Isla Bennett
Our nails are constantly regenerating, with new cells being produced in the nail matrix, the area under the cuticle. However, sometimes new nails can grow on top of old nails, a condition known as retronychia. This occurs when the nail plate grows into the nail fold, causing layers of nail plates to stack on top of each other. Retronychia is often caused by repetitive injury to the nail, such as wearing tight shoes, and can result in pain, inflammation, and discolouration. In some cases, wounds and infections may develop, requiring medical attention. Proper nail care and footwear choices can help prevent retronychia and other nail issues.
| Characteristics | Values |
|---|---|
| What is it called when a new nail grows under an old one? | Retronychia, Onycholysis |
| What causes it? | Repetitive injury to the nail, wearing tight shoes, toenail injury, nail trauma, allergic reaction, fungal infection, psoriasis, illnesses like COVID-19 or pneumonia, nail matrix damage |
| What are the symptoms? | Pain, inflammation, yellow or white discoloration of the nail, thickened nail, separation of the nail from the nail bed, discharge or bleeding from under the nail, blisters, corns, callus or sores on the skin |
| Treatment | Corticosteroids applied to or injected into the nail, nail trephination, surgery, keeping nails short and trimmed, avoiding activities that may harm nails, wearing gloves, addressing underlying causes |
| How long does it take for a new nail to grow? | Fingernails: 4-6 months, Toenails: 8-12 months |
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What You'll Learn
Onycholysis: when the nail separates from the skin underneath it
Onycholysis is a condition in which the nail separates from the nail bed, i.e., the skin underneath it. It is not usually painful, but its severity depends on the underlying cause. Onycholysis is often caused by nail trauma, an allergic reaction, a fungal infection, or psoriasis. It can also indicate a more serious health issue, such as a yeast infection or thyroid disease.
The condition does not go away on its own, and treatment focuses on addressing the underlying cause to encourage a new nail to grow. This process can take several months, during which it is important to keep nails short and avoid activities that may harm them. As the new nail grows, the lifted portion of the nail can be carefully clipped.
Onycholysis should be medically assessed to determine its cause. Minor damage to the nail matrix, the "factory" where new nails are produced, can cause temporary changes in nail appearance. However, severe damage can result in the nail falling off, and in rare cases, the nail matrix may be permanently damaged, preventing nail regrowth.
Retronychia is a separate condition caused by the ingrowth of the proximal nail plate into the proximal nail fold. It is characterised by inflammation of the nail fold and yellow or white discolouration of the nail plate. In the chronic stage, the nail plate becomes thickened and separates from the nail bed, leading to stacked layers of nail plates and a missing cuticle.
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Retronychia: when the nail plate grows into the nail fold
Retronychia is a recently identified disorder characterised by the ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent paronychia, particularly following trauma.
Retronychia occurs when the nail plate (the hard part of the nail made of the protein keratin) grows into the nail fold. Multiple generations of new nail plates can then grow on top of one another in a stack under the old nail plate because the nail matrix and the old nail plate are no longer aligned. The growth of a new nail plate pushes the old nail upwards. Retronychia most often affects the big toenails and is caused by repetitive injury to the nail, often due to wearing tight shoes or engaging in activities that lead to toenail injury.
In the acute stage, retronychia is painful and causes inflammation of the nail fold, white or yellow discolouration of the nail plate (xanthonychia), and the growth of new connective tissue on the inflamed areas (granulation tissue). In the chronic stage, the inflammation resolves, but the nail plate becomes thickened and separates from the nail bed. Layers of nail plates can become stacked, and the cuticle may be missing. The tissues around the nail may also be swollen, red, and tender.
Retronychia can be diagnosed by its appearance, including the layers of nail plates and the missing cuticle. Treatment options for acute retronychia include corticosteroids applied to the nail or injected into it.
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Nail injuries: bruises, wounds and blood under the nail
Bruises under the nail
If you have a darkened area under a nail and haven't injured yourself, it's important to see a doctor to rule out other possible causes. If you have injured yourself, the dark area is likely caused by a subungual haematoma, which is blood collecting under the nail due to an injury. This can be extremely painful due to the pressure of the pooled blood.
Wounds under the nail
If you have an open wound under your nail, you may have a nail infection called paronychia. This happens when bacteria enter broken skin near the cuticle and nail fold, causing an infection. Nail biting or picking at the cuticles can create tiny cracks in the nails or cuts in the skin, allowing bacteria to enter. Symptoms include pain, swelling and tenderness around the nail, skin that is red and warm to the touch, and pus that builds up under the skin. Antibiotics can treat paronychia.
Blood under the nail
If you have bleeding under a large area of the nail surface, the nail bed may be injured. In this case, a doctor may need to remove the entire nail and use stitches to repair the nail bed. If the area of bleeding is small, the nail will usually fall off on its own after several weeks because the pooled blood has separated it from its bed. A new fingernail can regrow in as little as 8 weeks, while a new toenail may take up to 6 months.
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Ingrown toenails: caused by ill-fitting shoes
Ingrown toenails are a common problem that can be caused by several factors, including ill-fitting shoes. While it may seem minor, an ingrown toenail can lead to serious complications if left untreated.
Ingrown toenails occur when the toenail grows into the soft skin of the toe. This can happen when the nail is cut too short, allowing the skin to cover the corners of the nail and causing the nail to grow back into the skin. Nails that are ripped or torn instead of being cut straight across can also become ingrown.
Ill-fitting shoes are a significant contributor to ingrown toenails. Shoes that are too tight or narrow can push the skin against the nail, forcing it to grow into the skin. High heels, for example, can force the toes against the front of the shoe, increasing the risk of ingrown toenails. Additionally, shoes that are too loose can cause the nail to repeatedly slam into the front of the shoe, leading to trauma and improper nail growth.
To prevent ingrown toenails caused by ill-fitting shoes, it is important to ensure your shoes fit comfortably. There should be at least a half-inch gap between the end of your toes and the inside of the shoe, allowing your toes to lie flat and have room to wiggle. The toe box should be deep and wide enough to accommodate your toes without cramming them together.
If you suspect your shoes are causing ingrown toenails, switching to a different pair with a deeper toe box and a better fit can help resolve the issue. It is also important to address any underlying causes, such as thick nails, and to consider seeking advice from a podiatrist if the problem persists.
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Nail matrix damage: injuries and illnesses that affect nail growth
The nail matrix is responsible for nail growth. It can be damaged by injuries and certain health conditions, which can interfere with nail growth. Minor damage to the nail matrix can cause temporary changes in the appearance of the nail. For instance, you may observe a change in how the nail feels to the touch. A severe injury could even cause the nail to fall off. In cases of severe nail matrix damage, the nail may not grow back at all.
Injuries that can damage the nail matrix include pinching or crushing your finger, dropping something heavy on your toe, or breaking your finger. Trauma to the nail can cause nail cell production to stop for as long as three weeks. Nail growth will usually resume at a faster rate and steadily after about 100 days. You may notice that the nail appears thicker than usual. If you have a deep cut or trauma to the germinal matrix at the base of the nail, the nail may never grow back. Ingrown nails can also be caused by trauma to the nail and wearing tight shoes.
Illnesses and health conditions can also affect the nail matrix. For example, fungal infections are a common nail disease that causes the nails to become thick, discoloured, and easier to break. Toenail fungus may appear as thick, yellow, cracked, or cloudy nails. Illnesses like a heart attack, COVID-19, pneumonia, or a high fever can interrupt new nail growth and cause Beau's lines (horizontal ridges in your nails). Beau's lines can also be caused by malnourishment. Chemotherapy and other medications can also affect the nail matrix, causing Beau's lines or slow nail growth. Medications may also cause Mees' lines (white bands across the nails) and nail colour changes.
Other conditions that can affect the nail matrix include pterygium unguis, which causes scarring that extends to the nail matrix, and lichen planus, burns, and lupus erythematosus, which can cause nail ridges. A nevomelanocytic nevus is a mole or collection of melanocytes under the nail matrix that can be acquired following nail trauma. Paronychia is an infection of the fingernails or toenails that can lead to nail deformities. Nail psoriasis is another common nail disease that can be managed with medication.
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Frequently asked questions
Retronychia is a nail disorder caused by the ingrowth of the proximal nail plate into the proximal nail fold. It is often caused by repetitive injury to the nail, such as wearing tight shoes, and can lead to multiple generations of new nail plates growing on top of each other under the old nail plate.
In the acute stage, retronychia can cause pain, inflammation of the nail fold, yellow or white discolouration of the nail plate, and the growth of new connective tissue on inflamed areas. In the chronic stage, the inflammation resolves, but the nail plate becomes thickened and separates from the nail bed, leading to stacked layers of nail plates and a missing cuticle.
In the early stages, you may experience mild pain or discomfort in the affected toe, and the base of the nail may appear discoloured. As the nail growth progresses, the existing toenail will be raised by the new nail, creating an entry point for bacteria and potential infection. If this happens, see a doctor or podiatrist for advice.
Ensure your footwear has a deep enough toebox and is long enough so that your nails/toes do not press against the top of the shoes. If you experience a bruise or wound under your nail due to tight shoes, relieve the pressure by choosing a pair with more room.
