Noah Sinclair
Nail injuries are common and can be extremely painful. They can occur in many ways, from catching your finger in a door to biting your nails. The pain caused by a nail injury can be throbbing and intense, and may even limit finger movement. In some cases, the nail may fall off before it regrows, and the new nail may be misshapen. Depending on the severity of the injury, medical attention may be required to ensure proper healing and to mitigate the risk of infection.
| Characteristics | Values |
|---|---|
| Nail injuries | Cutting, tearing, smashing, bruising, crushing, slicing |
| Nail bed injuries | Subungual hematoma (bruising), lacerations (cuts), avulsions (tearing) |
| Treatment | Antibiotics, pus drainage, stitches, bandages, pain medication |
| Healing time | 7-10 days for nail bed to heal, 4-6 months for fingernails to grow back, 12 months for toenails |
| Prevention | Avoid biting nails, use your own clippers at salons, moisturize cuticles, avoid chemicals |
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What You'll Learn
Nail biting
Serious or long-term damage from nail-biting is rare but possible. The greatest risk of long-term damage is from infections to the skin, stomach, or intestines, but these are usually treatable.
To stop biting your nails, it is helpful to identify your triggers—the emotions or situations that make you prone to biting—and develop coping mechanisms that replace nail-biting with healthier alternatives. For example, if you bite your nails when anxious, you could squeeze a stress ball or play with a fidget toy instead. Keeping nails trimmed and using bitter-tasting nail polish can also help to reduce the temptation to bite.
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Paronychia (nail infection)
Paronychia, or nail infection, is a bacterial or fungal skin infection that develops around the nail. It can be acute or chronic. Acute paronychia develops quickly and treatment can reduce symptoms rapidly. Chronic paronychia, on the other hand, has a slower onset and can take weeks for treatment to be effective.
Paronychia occurs when bacteria enter broken skin near the cuticle and nail fold, causing an infection. The cuticle is the skin at the base of the nail, and the nail fold is where the skin and nail meet. Common causes of skin damage around the nail include biting or chewing nails, working with wet hands, or exposure to chemicals.
Symptoms of paronychia include pain, swelling, and tenderness around the nail. The skin may be red and warm to the touch, with pus building up under the skin. A white to yellow, pus-filled abscess may form, and the nail may start to grow abnormally with ridges or waves. It may become dry, brittle, and distorted, often with transverse ridges, and can eventually detach from the nail bed and fall off.
Treatment for paronychia depends on the severity and cause of the infection. Mild cases can be treated at home by soaking the affected area in warm water several times a day and applying lemon and salt. It is important to minimise germ exposure and frequently wash and keep the infected area clean.
For more severe cases, medical treatment may be necessary. Doctors may prescribe antibiotics or antifungal medication, depending on the type of bacteria or fungi causing the infection. In some cases, pus may need to be drained from the affected area, and surgical removal of part or all of the nail may be required.
Chronic paronychia can be a persistent condition that may last for months or longer and can recur. It is important to seek medical advice if symptoms do not improve or the infection spreads beyond the nail. Severe, chronic paronychia often affects individuals with diabetes, vascular disease, or conditions affecting blood circulation.
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Subungual hematoma (nail bruise)
A subungual hematoma is a collection of blood under the nail, also known as a nail bruise. It is usually a red or purple-black colour, fading to blue over a few weeks. The entire finger or toe throbs and is painful to touch or even move through the air. The pain occurs due to the pressure of blood collecting between the nail and the nail bed.
Subungual hematomas usually occur when the nail gets crushed in an injury. For example, smashing a finger in a door, hitting it with a hammer, or cutting it with a knife.
Small subungual hematomas may not need medical treatment. You can ice and elevate the area to reduce swelling, and take over-the-counter anti-inflammatories like aspirin, Advil, Motrin, ibuprofen, or acetaminophen for minor pain.
If the pain is more severe, a doctor may perform decompression, also known as trephination, to relieve the pressure and pain. This involves creating a small hole in the nail to drain the blood. This can be done with a heated wire (electrocautery device), a carbon laser, a heated needle, a battery-operated heating device, or even a heated paperclip. The doctor may numb the affected finger or toe with a nerve block first.
In some cases, the nail may need to be removed and the nail bed repaired with stitches.
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Nail bed laceration (cut)
A nail injury can occur when the nail is cut, torn, smashed, or bruised, or when the nail is torn away from the skin. This can be caused by a variety of things, including smashing your finger in a door, hitting it with a hammer or another heavy object, or cutting it with a knife or another sharp object.
Nail bed lacerations (cuts) are a common type of nail injury. If you experience a nail bed laceration, you must first remove any jewelry, clean the area with soap and water, trim the nail if possible, stop any bleeding, apply ice, and elevate the area. If you are experiencing a more serious nail bed injury, you should seek help in the emergency room.
In the emergency room, the medical team will stop the bleeding and clean the wound. The nail and affected finger or toe will usually be numbed with medicine before treatment. For a larger bruise, a doctor will create a small hole in the nail to allow blood and fluid to drain out and relieve pressure and pain. If the bone is broken or the bruise is very large, the nail may need to be removed, and the nail bed repaired.
To repair the nail bed, the cut will be closed with stitches. The nail will then be reattached with medical-grade glue or stitches. If the nail cannot be reattached, a special type of material will be used to cover the nail bed as it heals. Antibiotics may be prescribed to prevent infection, and pain medications such as acetaminophen or ibuprofen may be recommended to reduce pain and swelling.
It will take about 7 to 10 days for the nail bed to heal, and a new fingernail will take about 4 to 6 months to grow back. Toenails take about 12 months to grow back. The new nail may have grooves or ridges and may be misshapen, which could be permanent.
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Home treatments for nail injuries
A nail injury can occur when the nail, nail bed (skin underneath the nail), cuticle (base of the nail), or the skin around the sides of the nail becomes injured. This can be caused by crushing forces, such as a hammer or a door slamming on the fingers, cutting or tearing, or accidents, nail biting, or frequent manicures or pedicures.
- If there is a minor cut or scrape, gently wash it with soap and water and apply a bandage if needed.
- If there is a subungual hematoma (nail bruise) that you do not want to be drained and it occupies less than 25% of the nail, keep the hand or foot elevated above the heart level to help with the throbbing.
- For pain, take acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Advil) if you are not allergic to these medications.
- If there is a large nail bruise, your doctor may decide to drain the blood by placing a hole in the nail plate. This procedure is painless and can be done with a heated paper clip, a heated needle, or a battery-operated heating device.
- If the nail is torn, use sterile scissors to cut off rough edges to prevent further injury.
- Clean the wound and torn nail area with soap and warm water, and apply antibiotic ointment to prevent infection and bandage.
- For swelling, ice the area and elevate the injured area above the heart.
If the injury is severe or there is a lot of bleeding, it is important to seek medical attention.
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Frequently asked questions
Nail cutbacks are not painful if done correctly. However, cutting nails too short can lead to pain and discomfort. Cutting nails too short can expose the nail bed, which can be painful and lead to infection.
A subungual hematoma is a collection of blood under the nail, often caused by crushing or heavy impact injuries. It usually looks like a bruise under the nail and can be very painful.
If you injure your nail, you should first remove any jewellery from your hand, especially rings, as the finger may begin to swell. Gently wash any cuts or scrapes with soap and water, and apply a bandage if necessary. For more serious injuries, you should seek medical attention.
You can use over-the-counter medications such as acetaminophen, ibuprofen, or naproxen to help reduce pain and swelling from a nail injury. Keeping your hand or foot elevated above the level of your heart can also help reduce throbbing and discomfort.
Yes, nail biting can cause pain and damage the tissue that helps nails grow. It also increases the risk of nail infections, which can be painful.
