Caleb Foster
Fingernails are made of the protein keratin and flattened cells. The nail plate, or the top part of the nail, is transparent, or clear, because the flattened cells don't have nuclei. The nail appears to be different colors because the clear nail exposes colors underneath the nail plate. The lunula, or the white crescent shape at the base of your nail, is the only visible part of your nail matrix. As your nails grow out beyond the nail bed, they usually change to white. This is because the nail is dry. This is nothing to worry about and is a sign of healthy nails. However, nail separation, or onycholysis, is when your nail separates from its nail bed, and it may be caused by injury or fungi.
| Characteristics | Values |
|---|---|
| Appearance | Nails are typically translucent, but can appear opaque when dry. |
| Colour | Nails can be clear, white, or pink. |
| Shape | The lunula is the white crescent shape at the base of the nail. |
| Structure | The nail matrix has two parts: the germinal matrix and the sterile matrix. |
| Growth | Nails grow from the nail matrix. Minor damage to the nail matrix can change the appearance of the nail. |
| Health | Nail colour can indicate health conditions, such as peripheral artery disease, eczema, psoriasis, and subungual melanoma. |
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What You'll Learn
Nail growth and injuries
Our nails are formed in the nail matrix, which consists of two parts: the germinal matrix and the sterile matrix. The germinal matrix contributes to about 90% of nail growth, while the remaining 10% comes from the sterile matrix, which is also responsible for keeping the nail attached to the underlying skin.
Injuries to the nail matrix can occur from pinching or crushing your fingers or dropping something heavy on your toes. This can cause bruising, ridges, or discoloration, and in severe cases, the nail may fall off. Nail injuries can also result from nail-biting, cuticle-biting, or ill-fitting shoes, leading to deformities, thickened nails, or discoloration.
If the nail is torn or jagged, it is advisable to trim it to prevent further injury. In cases where the nail separates from the nail bed, it will not reattach, but a bandage can be used to hold the nail in place for comfort until a new nail grows. Fingernails typically regrow in about two months, while toenails take around four months.
For minor nail bed injuries, such as subungual hematomas, home care may be sufficient, and the nail usually heals on its own. However, professional treatment is recommended to ensure smooth nail regrowth. In more severe cases, a doctor may perform trephination, a procedure that involves making a small hole in the nail to drain the pooled blood. If the injury involves the nail matrix, a ridge or split may develop, and severe damage can result in permanent nail loss.
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The role of the nail matrix
The nail matrix is a delicate structure situated at the base of the nail that plays a crucial role in nail growth and overall nail health. It is responsible for creating new cells, which become the fingernails or toenails. The nail matrix has two main parts: the germinal matrix and the sterile matrix.
The germinal matrix, located under the lunula (the white crescent shape at the base of the nail), is the most active part of the nail matrix. It contributes to approximately 90% of nail production, giving the nail its natural curvature. The cells created in this region start off soft and gradually harden as they move away from the matrix, filling with keratin. This process determines the thickness and shape of the nail, with a longer matrix resulting in thicker nail growth.
The sterile matrix, on the other hand, accounts for the remaining 10% of nail cell production. While it plays a smaller role in nail growth, the sterile matrix is crucial for keeping the nail attached to the underlying skin. It is located above the lunula and is connected to the fingertip skin.
Maintaining the health of the nail matrix is of utmost importance for optimal nail growth and vitality. Damage to the matrix, whether from injuries, diseases, or nutritional deficiencies, can lead to various nail imperfections, such as white spots, ridges, or deformities. In severe cases, the nail may even stop growing or fall off. Therefore, proper care and protection of the nail matrix are essential to prevent damage and promote healthy nail development.
Additionally, the nail matrix is susceptible to certain conditions and diseases. For example, peripheral artery disease can slow nail growth by reducing blood flow to the legs and feet, affecting the nail matrix. Skin conditions like severe eczema and nail psoriasis can also interfere with nail growth, causing changes in texture, colour, and the appearance of Beau's lines (horizontal ridges). Nail matrix melanoma, or subungual melanoma, is a type of skin cancer that affects the nail matrix and can cause brown or black discolouration. Seeking medical care for any colour changes in the nails is essential.
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Nail hydration and colour
The colour of your nails can be an indicator of your health. Healthy nails are typically transparent and pink due to the vascular activity under the nail bed. As nails grow out past the skin, they often turn white or clear. This is because the nail is dry, and the flattened cells do not have nuclei. However, well-hydrated nails will appear more translucent.
Genetics, health, and natural nail thickness influence the colour of your nails. The average number of keratin layers in fingernails is around 50, while toenails have 100. Individuals with 40 layers may have nail tips that remain transparent, whereas those with 60 layers may observe more white spots if they fail to keep their nails hydrated.
Various factors can affect nail hydration and colour. For example, peripheral artery disease slows nail growth by reducing blood flow to the legs and feet. Skin conditions like severe eczema can also interfere with nail growth, leading to Beau's lines, pitting, and texture or colour changes. Nail psoriasis can cause similar issues, including white lines and crumbling nails. Additionally, subungual melanoma, a type of skin cancer, may manifest as brown or black discolouration on the nail.
Certain health events, such as a heart attack, COVID-19, or pneumonia, can interrupt nail growth and cause Beau's lines (horizontal ridges). Chemotherapy and other medications may lead to slow nail growth, Mees' lines (white bands), and nail colour changes. Fungal infections can also cause thick, yellow nails with white spots and streaks.
Nail care practices can impact nail hydration and colour. Manicures, frequent trimming, buffing, and polishing can lead to onycholysis (nail separation from the nail bed). Chemical exposure from nail products can also cause onycholysis. Environmental factors, such as frequent handwashing and exposure to cleaning chemicals, can contribute to nail discolouration. To maintain nail hydration, you can apply emollients like petroleum jelly or lotion containing alpha-hydroxy acids or lanolin.
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Onycholysis and nail separation
Onycholysis, or nail separation, is a common condition in which the nail separates from the nail bed, or the skin beneath it. It is usually not painful, but the cause of onycholysis may be irritating or painful. It can last for several months or over a year, and may resolve once a new nail grows to replace the old one.
Onycholysis can be caused by a variety of factors, including:
- Trauma or injury to the nail or the nail matrix (the area where nails start to grow)
- Exposure to chemicals in nail polish, nail gloss, nail hardener, nail polish remover, and fake nails
- Fungal infections, which cause nails to become thick and yellow, with white spots and streaks
- Certain medications, such as chemotherapy, tetracycline, nonsteroidal anti-inflammatory drugs (NSAIDs), psoralens, and oral retinoids
- Nail psoriasis, which causes changes to the structure of the nail
- Iron deficiency
- Hyperthyroidism
- Skin conditions, such as eczema and psoriasis
- Peripheral artery disease (PAD), which reduces blood flow to the legs and feet, affecting nail growth
Treatment for onycholysis depends on the underlying cause. It is important to keep the affected area clean and dry to prevent bacterial or fungal infections. In some cases, topical medications or oral supplements may be prescribed to address the root cause. As the nail grows out, the lifted nail can be clipped away.
To prevent onycholysis, it is recommended to avoid activities that may harm the nails, such as aggressive clipping, and to keep nails short and trimmed. Wearing gloves while handling substances that could damage nails is also suggested.
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Environmental factors and medical conditions
Fingernails are made of the protein keratin and flattened cells. The nail plate, or the top part of the nail, is transparent, or clear, because the flattened cells don't have nuclei. The nail appears to be different colours because the clear nail exposes colours underneath the nail plate. Healthy nails are transparent and look pink because of the vascular activity under the nail bed. They change to clear or white when they grow out past the skin.
Discolouration or changes to the texture of your nail may be signs of certain environmental factors, injuries, or medical conditions. Not all changes to fingernails are a medical concern. However, if you experience drastic changes to your fingernails or suspect a health condition is affecting your nail health, you should see a doctor or medical professional.
One environmental factor that affects the colour of your nails is moisture level. Usually, the nail tips that have grown out get dry, so they appear opaque or white. A well-moisturised nail will be more translucent. Genetics, health, and natural nail thickness also play a role in determining the colour of your nail as it leaves the fingertip. A person with 40 layers of keratin may have nail tips that stay more transparent, whereas a person with 60 layers will have more layers to keep hydrated, and if they don't, the tips turn whiter.
Chemical exposure, weather, and frequent handwashing can also cause nails to become clear. If you suspect that your nails have changed because of environmental factors, you can wear gloves when using chemical cleaners, avoid frequent handwashing, and apply emollients like petroleum jelly or lotion containing alpha-hydroxy acids or lanolin after soaking your hands.
Injuries to the nail or the nail matrix (where your nails start to grow) can also cause changes to your nails. You can injure your nails by bumping or hitting them, wearing shoes that are too small, or even keeping your nails in water for too long. Regular manicures can also cause nail injuries, as manicurists use a lot of force to trim, buff, and polish nails. Even tapping your nails on a hard surface over a long period can cause injuries.
Additionally, certain skin conditions and diseases can affect your nail matrix. For example, severe eczema can interfere with nail growth, and up to 80% of people with psoriasis develop nail psoriasis, which can cause white lines, pitting, and crumbling of the nails. Peripheral artery disease (PAD) causes less blood flow to your legs and feet, affecting your nail matrix and slowing nail growth. Subungual melanoma, or nail matrix melanoma, is a type of skin cancer that affects your nail matrix. Brown or black discolouration on your nail is a common sign of this condition. Seek medical care if you see any colour changes in a single nail.
Other medical conditions that can affect your nails include fungal infections, which can cause your nails to become thick and yellow, with white spots and streaks. Illnesses like heart attacks, COVID-19, or pneumonia can interrupt nail growth and cause Beau's lines (horizontal ridges in your nails). Chemotherapy and other medications can also affect the nail matrix, causing Beau's lines or slow nail growth, Mees' lines (white bands across the nails), and nail colour changes.
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Frequently asked questions
Healthy nails are actually transparent and look pink because of the vascular activity under the nail bed. They turn clear or white when they grow out past the skin.
Not necessarily. Changes to your nail like peeling, splitting, or colour alterations may be signs of environmental factors or other medical conditions.
Environmental factors like chemical exposure, weather, and frequent handwashing can cause nail discolouration.
Peripheral artery disease, eczema, psoriasis, and subungual melanoma are some conditions that can affect your nail colour. Illnesses like a heart attack, COVID-19, or pneumonia can also cause horizontal ridges in your nails.
To maintain clear and healthy nails, avoid environmental factors that can cause discolouration. You can also apply emollients like petroleum jelly or lotion containing alpha-hydroxy acids or lanolin after soaking your hands.
