Ava Monroe
Fingernails and toenails are made up of layers of keratinized cells, which are produced in the nail matrix, an area beneath the cuticle at the base of the nail. When an injury occurs, the nail may stop growing temporarily as it recovers. The nail may also grow unevenly or distortedly, and severe trauma may result in long-term or permanent effects, such as nail loss. Treatment for nail injuries depends on the severity of the injury, and proper care can help the nail matrix heal and restore nail health.
| Characteristics | Values |
|---|---|
| Nail trauma effects | Bruising, ridges, rough surface, discoloration, irregularities, nail loss |
| Nail matrix injuries | Bruising, ridges, discolouration, nail loss |
| Nail recovery time | 6-18 months for a new nail to grow back |
| Nail bed recovery time | 7-10 days |
| Treatment | Keep the nail bed dry, clean, and covered with petroleum jelly and an adhesive bandage |
| Treatment for severe injuries | Surgery, chemotherapy, radiation |
| Factors influencing nail growth | Skin conditions (e.g. psoriasis, eczema), thyroid imbalances, age, season, protein intake, hydration, medication |
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What You'll Learn
Nail injuries and their treatment
A nail injury can occur when the nail, nail bed, cuticle, or the skin around the nail is damaged. This includes cuts, tears, smashing, or bruising. Treatment for nail injuries depends on the type and severity of the injury. For instance, minor injuries can be treated at home, while more severe injuries may require urgent medical attention.
For minor nail injuries, the first step is to stop any bleeding and clean the wound with soap and water. If the wound is bleeding, avoid putting a dry bandage or gauze on top, as it will stick to the wound. Instead, apply petroleum jelly to keep the wound moist, then cover it with gauze or a bandage. Change the dressing daily while the wound heals. To reduce swelling, apply a cool, damp washcloth to the wound or prop the injured arm or leg on pillows so that the nail is higher than your heart. Non-prescription medications like ibuprofen or acetaminophen can also help relieve pain and reduce swelling.
For more severe nail injuries, it is recommended to seek medical attention at an urgent care center or emergency room. Providers will stop the bleeding and clean the wound. They may also numb the affected area with medicine before treating it. In some cases, a small hole may be created in the nail to drain blood and relieve pressure and pain. If the injury is severe, part or all of the nail may need to be removed, and the nail bed may need to be repaired with stitches or special glue. Antibiotics may also be prescribed to prevent infection.
After a nail injury, it is common to see temporary changes in nail growth, such as bruising, ridges, discolouration, or uneven growth. These changes can be long-term or permanent if the nail matrix is significantly damaged. Nails grow back slowly, with fingernails taking about six months or longer to regrow, and toenails taking up to 18 months. During this time, it is important to keep the nail bed dry, clean, and covered with petroleum jelly and a bandage until the nail has grown back.
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Nail growth after severe trauma
Trauma to the nail can cause a variety of temporary or lasting changes in nail growth, from discoloration to irregularities. The extent of these changes depends on factors like the severity of the nail injury, the depth of the trauma, and the area affected. For example, damage to the base of the nail near the cuticle is more likely to cause significant changes than a crack at the tip.
Severe trauma, such as crushing injuries or deep cuts, may result in long-term or permanent damage if the nail matrix is significantly injured. The nail matrix is the tissue inside the cuticle at the base of the nail where new nail cells are formed. After an injury to the nail matrix, you may experience bruising, ridges, or discoloration. Your nail may even fall off. In cases of severe nail matrix damage, some or all of the nail may not grow back, and the nail may become misshapen.
After a severe nail injury, it is common for nails to show temporary changes as they heal, such as bruising, ridges, or a rough surface. Nail growth may be stunted or absent for up to 21 days after the injury. The nail then grows rapidly for approximately 50 days, creating the characteristic lump that is often observed on nails that regrow after trauma. As a result of scar tissue being unable to produce nail material, damage to specific components of the perionychium will lead to defects during regrowth. For example, a scar on the dorsal roof of the nail fold may create a dull streak on the nail surface, while a scar on the germinal matrix may cause the nail to split or be absent.
To promote recovery after a severe nail injury, it is important to keep the area clean and dry. Cover the nail bed with petroleum jelly and an adhesive bandage until the nail bed is firm or the nail has grown back. Apply a new bandage whenever the bandage gets wet. Watch for signs of infection such as increasing heat, redness, pain, tenderness, swelling, or pus. If the nail has lifted completely off the nail bed, it may be most comfortable to replace the nail and hold it in place with a bandage. However, nails will not reattach themselves to the nail bed after they have separated. In most cases, a new nail will slowly regrow, although it may take several weeks for the new nail to appear.
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The impact of skin conditions on nail regrowth
Nail injuries can cause temporary or permanent changes in nail growth, from discoloration to irregularities. Minor nail injuries can cause noticeable changes, such as stubbing your toe, catching your finger in a door, or hitting your nail on a hard surface. Severe trauma, on the other hand, such as crushing injuries or deep cuts, may result in long-term or permanent damage if the nail matrix is significantly affected.
The nail matrix is where your fingernails and toenails form. It is made up of two parts: the germinal matrix and the sterile matrix. The germinal matrix contributes about 90% of nail growth, while the remaining 10% comes from the sterile matrix, which is responsible for keeping the nail attached to the underlying skin. When the nail matrix is damaged, it can interfere with nail growth, causing the nail to grow unevenly, slowly, or even stop growing temporarily as it recovers from the injury.
Several skin conditions can affect nail regrowth by interfering with the nail matrix. Here are some examples:
- Eczema: Severe eczema can affect the nail matrix, causing Beau's lines (horizontal ridges), pitting (small, pinhole-like dots), and changes in texture or colour.
- Psoriasis: Nail psoriasis can lead to white lines, pitting, and crumbling of the nails. It is prevalent in up to 80% of individuals with psoriasis.
- Subungual melanoma: This type of skin cancer affects the nail matrix and can cause brown or black discolouration of the nails.
- Fungal infections: Certain types of fungi can invade the nails, usually the toenails, leading to thick, yellow, cracked, or cloudy nails.
- Peripheral artery disease (PAD): PAD reduces blood flow to the legs and feet, affecting the nail matrix and slowing down nail growth.
It is important to note that any changes in the appearance or texture of nails could indicate a nail matrix problem or another underlying condition. Therefore, consulting with a dermatologist or a healthcare provider is crucial to determine the cause and receive appropriate treatment.
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Nutrition and nail health
Nail trauma can cause temporary or lasting changes in nail growth, from discoloration to irregularities. Severe injuries that involve the nail matrix may result in long-term or permanent changes, such as chronic thickening, uneven growth, or even complete nail loss. After an injury, nails may show temporary changes during the healing process, such as bruising, ridges, or a rough surface.
Proper nutrition is essential for supporting nail health and promoting healthy nail growth, especially after an injury. Here are some key nutrients to focus on:
Biotin
Biotin, also known as vitamin B7, helps strengthen brittle nails and improve their growth. It can be found in eggs, nuts, seeds, salmon, sweet potatoes, and avocados. While biotin deficiency is rare, consuming biotin through whole foods or supplements can be beneficial for nail health.
Vitamin B12 and Folate (Vitamin B9)
Vitamin B12 plays a crucial role in iron absorption and the development of red blood cells, both of which are necessary for strong and healthy nails. A deficiency in vitamin B12 can lead to changes in nail pigmentation. Folate, or vitamin B9, is also important for nail growth by contributing to red blood cell formation and new cell development. Include vitamin B12-rich foods like meat, poultry, fish, and dairy products in your diet. Folate can be found in leafy greens, citrus fruits, beans, and nuts.
Iron
Iron is essential for providing cells with oxygen, including nail cells. An iron deficiency can cause vertical ridges in the nails, or the nails may become concave or "spoon-shaped" (koilonychia). Include iron-rich foods such as red meat, poultry, fish, lentils, beans, and fortified cereals in your diet. Pairing these with vitamin C-rich foods like citrus fruits, strawberries, and bell peppers can enhance iron absorption.
Magnesium
Magnesium is involved in protein synthesis, which is necessary for nail growth. A deficiency in magnesium may manifest as vertical ridges in the nails. Whole grains, dark green leafy vegetables, quinoa, almonds, cashews, peanuts, and black beans are good sources of magnesium.
Omega-3 Fatty Acids
Omega-3 fatty acids have anti-inflammatory properties and help maintain healthy cell membranes. They keep nails moisturized and prevent dryness and brittleness. Fatty fish like salmon, mackerel, and sardines are excellent sources of omega-3s. Plant-based options include chia seeds, flax seeds, and walnuts.
Vitamin E
Vitamin E is a powerful antioxidant that protects nails from damage caused by free radicals. It also improves blood circulation, supporting nail growth. Almonds, sunflower seeds, spinach, and avocados are good sources of vitamin E.
Zinc
Zinc plays a vital role in nail growth and repair. A deficiency in zinc can cause white spots on the nails and slow down their growth. Incorporate zinc-rich foods like oysters, beef, pumpkin seeds, and chickpeas into your diet for healthy nail growth.
Vitamin C
Vitamin C is essential for collagen production, which provides strength and structure to nails. It also enhances the absorption of iron from plant-based sources. Include citrus fruits, strawberries, bell peppers, and broccoli in your diet to boost your vitamin C intake.
In addition to these specific nutrients, staying properly hydrated by drinking enough water and consuming hydrating foods is crucial for nail health. Dehydration can lead to dry, brittle nails that are more prone to breaking. Finally, limiting your consumption of sugary and processed foods can help reduce inflammation and support nail health.
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Home care for nail injuries
Nail injuries can be very painful and can cause temporary or permanent damage to the nail. The treatment depends on the severity of the injury. Minor nail injuries may heal on their own, while more severe injuries may require medical attention. Here are some tips for treating a nail injury at home:
Treating the wound
If any part of your nail is hanging off, gently trim away the part that is not connected to your skin. Then, gently clean the wound using soap and water. If the wound is bleeding, do not put a dry bandage or gauze on top, as it will stick to the wound. Instead, apply petroleum jelly to keep the wound moist, and then cover it with gauze or a bandage. Repeat these steps daily while the wound heals.
Bandaging
Make sure to only apply sticky products, such as adhesive bandages or medical tape, to the skin around the nail. This will prevent further irritation to the injury. Wrapping the wound with an elastic bandage is also an option, but do not wrap it too tightly. Change the bandage whenever it gets wet.
Reducing swelling
Apply a cool, damp washcloth to the wound to reduce swelling. Prop the injured arm or leg on pillows so that the nail is higher than your heart. Taking ibuprofen or acetaminophen can also help relieve pain and reduce swelling when the injury is fresh.
Preventing further injuries
Keep your nails short to prevent them from bending or catching on objects. Ensure your shoes fit well and have a wide toe box to prevent rubbing. Wear appropriate gear to protect your nails when playing sports.
When to seek medical help
If your injury does not look or feel better after a few days, or if you cannot bend your finger or toe, see a board-certified dermatologist. Other signs that you should seek medical attention include:
- Blood covering more than half of your nail
- Your nail turning black or purple
- Severe pain
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Frequently asked questions
It takes about 6 months or longer for a fingernail to grow back, and up to 18 months for a toenail. The new nail will probably have grooves or ridges and be somewhat misshapen. This may be permanent.
Keep the nail bed dry, clean, and covered with petroleum jelly and an adhesive bandage until the nail has grown back. Apply a new bandage if the original gets wet. Make sure to watch out for signs of infection such as increasing heat, redness, pain, tenderness, swelling, or pus.
You may benefit from a procedure called nail trephination, which involves draining the trapped blood. This procedure provides pain relief and helps your new nail grow in correctly. It must be performed within 48 hours of the injury.
