Ava Monroe
A nail bed is the tissue that sits underneath the fingernail and helps the nail grow normally. When a nail separates from its nail bed, it can be very painful and will not reattach. The nail bed should be kept dry, clean, and covered with petroleum jelly and an adhesive bandage to prevent infection until the nail has grown back, which can take 6 months or longer for a fingernail and up to 18 months for a toenail. Doctors may remove part or all of the nail if the nail bed is damaged, and in some cases, repair the nail bed.
| Characteristics | Values |
|---|---|
| Appearance | The nail bed is the tissue that sits underneath the fingernail and helps it grow normally. |
| Injury | Common causes include crushing the fingers between heavy objects, fungal infections, and chemical reactions. |
| Symptoms | Redness, purple, grey or white skin, irritation, swelling, pain, and tenderness. |
| Treatment | Keeping the nail bed dry, clean, and covered with petroleum jelly and an adhesive bandage. Antibiotics may be prescribed to treat infections. |
| Healing Time | It takes around 6 months for fingernails and up to 18 months for toenails to grow back. |
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What You'll Learn
Nail bed repair
Nail bed injuries are common and often occur when fingers or toes are crushed by a heavy object or cut by a sharp object. The nail bed is the tissue that sits underneath the fingernail and helps the nail grow normally. When injured, the nail can lift away from the nail bed, resulting in a detached or cracked nail that can be painful and unsightly.
If you have a detached nail, there is little that can be done to replace or repair it. However, you should assess the damage to ensure there is no infection or damage to the surrounding structures. If there is any damage to the nail bed, nail matrix, or proximal nail fold that could result in scarring, it should be evaluated by a physician and repaired if necessary. You should visit a physician if there are any signs of infection, such as redness, swelling, increasing pain, or pus.
If there is no evidence of tears or lacerations to the matrix or nail bed, simply remove any unattached remnants of the nail with a nail clipper, and clean the nail bed with a soapy washcloth and water to remove foreign material and blood. Keep your nails short to prevent them from catching on objects and causing further damage. Avoid biting your nails and be careful when cleaning underneath them, as tools like cuticle sticks and nail brushes can break the skin and cause infection. Refrain from using nail polish, nail gloss, nail hardener, nail polish remover, and fake nails, as these chemicals can irritate the nails and surrounding skin.
It typically takes a long time for the nail to recover. You can expect a new but abnormal nail to grow within three months, and a normal nail can take up to nine months to regrow. To prevent stiffness in your fingers during this time, it is recommended to touch the tips of each finger with your thumb and move your wrist forward and backward as often as possible.
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Preventing infection
After nail removal, the nail bed is exposed, and the tissue underneath the nail is vulnerable to infection. The nail bed is the tissue that sits under the nail and supports its growth. It is crucial to keep the wound clean and change the dressing regularly to prevent infection. Here are some detailed instructions to prevent infection after nail removal:
Keep the Wound Clean
Gently cleanse the area with warm, soapy water, and then pat it dry. Do this twice a day for the first 24 to 48 hours, and avoid using hydrogen peroxide or alcohol, as these can slow the healing process.
Change Dressings Regularly
Maintain a dry dressing for the wound for the first week. Change the dressing once or twice daily, or as advised by your healthcare provider. Soak your wound in warm water to ease dressing removal.
Monitor for Infection
Keep an eye out for signs of infection, such as redness, purple, grey, or white skin, irritation, and swelling. If you notice any of these symptoms, contact your healthcare provider immediately.
Avoid Certain Substances
Refrain from using nail care products that can irritate the nail bed and skin, such as nail polish, nail gloss, nail hardeners, nail polish remover, and fake nails. These products contain chemicals that can cause onycholysis (nail separation) and increase the risk of infection.
Keep Nails Short
Maintain short nails to prevent them from catching on objects and pulling off the nail bed. Avoid biting your nails and be cautious when cleaning underneath them. Tools like cuticle sticks and nail brushes can break the skin and cause infection.
Follow-up Care
Schedule a follow-up appointment with your healthcare provider to assess the healing process and check for any signs of infection. They can also provide further treatment recommendations to ensure proper healing.
By following these steps, you can help prevent infection and promote proper healing after nail removal.
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Signs of infection
After nail removal, the nail bed is exposed and vulnerable to infection. The nail bed is the tissue that sits underneath the fingernail and aids in the normal growth of the nail. It is susceptible to bacterial infections, particularly in individuals exposed to irritants such as detergents and other chemicals.
- Throbbing pain, redness, warmth, and swelling in the skin around the nail are common symptoms of an acute paronychia infection.
- A small collection of pus may form under the skin next to the nail or underneath it. If left untreated, the infection can cause damage to the nail and, in rare cases, progress to a deeper infection of the underlying bone.
- The skin around the nails may appear red, purple, gray, or white, indicating irritation and possible infection.
- In the case of fungal infections, the fungus can enter through cracks or cuts in the finger or toe, causing the nail to separate from the nail bed.
- Pseudomonas infections can cause a greenish discoloration in the nail bed.
It is important to seek medical attention if any of these signs of infection are present, especially for individuals with diabetes, immunosuppression, or other conditions affecting circulation and the body's ability to fight infection. Antibiotic treatment and proper wound care are crucial to preventing further complications.
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Treatment for nail separation
Onycholysis, or nail separation, is a common condition where the nail detaches from the nail bed. It can be caused by injury, fungal infection, or an underlying condition such as psoriasis, thyroid disease, or vitamin deficiency. Treatment for nail separation aims to promote new nail growth and prevent further detachment. Here are some measures to treat nail separation:
Identify the Underlying Cause
The first step in treating nail separation is to identify the underlying cause. This may involve consulting a medical professional for diagnosis. A blood test or physical examination may be necessary to determine if an underlying condition is causing the nail separation.
Manage the Underlying Condition
Once the underlying cause is identified, managing the condition can help relieve symptoms and prevent further nail detachment. For example, if nail separation is caused by a fungal infection, antifungal medication may be prescribed. If it is related to an underlying condition such as psoriasis, treatments such as topical vitamin D or corticosteroids may be recommended.
Keep Nails Short and Trimmed
Trimming the nails short can help prevent them from catching on objects and pulling further off the nail beds. It is important to avoid aggressive clipping and biting of the nails. As the nail grows out, the lifted portion can be carefully clipped or trimmed to promote healthy nail growth.
Avoid Irritants and Nail Products
Avoiding chemicals and products that can irritate the nails is crucial. This includes nail polish, nail polish remover, artificial nails, and nail hardeners. These products can contain harsh chemicals that may contribute to nail separation. It is also important to be cautious when cleaning underneath the nails to prevent breaking the skin and causing infection.
Protect the Nail Bed
Keeping the nail bed dry and protected can aid in the healing process. Wearing gloves, especially when working with substances that could irritate the nails, can help. For toenail lifting, ensuring properly fitting shoes are worn can prevent further irritation. Applying an adhesive bandage to the affected nail can also help protect it and prevent it from catching on objects.
Promote Nail Growth
Promoting healthy nail growth is an important aspect of treatment. This may include taking supplements or medications to address any underlying nutritional deficiencies. Keeping the nails and surrounding skin clean with gentle soap and water can also encourage healthy growth. In some cases, a medical professional may recommend specific medications or treatments to enhance nail growth.
It is important to note that treatment for nail separation may vary depending on the underlying cause. Consulting with a healthcare provider is advisable to determine the most appropriate treatment plan for nail separation.
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Nail bed injuries
Crush injuries squeeze the soft tissue of the nail bed between the nail and the distal phalanx, which may result in a simple subungual hematoma or a simple or stellate laceration. Sharp lacerations can occur when objects land with enough force to penetrate the nail plate. Avulsion injuries can result from crush or grinding type injuries, resulting in partial loss of the nail bed. Iatrogenic injuries can occur from traumatic nail plate removal for procedures or during the placement of K wires. Self-inflicted injuries can happen through nail biting, the insertion of artificial nails, or improper manicures.
In the case of a subungual hematoma, if the hematoma covers more than 25% of the nail bed or is causing pain, the patient should be offered evacuation via trephination or nail removal. Lacerations to the nail bed should be repaired using absorbable sutures. Minimal to no debridement should be performed because aggressive debridement may cause undue tension on the repair and result in scarring. When repairing avulsed nails and nail beds, if the nail is detached proximally, it must be removed to inspect for any damage to the nail bed.
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Frequently asked questions
A nail bed injury can look like a bruise, known as a subungual hematoma.
If your nail is detached from the nail bed, you should keep the area dry and apply petroleum jelly and an adhesive bandage to prevent infection. You should also watch for signs of infection such as increasing heat, redness, pain, tenderness, swelling, or pus.
No, once a nail has separated from the nail bed, it cannot reattach. However, treatment can keep new nail growth attached to the nail bed.
It takes about 6 months or longer for a fingernail to grow back and up to 18 months for a toenail.
