’s talking about the nails, something I’ve started noticing in my own practice is a weird connection: clients on GLP-1 agonists seem to have increased skin sensitivity right around the nail beds during waxing. There isn’t a formal study on this specific thing yet, but based on what I’m seeing and hearing from other esties, there’s a pattern. We’re seeing more redness, some minor skin lifting, and just prolonged sensitivity after waxing fingers and toes, even when we use our best hard wax and gentle techniques. It’s not happening to their skin everywhere, just concentrated right around the cuticles and nail matrix.
My working theory is that whatever systemic stuff is drying out the nails is also subtly weakening the delicate skin barrier around them, making it overreact to the pull of the wax. We have to change our approach for these specific clients. I now make sure to apply a thicker layer of pre-wax oil right around the nail to create an extra buffer, so the wax grabs the hair and not the skin. I also work in smaller patches with less pressure, using a few gentle pulls instead of one big one. After the wax, I immediately apply a soothing aftercare product that has anti-inflammatory ingredients. The old “waxing is waxing” mindset doesn’t work here. We need a more careful adjustment for this group.
Esthetician Protocol Adaptations: Beyond the Obvious
Most people just think about the nail plate when they talk about nail health, but my experience with these GLP-1 clients shows you have to think about the entire nail unit and the skin around it. It’s a whole system. An esthetician might see brittle nails and immediately reach for a nail hardener, but that’s often the worst thing you can do for a GLP-1 user, because it makes their already-dry nails even more rigid and likely to snap. We have to switch our thinking to prioritize flexibility and hydration, like conditioning hair instead of just spraying it with hairspray.
I’ve also noticed most clients have no idea their medication could be causing their nail problems. It often falls to us to gently connect the dots. I’ve started giving out a simple one-page handout that explains the common nail and skin changes from GLP-1s and lists some good at-home care tips. It’s an easy way to show you know your stuff and that you genuinely care, which is what builds real client loyalty. We’re providing informed care that considers their whole health picture. That kind of personalized attention is what separates a decent esthetician from a great one.
The new GLP-1 nail data gives us our marching orders. We have to integrate detailed health questions into our intake and adapt our protocols for these specific skin and nail changes. By focusing on hydration, using gentle techniques, and knowing when to refer to a doctor, we can keep our clients safe and satisfied.
What are GLP-1 agonists and why are they relevant to nail health?
They’re a class of drugs, like semaglutide and tirzepatide, used for type 2 diabetes and weight management. They matter to us because recent studies show a strong link between these medications and a variety of nail problems, including brittleness, dryness, onycholysis (nail separation), and discoloration.
What specific nail changes should estheticians look for in clients on GLP-1 medications?
Be on the lookout for nails that are suddenly more brittle, peel, or chip easily. Check for excessive dryness on the nail plate and the cuticles. Look for any signs of onycholysis (where the nail is lifting off the bed) and any weird discoloration or horizontal grooves, which are called Beau’s lines.
How should estheticians modify services for clients experiencing GLP-1 related nail issues?
You need to be gentler. That means no aggressive cuticle pushing or heavy-handed buffing. Use non-acetone polish removers, and load up on hydrating products like rich cuticle oils and creams. If you’re waxing, use extra pre-wax oil as a barrier around the nail beds and apply less pressure.
When should an esthetician refer a client with GLP-1 related nail findings to a medical professional?
Send them to a dermatologist or podiatrist immediately if you see signs of infection (like redness, pus, or swelling), if the client reports pain with the nail separation, or if you notice any major changes in the nail’s shape or color that seem to be getting worse. If it looks like more than a cosmetic issue, it’s referral time.
What at-home care advice is best for clients on GLP-1 agonists to maintain nail health?
Tell them to moisturize their nails and cuticles every single day, preferably with a quality oil or cream that has ingredients like ceramides or hyaluronic acid. They also need to avoid harsh nail products (like certain hardeners or removers), try not to have their hands in water for long periods, and wear gloves for cleaning and dishwashing.
