Ava Monroe
Fingernails and toenails are made up of three main parts: the nail itself, the underlying structure that supports nail growth, and the skin tissue that surrounds it. The growing part of the nail is under the skin at the nail's proximal end under the epidermis, which is the only living part of a nail. The nail root, which is the base of the nail underneath the skin, produces most of the nail's volume and length. The nail bed, or sterile matrix, determines the thickness of the nail. The nail matrix, which lies beneath the skin at the inner edge of the nail plate, is responsible for most of the nail's growth. It produces new cells that advance forward to form the nail.
| Characteristics | Values |
|---|---|
| Average growth rate of fingernails | 3-3.5 mm per month |
| Average growth rate of toenails | 1.6 mm per month |
| Fingernail growth time | 3-6 months |
| Toenail growth time | 12-18 months |
| Growth rate influenced by | Age, sex, season, exercise level, diet, hereditary factors, hand dominance, finger length, overall health |
| Growth rate affected by | Peripheral artery disease, skin conditions, chemotherapy, medication, injuries, fungal infections, illnesses, vitamin deficiencies |
| Nail structure | Nail, underlying structure, skin tissue |
| Nail root | Extends several millimetres into the finger, produces volume of the nail and nail bed |
| Nail bed | Determines thickness, contains blood vessels, nerves, melanocytes |
| Proximal nail fold | Skin bordering the bottom of the nail, keeps the nail in place and protects it as it grows |
| Cuticle | Found between the skin of the finger and the nail plate, provides a waterproof barrier |
| Paronychium | Skin that overlaps onto the sides of the nail plate |
| Hyponychium | Area between the free edge of the nail plate and the skin of the fingertip |
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What You'll Learn
The nail matrix and its role in nail growth
The nail matrix is a critical structure within the nail unit, responsible for initiating nail growth. Located at the base of the nail, underneath the skin, it is the birthplace of new nail cells. The nail matrix is composed of special cells that continuously create new layers of nail plate cells, which are then pushed outward, forming the nail plate or nail body. This process replaces old, dead skin cells, contributing to nail growth.
The nail matrix consists of two main parts: the germinal matrix and the sterile matrix. The germinal matrix, also known as the nail matrix itself, is the active growing tissue responsible for about 90% of nail growth. It lies beneath the skin, at the inner edge of the nail plate, and extends several millimetres into the finger. The sterile matrix, also called the nail bed, makes up the remaining 10% of nail growth. It extends from the edge of the nail root to the hyponychium, the area between the free edge of the nail plate and the skin of the fingertip. The nail bed provides attachment for the nail plate and contains blood vessels, nerves, and melanocytes that produce melanin.
The nail matrix plays a crucial role in determining the thickness and shape of the nail. The length of the matrix directly influences the thickness of the nail plate. A longer matrix results in a thicker nail, while a shorter matrix leads to a thinner nail. Additionally, the shape of the matrix affects the curvature of the nail plate. A flatter matrix produces a flatter nail, whereas a more curved matrix creates a deeper C-shaped curve in the nail plate.
Maintaining the health and integrity of the nail matrix is essential for optimal nail growth and overall nail health. Damage to the matrix can result from injuries, certain health conditions, medications, and skin diseases. This damage can lead to nail imperfections such as white spots, ridges, and grooves, as well as weaken the nail plate, making it more prone to breakage. In severe cases, damage to the matrix may cause permanent nail deformities or even nail loss. Proper nail care, protection of the matrix, and a well-balanced diet are crucial for supporting nail growth and maintaining nail health.
The nail matrix is an intricate and delicate structure that plays a vital role in nail growth and development. Its continuous production of new nail cells and influence on the characteristics of the nail highlight its significance in nail health and appearance. Protecting the nail matrix and addressing any issues promptly are essential steps in ensuring the long-term health and vitality of nails.
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Factors influencing nail growth rate
The growth rate of nails is influenced by a variety of factors, some of which are within our control, while others are not.
Age, Sex, and Genetics
The growth rate of nails is influenced by age, with older individuals experiencing slower nail growth than younger people. This is due to a decrease in blood circulation as we age. Additionally, hormone levels, particularly during pregnancy and lactation, can affect nail growth rates. The growth rate also differs between males and females and can be influenced by hereditary factors.
Season, Exercise, and Diet
Seasonal changes can impact nail growth rates, with nails growing faster during the summer months. Exercise levels and physical activity can also play a role, as increased circulation stimulates nail growth. A well-balanced diet that includes sufficient protein, omega-3 fatty acids, and vitamins (such as vitamin A, B12, and folate) is essential for nail health and growth.
Overall Health and Medical Conditions
Overall health and medical conditions can significantly affect nail growth. Certain illnesses, such as a heart attack, COVID-19, pneumonia, or peripheral artery disease (PAD), can interrupt nail growth and cause abnormalities in the nails. Skin conditions like severe eczema and psoriasis can also interfere with nail growth and lead to changes in nail appearance.
Nail Trauma and Habits
Trauma to the nail, such as biting your nails or frequent nail clipping, can stimulate circulation in the nail bed and result in faster nail growth. However, these habits may carry risks, and it is generally recommended to practice good nail hygiene by keeping nails clean, trimmed, and moisturized. Additionally, protecting your nails from injuries and properly treating any nail disorders, such as ingrown toenails, is crucial for maintaining healthy nail growth.
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Nail injuries and their treatment
A nail injury occurs when any part of the nail, including the nail bed, cuticle, or surrounding skin, is cut, torn, smashed, or bruised. Minor damage to the nail matrix can cause temporary changes in nail appearance, while severe injuries can cause the nail to fall off.
Treating Mild Nail Injuries at Home:
- Treat the wound by gently cleaning it with soap and water.
- If the wound is bleeding, avoid putting a dry bandage or gauze on top, as it will stick. Instead, apply petroleum jelly to keep the wound moist, then cover it with gauze or a bandage.
- Apply a cool, damp washcloth to reduce swelling.
- Prop the injured arm or leg on pillows so that the nail is higher than your heart to further reduce swelling.
- Take over-the-counter pain relievers like ibuprofen or acetaminophen to manage pain and swelling.
- Keep a light dressing on the nail, such as an adhesive bandage or gauze, to provide padding and protection during the healing process.
- Keep your nails short to prevent them from bending or catching on objects.
Medical Treatment for Severe Nail Injuries:
- For severe nail injuries with significant bleeding, visit an urgent care center or emergency room.
- Medical professionals will stop the bleeding, clean the wound, and numb the affected area before treatment.
- For large bruises, a procedure called nail trephination is performed to create a small hole in the nail, allowing blood and fluid to drain out and relieving pressure and pain.
- If the injury is severe, the nail may need to be removed, and the nail bed repaired with stitches or special glue.
- Antibiotics may be prescribed to prevent infection.
- In the case of a broken bone, a wire may be placed in the finger to keep the bone in place.
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The structure of a nail
The nail is a protective plate found at the tip of the digits (fingers and toes) of almost all primates. It is made of a tough rigid protein called alpha-keratin, which is also found in claws, hooves, horns, and nails of vertebrates. The nail is divided into three main parts: the nail plate, the underlying structure that supports nail growth, and the skin tissue that surrounds it.
The nail plate, also known as the nail body, is the hard nail area from the nail root to the free edge. It is made of translucent keratin protein and is about half a millimeter thick and slightly curved. The shape of the nail plate is determined by the form of the underlying bone. The nail plate is strongly attached to the nail bed and does not contain any nerves or blood vessels.
The nail root is the base of the nail underneath the skin. It produces most of the volume of the nail and the nail bed. The nail root appears as a visible white crescent, known as the lunula. The lunula is the whitish crescent-shaped base of the visible nail and can be best seen in the thumb.
The nail bed is the soft tissue and skin underneath the nail plate that helps support nail growth. It contains blood vessels, nerves, and melanocytes that produce melanin. The nail bed extends from the edge of the nail root, or lunula, to the tissue known as hyponychium.
The hyponychium is the area between the free edge of the nail plate and the skin of the fingertip. It is the epithelium located beneath the nail plate at the junction between the free edge and the skin of the fingertip.
The nail matrix is the active tissue that generates cells. It lies beneath the skin, at the inner edge of the nail plate, and is responsible for most of a nail's growth. It is where new cells grow and then advance forward to form the nail. The nail matrix is also known as the germinal matrix, matrix unguis, keratogenous membrane, or onychostroma.
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Nail disorders and infections
Healthy nails serve to protect the distal phalanx, the fingertip, and the surrounding soft tissues from injuries. They also improve dexterity and sensation in the fingertips. However, several nail disorders and infections can affect the health, strength, and appearance of fingernails and toenails.
Nail Disorders
- Beau's lines: Deep, horizontal grooves across the nails. They are usually a natural consequence of aging, although they may also indicate a disease, nutrient deficiency, poisoning, or local injury.
- Onychoschizia: A common issue characterised by brittle, soft, splitting, or thin nails. It is often caused by repeatedly wetting and drying the nails, but can also be due to iron deficiency or underlying illness.
- Onycholysis: The separation of the nail from the nail bed, resulting in discolouration (green, yellow, or opaque) and additional skin tissue under the nail, nail pitting, nail thickening, or bending of the nail edges.
- Onychogryphosis: A condition where the nail becomes overgrown and thick, often affecting the big toe. It can cause one portion of the nail to grow longer than the other.
- Onychomycosis: A chronic infectious disease that impairs proper nail formation.
- Ingrown toenails: A common nail disorder that can cause pain, swelling, and infection. Genetics is thought to play a role in their development.
- Subungual melanoma: A type of skin cancer that affects the nail matrix. It is identified by brown or black discolouration on the nail.
- Nail psoriasis: Up to 80% of people with psoriasis develop nail psoriasis, which causes white lines, pitting, crumbling, and changes to the nail texture.
- Vitamin deficiencies: Insufficient vitamin B12 can lead to darkened nails and curved nail ends, while inadequate vitamin A and B intake results in fragile nails with horizontal and vertical ridges.
Nail Infections
- Paronychia: A bacterial nail infection that usually results from bacteria entering broken skin near the cuticle and nail fold. It causes discolouration and swelling around the edges of a nail bed.
- Fungal infections: Certain types of mould and fungus can infect the nails, causing them to become thick, discoloured, and brittle.
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Frequently asked questions
On average, a healthy person's fingernails grow about 3 to 3.5 millimeters per month.
Toenails grow about half as fast as fingernails, at an average of 1.6 millimeters per month.
The rate of nail growth depends on age, sex, season, exercise level, diet, hereditary factors, and overall health. Nails on the dominant hand and longer fingers tend to grow faster.
Fingernails protect the distal phalanx, fingertip, and surrounding soft tissues from injuries. They also improve dexterity and sensation in the fingers.
Minor damage to the nail matrix can temporarily change the nail's appearance. Severe damage could cause the nail to fall off. Once the nail matrix heals, the nail will usually start to grow again, although it may take several weeks. In cases of severe damage, the nail may not grow back.
