Isla Bennett
Nails grow from underneath the skin at the matrix, which is the root of the nail. The nail matrix creates new cells that become your fingernails or toenails. As these new cells grow, older cells move up and push through the skin. The cells on the surface die and harden, turning into nails. The proximal nail fold is the skin that borders the bottom of your nail, keeping the nail in place and protecting it as it grows. Fingernails grow at a rate of 0.13 inches per month, while toenails grow at an average rate of 1.62 mm per month. Fingernails can regrow entirely in 3-6 months, whereas toenails can take up to 18 months.
| Characteristics | Values |
|---|---|
| Time taken for a toenail to grow back | Up to 18 months |
| Time taken for a fingernail to grow back | Up to 6 months |
| Toenail growth rate | 1.62 mm per month |
| Fingernail growth rate | 0.13 inches per month |
| Factors affecting nail growth | Trauma, infection, nutritional deficiencies, underlying conditions, age, time of year, etc. |
| Nail matrix | The "factory" where new nails are created |
| Proximal nail fold | The skin bordering the bottom of the nail, keeping it in place during growth |
| Nail damage causes | Working, playing, repeated trauma, poorly fitting shoes, etc. |
| Nail damage prevention | Proper nail clipping, avoiding nail biting, moisturising nails and cuticles, etc. |
| Nail damage treatment | Cold compress, bandaging, surgery, nail trephination, etc. |
| Nail infections | Toenail fungus, nail psoriasis, nail matrix injuries, etc. |
| Nail deformities | Pitting, dents, ridges, grooves, horizontal lines, discoloration, etc. |
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What You'll Learn
Nail growth speed
The growth rate of nails depends on various factors, including age, sex, genetics, hormones, season, and overall health. On average, fingernails grow about a tenth of a millimeter per day or 3.47 millimeters per month. Toenails, on the other hand, grow much slower, at an average rate of 1.62 millimeters per month.
Age plays a significant role in nail growth speed, with nail growth peaking during puberty and gradually slowing down as we age. This slowdown may be attributed to a decrease in blood circulation and changing hormone levels with age. For example, a study observed that between the ages of 23 and 67, the growth rate of a thumbnail decreased from 0.123 mm per day to 0.095 mm per day.
Hormones also influence nail growth, with pregnancy and androgen replacement therapy (testosterone) leading to increased nail growth. On the other hand, conditions like thyroid disease, hypopituitarism, diabetes, and osteoporosis can cause fragile, slow-growing nails.
Genetics and environmental factors also come into play. For instance, nails on the dominant hand tend to grow faster, possibly due to increased usage and a higher risk of trauma or injury. Additionally, warm weather and summer are associated with increased nail growth, while cold environments may slow it down.
Certain habits, such as nail biting (onychophagia) and nail picking (onychotillomania), can impact nail growth. Nail biting can stimulate circulation in the nail bed, leading to faster growth, while both habits can damage the nail matrix, nail bed, and surrounding skin, resulting in slower growth and potential nail deformities.
Overall, while there are many factors influencing nail growth speed, maintaining good nail hygiene and caring for your nails can promote healthier and potentially faster nail growth.
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Nail matrix and nail bed
The nail matrix is the "factory" where your body makes new fingernails and toenails. It is the area where your nails start to grow, located at the base of the nail. The nail matrix creates new skin cells, pushing out old, dead skin cells to make your nails. This process is interrupted by injuries or certain health conditions, which can cause nail infections, discolouration, ridges, or changes in texture. In severe cases, the nail may fall off or stop growing altogether.
The nail bed is the skin beneath the nail plate, where the nail adheres to the finger. It is composed of a monocellular basal layer and a spinous layer, devoid of a stratum granulosum. The nail bed is highly innervated, and the removal of the nail plate can be extremely painful. The nail bed dermis consists of collagen bundles, elastic fibres, and a rich vascular network. Nerves and blood vessels in the nail bed supply nourishment to the entire nail unit.
The lunula is the whitish, crescent-shaped base of the visible nail, where the nail matrix and nail bed meet. It is most prominent on the thumb and may not be visible on the little finger. The lunula appears white due to the reflection of light at this meeting point.
The nail plate, also known as the nail body, is the hard, visible nail area from the nail root to the free edge. It is made of several layers of dead, compacted, translucent keratin protein. The nail plate is firmly attached to the nail bed and does not contain any nerves or blood vessels. The nail plate is shaped by the underlying fingertip bone, which determines whether it is flat, arched, or hooked.
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Nail injuries
A nail injury refers to any injury to the nail, nail bed (skin underneath the nail), cuticle (base of the nail), or the skin around the sides of the nail. This includes cuts, tears, bruises, and nails being torn away from the skin. Nail injuries can occur in various ways, such as smashing a finger in a door, hitting it with a heavy object, or cutting it with a sharp object.
One common type of nail injury is a subungual hematoma, which is when blood gets trapped under the nail bed, often due to a crush injury or a heavy blow to the nail. This can cause throbbing pain and the nail may turn black and blue, resembling a bruise. Treatment for a subungual hematoma involves draining the trapped blood through a small hole made in the nail, relieving pain and pressure.
Another type of nail injury is a nail bed laceration, which occurs when the nail and the underlying nail bed are cut, typically by a sharp object like a knife or saw. This type of injury usually bleeds and may require stitches. In some cases, the nail may need to be removed, but it should grow back over time.
Nail bed avulsions are another serious type of nail injury, where the nail and part of the nail bed are pulled away from the finger. This type of injury is very painful and often causes the finger to swell. It typically requires the removal of the nail and possibly a finger fracture, which may need to be splinted for several weeks.
In the case of severe nail injuries, it is important to seek medical attention. A physician should be consulted if there is significant bleeding under the nail, as it could indicate an underlying bone fracture or tissue tear. Additionally, if the injury involves the nail matrix (the tissue inside the cuticle where new nail cells are formed), it may result in permanent cosmetic changes to the nail.
With proper treatment and care, most nail injuries can heal, and healthy nail growth can resume. Fingernails typically regrow within two months, while toenails can take up to four months. However, in rare cases of severe damage to the nail matrix, some or all of the nail may not grow back.
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Nail infections
The growth of new nails can be affected by several factors, including injuries, illnesses, and certain medications. Nail infections, specifically, can cause significant disruptions to nail growth and appearance.
One common type of nail infection is paronychia, which usually results from bacterial entry through cuts or broken skin near the cuticle and nail fold. Symptoms of paronychia include pain, swelling, and tenderness around the nail, with the skin appearing red and warm to the touch. In some cases, pus may build up under the skin, leading to a white to yellow, pus-filled abscess that requires medical attention. If left untreated, paronychia can cause the nail to grow abnormally, with ridges or waves, and may result in discolouration, dryness, and brittleness.
Another type of nail infection is onychomycosis, or fungal nail infection, which is caused by a fungus that thrives in warm, dark, and moist environments, such as the feet. This type of infection causes the nail to become thick, discoloured, and brittle, making it easy to break. Fungal nail infections often affect the toenails but can also occur on the fingernails, typically starting at the edge of the nail and gradually spreading.
Fungal nail infections usually require treatment as they are unlikely to resolve on their own. Pharmacists often recommend antifungal nail medicine that is brushed onto the nail regularly for several months. In more severe cases, a GP may prescribe antifungal tablets, but these are not suitable for individuals with certain medical conditions.
In addition to bacterial and fungal infections, nail infections can also be caused by viruses, such as the wart-causing human papillomavirus (HPV). These types of infections may require different treatments, such as topical medications or, in severe cases, surgical removal of the affected nail.
It is important to note that some nail abnormalities, such as horizontal ridges (Beau's lines), can be indicative of serious underlying health conditions. These include cardiovascular events like heart attacks, illnesses like COVID-19 or pneumonia, and nutritional deficiencies. Therefore, it is always advisable to consult a healthcare professional if you notice any persistent changes or abnormalities in your nails.
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Nutritional deficiencies
The appearance of new nail growth depends on several factors, including age, genetics, and dominant hand usage. While nail issues often occur due to injury or overexposure to moisture, nutritional deficiencies can also play a role in how your nails look as they grow.
Nails are often considered a mirror of one's nutritional status, and almost any nutritional deficiency can lead to changes in the nail plate. Nutritional deficiencies can cause nail changes that are mostly minor and non-specific, making it challenging to identify a specific deficiency solely based on nail appearance. However, here are some common nutritional deficiencies and their potential effects on nail growth:
Protein Deficiency
Protein deficiency can lead to Beau's lines, which are transverse linear depressions in the nail plate. These lines may be caused by any severe disease that disrupts normal nail growth. The width of the furrow can indicate the duration of the ailment, as measuring the distance from the furrow to the proximal nail fold provides an approximate timeframe. Malnutrition associated with chronic alcoholism can also cause Beau's lines.
Iron Deficiency
Iron deficiency can cause vertical nail ridges and koilonychia, also known as spoon nails. Spoon nails appear concave either horizontally or vertically and can affect both fingernails and toenails. Iron deficiency can also lead to nail peeling, and the inclusion of iron-rich foods in the diet may help address this issue.
Zinc Deficiency
Zinc deficiency is associated with Beau's lines and white spots on the nails.
Vitamin B12 Deficiency
Vitamin B12 deficiency can cause nail discoloration.
Hypothyroidism
Hypothyroidism can result in thick, brittle nails with vertical ridges. The nails may crumble or break easily, and the fingertips may appear puffy.
While these are some of the common nutritional deficiencies that can impact nail growth, it is important to consult a healthcare professional for proper diagnosis and treatment.
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Frequently asked questions
Nails grow from the nail matrix, or the root of the nail, which is underneath the skin. As new cells form in the matrix, older cells are pushed through the skin and harden into nails.
Fingernails grow faster than toenails. Fingernails grow at a rate of 0.13 inches per month and can take 3-6 months to completely regrow. Toenails grow more slowly, at an average rate of 1.62 mm per month, and can take up to 18 months to grow back.
A new nail will usually start to grow once the nail matrix heals. It may take several weeks for the new nail to appear. Minor damage to the nail matrix may cause minor defects in the new nail, such as ridges or discoloration.
Severe damage to the nail matrix can cause permanent deformities in the nail or prevent it from growing back altogether. Peripheral artery disease, which causes reduced blood flow to the legs and feet, can also interfere with nail growth.
