Caleb Foster
The human nail is made up of three main parts: the nail, the underlying structure that supports nail growth, and the skin tissue that surrounds it. While nails are constantly growing, they can develop issues such as ridges, discolouration, and thickening, which may be indicative of an underlying health condition. Thick toenails, for example, can be caused by fungal infections, psoriasis, or a condition called subungual exostosis, where a bony growth occurs underneath the nail bed, causing a second nail to grow.
| Characteristics | Values |
|---|---|
| Reason for nails growing in layers | Fungal infection, psoriasis, onychogryphosis, subungual exostosis, or an underlying illness |
| Symptoms | Discomfort, pain, change in colour (brown, yellow, or green), change in texture, swelling in arms and legs, cough |
| Prevention | Good foot hygiene, properly fitting shoes, trimming toenails, avoiding prolonged use of nail polish, treating underlying medical conditions |
| Treatment | Fungal infection medication, removal of the nail, store-bought remedies |
| Nail structure | Nail, underlying structure that supports nail growth, skin tissue that surrounds it |
| Nail growth | Germinal matrix (nail matrix), nail root, nail bed |
| Nail thickness | Determined by the nail root and nail bed |
| Nail growth rate | On average, a healthy person's fingernails grow about 3 to 3.5 millimeters per month |
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What You'll Learn
- Toenails growing in layers could indicate an underlying illness
- A fungal infection can cause toenails to grow in layers
- Subungual exostosis can cause a second nail to grow
- Onychogryphosis or Ram's horn nails cause one side of the nail to thicken
- Factors that affect nail growth include circulation, aging, and underlying health conditions
Toenails growing in layers could indicate an underlying illness
Toenails growing in layers can be a sign of underlying illness or other medical conditions. This phenomenon is called Onychauxis, where the nail bed is injured or damaged, causing the nail to grow abnormally and creating a second nail underneath the first nail. This condition can also be caused by subungual exostosis, a bony growth that occurs underneath the nail bed, pushing the nail upward and causing a second nail to grow.
One of the most common causes of toenails growing in layers is a fungal infection called onychomycosis. This infection causes the nail to change colour to yellow, green, or brown and thicken. It is important to treat this infection in its early stages as it can lead to other serious problems if left untreated. Besides fungal infections, other conditions such as psoriasis and onychogryphosis can also contribute to toenails growing in layers. Onychogryphosis is characterised by the thickening of nails due to injury or infection, often affecting the big toes and causing the nails to curve and resemble the shape of a ram's horn or claw.
Additionally, underlying illnesses such as diabetes, a weak immune system, or peripheral artery disease can cause toenail injuries and infections. People with these conditions may experience reduced sensation in their feet, making them less likely to notice and treat injuries or infections promptly. Toenails can also thicken or become disfigured due to trauma or injury to the matrix, the area below the skin where nails grow from. This trauma can be chronic or the result of an acute injury.
To prevent toenails from layering, it is essential to practice good foot hygiene, wear properly fitting shoes, trim toenails regularly, and treat any underlying medical conditions. If you notice any changes in your toenails, such as discolouration or thickening, it is recommended to consult a healthcare provider or podiatrist for diagnosis and treatment. They will be able to determine the underlying cause and prescribe appropriate medication or treatments.
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A fungal infection can cause toenails to grow in layers
Toenails can sometimes grow in layers, and while there are several causes for this, the most common is a fungal infection. This condition is called onychomycosis, also known as tinea unguium, and it occurs when fungi get between the toenail and the nail bed, usually through a crack or cut in the toe.
Fungal infections can cause the nail to thicken and change colour to yellow, green, or brown. The nail may also become fragile and separate from the nail bed. This is because fungi thrive in moist environments, and nail polish can trap moisture from the nail bed, making the infection worse. In rare cases, toenail fungus can cause a serious infection called cellulitis, which can be dangerous to your health.
It is important to seek treatment for toenail fungus, as it can be difficult to get rid of and often comes back. A healthcare provider will evaluate the affected toenail and may take a small sample from underneath the nail to confirm the diagnosis. Treatment options can then be discussed with a skin specialist or foot doctor.
To prevent toenails from layering, it is important to practice good foot hygiene, wear properly fitting shoes, trim toenails properly, and avoid prolonged use of nail polish. Treating any underlying medical conditions is also crucial. If you notice any changes in your toenails, it is best to consult a medical professional for proper diagnosis and treatment.
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Subungual exostosis can cause a second nail to grow
While nails do not grow in layers, there are several conditions that can cause nails to appear as if they are growing in layers. One such condition is a fungal infection called onychomycosis, which can cause nails to thicken and change colour to yellow, green, or brown. Other conditions that can cause similar symptoms include psoriasis and onychogryphosis, also known as Ram's horn nails.
In addition to these conditions, a rare phenomenon called subungual exostosis can cause a second nail to grow. Subungual exostosis is a benign bony growth that occurs underneath the nail bed, pushing the nail upward and causing it to separate from the bed, a process known as onycholysis. This condition can lead to nail deformities and is often associated with pain. While it can occur at any age, half of the reported cases tend to occur by 20 years of age, and it is more common in women.
The pathology of subungual exostosis involves the overgrowth of normal bone, which may present beneath the toenail or on the sides of the toe. It was first described by Dupuytren, who observed it on toes, and later by Hutchinson, who reported it on fingertips. The growth usually develops slowly over weeks to months and can cause swelling, ulceration, infection of the nail bed, and secondary changes in the surrounding tissues. As the mass grows, it can obstruct nail growth and cause the nail to detach, leading to the formation of fibrous tissue on its surface.
The treatment of choice for subungual exostosis is surgical removal of the lesion, usually performed under local anaesthesia. The tumour is completely removed, and the underlying bone is curetted (scraped clean) to prevent future recurrence and potential tumour development. In some cases, surgery may also be needed to repair the nail bed and prevent nail deformities. While subungual exostosis is uncommon, early detection and treatment are important to ensure the best outcomes.
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Onychogryphosis or Ram's horn nails cause one side of the nail to thicken
Onychomycosis, a fungal infection, is the most common cause of toenails growing in layers and becoming thick. Nails affected by onychomycosis may change colour to yellow, green, or brown. However, another condition that can cause toenails to thicken is onychogryphosis, also known as Ram's horn nails. This condition causes nails to thicken and curve like horns or claws, with one side of the nail growing faster than the other.
Onychogryphosis is a nail disorder resulting from slow nail plate growth. The nail plate becomes hypertrophied and uneven at the proximal matrix (the nail growth plate). The nails often become yellow, hardened, and veined in appearance. This condition mostly affects the big toe, but it can develop at any age and impact any of the other toes. It is more commonly observed in older people, those with poor personal care, and patients with senile dementia.
The exact cause of onychogryphosis is unknown, but it is associated with various skin diseases, including ichthyosis, psoriasis, pemphigus, tertiary syphilis, hyperuricaemia (gout), and, historically, smallpox. Peripheral vascular disease or peripheral artery disease (PAD) has also been linked to onychogryphosis, as it causes plaque buildup in the leg arteries. Additionally, conditions like hammer toe and wearing ill-fitting shoes can cause foot trauma, which may lead to onychogryphosis.
Treatment for onychogryphosis can be either conservative or operative, depending on its cause and symptoms. Surgery is often necessary, especially if the condition is genetic, as the nails may grow back, requiring multiple surgeries. In some cases, the affected nail plate may need to be removed. For less severe causes, such as foot trauma or infection, surgery can correct the problem, and patients can be taught proper nail care to prevent recurrence. To minimise excessive pressure on the nail bed, it is important to select properly fitted footwear.
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Factors that affect nail growth include circulation, aging, and underlying health conditions
Fingernails and toenails have an average growth rate of 3mm and 1mm per month, respectively. However, this rate is subject to variation due to factors such as circulation, aging, and underlying health conditions.
Circulation
Good circulation in the nail bed promotes nail growth. Nail biting, for instance, can stimulate circulation and lead to faster nail growth. Similarly, frequent nail clipping may also contribute to faster nail growth. Conversely, blood circulation slows down with age, leading to a decrease in nail growth rate over time.
Aging
Aging is associated with a slowdown in nail growth rate, with a decrease of approximately 0.5% per year starting at the age of 25. This can be attributed to factors such as changes in hormone levels, dysfunctional blood circulation at the distal extremities, and the effects of ultraviolet radiation. Additionally, nails may become more brittle and prone to breaking due to repeated wetting and drying or exposure to harsh chemicals.
Underlying Health Conditions
Underlying health conditions can also impact nail growth and appearance. For example, conditions like anemia, hardening of the arteries, and hormonal imbalances can cause changes in nail texture. Nails may become thicker or thinner, and fungal infections, which are common in older adults, can lead to nail thickening and discoloration. In some cases, dark ridges on the nails can indicate a more serious condition, such as melanoma or malignant skin cancer. Other conditions such as psoriasis and rheumatoid arthritis can also result in thicker nails.
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Frequently asked questions
Nails can grow in layers due to a fungal infection, which causes discolouration and thickening of the nail. Other conditions such as psoriasis and onychogryphosis can also cause this.
If your nails change in colour and texture and appear to be growing in layers, it is best to seek medical advice.
If you notice that your nails are growing in layers, it is important to see a healthcare provider or a podiatrist for diagnosis and treatment. There are treatments available for layered nails, but it is important to get the correct diagnosis.
To prevent your nails from growing in layers, practice good foot hygiene, wear properly fitting shoes, trim your toenails, avoid prolonged use of nail polish, and treat any underlying medical conditions.
