Noah Sinclair
Nails are produced by the nail matrix cells that reside in the moon-shaped whitish area (lunula) at the base of the nail. If the nail matrix is not damaged, the nail is typically capable of regrowth. The nail protects the nail bed, the skin at the upper tip of the finger or toe. A well-rounded diet and good general health help to produce strong nails. Nail damage can be caused by working, playing, or repeated trauma. Since nails are on the back of our fingertips and toes, they are prone to damage. Longer nails are more likely to become damaged because they can be levered off the nail bed or run into the end of an athletic shoe.
| Characteristics | Values |
|---|---|
| Nail regrowth after removal | Nails typically regrow after being removed or falling off, although this may take several weeks or months. |
| Factors influencing regrowth | Proper medical care, a well-rounded diet, and good general health can promote nail regrowth. |
| Preventing nail removal | Keeping nails short and wearing well-fitting shoes can help prevent nail damage and removal. |
| Nail matrix damage | Damage to the nail matrix can cause defects in the regrowing nail, ranging from minor to significant deformities. |
| Onycholysis | A condition where the nail separates from its nail bed, often due to injury, fungus, or skin conditions. Treatment includes cutting away the nail, antifungal medications, and avoiding irritants. |
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What You'll Learn
Nail matrix damage can cause permanent nail loss
The nail matrix is the "factory" where your body produces new fingernails and toenails. It is the living, delicate structure responsible for nail growth and regeneration of the nail bed. The nail matrix is located just below the nail fold, which protects it from injuries. However, damage to the nail matrix is a common problem, often resulting from mechanical injuries or improper nail care procedures.
When the nail matrix is damaged, it can lead to nail growth disorders, an unfavourable appearance, and pain. Minor damage to the nail matrix can cause temporary changes in the nail's appearance, such as white spots, ridges, or grooves. These imperfections occur as the new cells produced in the matrix move forward and harden, resulting in the formation of the nail. The length and shape of the nail matrix determine the thickness and shape of nail growth. Therefore, damage to the matrix can permanently reshape it, resulting in a lasting ridge or deformity in the nail plate.
In cases of severe nail matrix damage, some or all of the nail may not grow back. This is because the nail matrix is responsible for producing new nail cells. If the matrix is destroyed, it will not be able to create the nail, resulting in permanent nail loss. While it is rare for the nail matrix to be permanently damaged, it is important to seek medical care to promote proper nail growth and prevent further issues.
To treat nail matrix damage, it is essential to consult a specialist who can assess the severity of the injury. Initial treatment may involve applying antiseptic agents to prevent infection. For serious damage, nail reconstruction or surgical intervention may be necessary. Proper nail care and protection are crucial to safeguarding against potential damage and promoting optimal nail growth. This includes maintaining nail hygiene, avoiding excessive pressure or trauma to the matrix area, and ensuring a well-balanced diet for strong and resilient nails.
While nail matrix damage can have various repercussions on the health and appearance of the nail, with proper medical care, healthy nails can often grow back. It is important to prioritize the well-being of the matrix to maintain the long-term health and vitality of the nail.
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Nails can be surgically removed
Indications for Surgery
Ingrown toenails are a common indication for nail removal surgery. Ingrown toenails occur when the side corners of a toenail grow into the surrounding nail fold and pierce the soft tissue. If left untreated, ingrown toenails can cause pain, swelling, redness, and infection. In most cases, ingrown toenails can be treated at home or with the help of a podiatrist or orthopedic surgeon. However, in severe or recurrent cases, surgery may be recommended to provide relief and prevent further issues.
Other indications for nail removal surgery include onycholysis, which is when the nail separates from its nail bed due to injury, fungal infections, or other conditions that affect the skin underneath the nail. Hypertrophied granulation tissue and chronic paronychia, often caused by fungal infections, may also require surgical intervention if conservative treatments are ineffective.
Surgical Procedures
Several surgical procedures are available for nail removal, and the specific technique depends on the underlying condition and its severity. Here are some common approaches:
- Wedge resection or partial nail avulsion: This involves removing a portion of the toenail to prevent it from growing into the surrounding tissue. It is a common procedure for ingrown toenails and is intended to preserve the rest of the toenail.
- Total nail removal or complete nail plate avulsion: This procedure involves removing the entire toenail. While it effectively treats the ingrown toenail, it increases the risk of the nail growing back misshapen or deformed, which can lead to future ingrown toenail issues.
- Surgery on the tip of the toe: In cases where other surgeries are unsuitable or unsuccessful, a doctor may remove and reshape the soft tissue at the tip of the toe.
- The Bunnell technique: This technique involves avulsing (removing) the proximal one-third of the nail using scissors and placing non-stick gauze under the nail plate.
- Laser treatment: Patients with multiple infected digits or immunocompromised individuals may respond better to laser treatment than surgical nail removal. Carbon dioxide laser vaporization offers precise control over tissue destruction and significantly reduces pain, edema, inflammation, and healing times.
- Matricectomy: This procedure involves the surgical resection of the lateral nail-forming unit, including the lateral nail plate, hyponychium, nail bed, and nail matrix. It is important to ensure that no remnants of the lateral matrix horn are left behind to prevent the recurrence of nail spicules.
Post-operative Care and Recovery
After nail surgery, it is crucial to follow the instructions provided by your healthcare professional to ensure proper healing and reduce the risk of infection. Here are some general guidelines:
- Keep the dressing on, clean, and dry until your redressing appointment, usually within 3 to 7 days after surgery.
- Redress your toe at least every 2 days or if the dressing gets wet or dirty. Use non-adherent, sterile dressings and tape.
- Bathe or shower as normal with the dressing in place, then remove it and allow the wound to air dry.
- You can soak your foot in warm, salty water for a few minutes and pat it dry before redressing.
- Avoid driving until the numbness in your toe wears off, as it may affect your insurance coverage in case of an accident.
- Keep your nails trimmed short to prevent them from catching and pulling off the nail bed as they grow.
- Be cautious when cleaning underneath your nails to avoid breaking the skin and causing infection.
- Avoid nail products that can irritate your nails or the surrounding skin, such as nail polish, nail gloss, nail hardeners, and nail polish remover.
- Be mindful of potential complications, such as allergic reactions to surgical equipment, phenol flare (a reaction to the chemical applied to prevent nail regrowth), and infection.
Nail removal surgery is generally successful, but it is important to be aware of the potential risks and follow the necessary pre and post-operative instructions to ensure a smooth recovery.
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Nails regrow after about 3-6 months
Fingernails and toenails are made of keratin, a protein that forms the cells that make up the tissue in nails. Nails form under the skin and push old cells through as they grow. The cells on the surface die and harden, turning into the nails that we see.
The nails that we see have no feeling, but the inner part of the nails under the skin does. This is why you can feel pressure near your cuticles but feel nothing when you clip your nails. Cuticles are there to protect the growth of the cells and prevent infection.
If you lose a fingernail, it can take anywhere from 3 to 6 months to regrow. Toenails take much longer, anywhere from 12 to 18 months. The rate of regrowth depends on various factors, including age, overall health, and hormones. For example, nail growth slows down if you are sick or malnourished, and it may peak during puberty and decline as hormone levels balance out with age.
There are no scientifically proven methods to make nails grow faster, but there are ways to increase their health and prevent them from breaking. Taking biotin supplements can promote cell growth and help your body metabolize protein-building amino acids, contributing to faster nail growth.
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Nail bed trauma can cause detachment
Fingernails and toenails are composed of protein and fat and are not live tissue. They grow a bit more than one-tenth of an inch per month and require 3-6 months to completely regrow. Nails are produced by the nail matrix cells that reside in the moon-shaped whitish area at the base of the nail.
If the entire nail is detached from the finger or toe, there is nothing that can be done to repair, reattach, or replace it. If there is any damage to adjacent tissues, the nail bed, the nail matrix, or the proximal nail fold that could result in scarring, this should be assessed by a physician and repaired if appropriate. If a portion of the nail is still adherent to the nail bed, it can be left intact. The non-adhering portion of the nail should be removed. The usual local precautions to prevent infection should be taken. The damaged skin should be covered with an appropriate dressing. If the nail bed and nail matrix are not damaged, the nail should regrow normally.
Treatment may involve cutting away the separated nail as it grows out, or taking antifungal medications, or stopping the use of certain nail products. If you have onycholysis due to a fungus, your healthcare provider may prescribe liquid medicines or pills/tablets that you swallow with water. Topical antifungal medication comes in the form of creams, ointments, or gels that you rub directly onto your nails. Nail fungi can be difficult to treat, so it’s important to finish your full course of medicine.
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Nail fungi can be treated with medication
Nail fungus, or onychomycosis, is a common condition that can be treated with medication. It is characterised by discoloured (yellowish-brown or opaque), thick, and brittle nails that may separate from the nail bed. While it is possible to get rid of nail fungus without a doctor's visit, it is important to note that hiding the condition or neglecting treatment will not make it go away. In fact, nail fungus is contagious and can spread through direct contact, sharing personal items, or by walking barefoot in moist, warm environments where someone with a fungal infection has been.
There are several treatment options available for nail fungus, including both topical and oral antifungal medications. Topical antifungal medications come in the form of creams, ointments, or gels that are applied directly to the nails. While these treatments are easily accessible over the counter, they are often not strong enough to completely eradicate the fungus. Additionally, keeping the nails trimmed short can enhance the effectiveness of topical treatments.
Oral antifungal medications, on the other hand, are prescribed by healthcare providers and tend to work faster and more effectively. These medications are taken by mouth in the form of pills, liquids, or tablets. Examples of oral antifungal drugs include terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan). It is important to follow the full course of treatment as directed by a healthcare professional to ensure the fungus does not return and become harder to treat.
In more severe or persistent cases of nail fungus, temporary or permanent nail removal may be recommended to facilitate treatment. This procedure is typically performed on an outpatient basis under local anaesthesia. While it may take a year or more for a new, healthy nail to grow back, nail removal can provide an opportunity for topical medications to reach the infected area more effectively.
To summarise, nail fungi can be effectively treated with medication, including both topical and oral antifungal options. Seeking treatment early and following the instructions of healthcare professionals is crucial for successful outcomes. Additionally, maintaining proper nail hygiene, keeping nails trimmed, and avoiding barefoot walking in communal areas can help prevent nail fungus and ensure overall nail health.
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Frequently asked questions
Yes, nails can be removed through a procedure performed under local anaesthesia. A tourniquet is applied to the finger or toe, and a surgical instrument is used to separate the nail from the nail bed.
Nails typically grow back after being removed, although this depends on the nail matrix and nail bed not being permanently damaged. In cases of severe nail matrix damage, some or all of the nail may not grow back.
It usually takes less than four weeks to fully recover from a nail removal procedure. Nails grow at a rate of about one-tenth of an inch per month, so it may take up to six to nine months for fingernails and 12 to 18 months for toenails to regrow completely.
Onycholysis, or nail separation, can be caused by injuries, fungal infections, and certain health conditions. Peripheral artery disease, eczema, psoriasis, and subungual melanoma can also affect nail growth and cause separation.
