Caleb Foster
The growth of nails is an intriguing process that occurs beneath the epidermis, with the nail matrix playing a pivotal role in generating new cells. This process is responsible for the formation of fingernails and toenails, which are composed of a tough protein called alpha-keratin. While nails serve protective functions, various factors can impact their health and appearance, including injuries, health conditions, and even manicures. Changes in colour, texture, or shape can signal underlying issues, warranting a visit to a dermatologist. Understanding the intricacies of nail growth and its potential challenges empowers individuals to maintain the health and aesthetics of their nails effectively.
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What You'll Learn
Causes of skin under the nail
The hyponychium is the skin just under the free edge of the nail, located near the fingertip. It acts as a barrier to prevent germs, debris and pathogenic bacteria from getting under the nails. However, the hyponychium can sometimes overgrow and become thicker, which can be unsightly and make trimming nails painful.
There are several possible causes of overgrown skin under the nails:
Pterygium Inversum Unguis (PIU)
The hyponychium attaches to the underside of the nail as it grows. It is an uncommon condition but a common cause of skin overgrowth under the fingernail. Scientists don't fully understand PIU, but it can be present from birth or acquired later, often associated with autoimmune conditions such as lupus or triggered by external factors.
Nail Psoriasis
Psoriasis is a skin condition where skin cells grow too quickly, and it can affect the nails. Nail psoriasis causes skin cells to grow excessively under the nails, leading to scaling and buildup (subungual hyperkeratosis). If the skin becomes very thick, it can cause onycholysis, or nail separation.
Fungal Infections
Fungal infections can cause skin cells to accumulate under the nails. Nail fungus can be spread through skin-to-skin contact or by touching infected surfaces. Onycholysis can result from a fungal infection, causing the nail to separate from the nail bed.
Manicures and Nail Habits
Certain manicures, such as gel manicures or acrylic nails, can cause skin overgrowth under the nails. Nail biting, frequent manicures or pedicures, and the use of cuticle sticks or nail brushes can also break the skin under the nails, leading to infection and potential onycholysis.
Paronychia (Nail Infection)
Paronychia is a nail infection caused by bacteria or fungi entering the skin around the nail. It can result in redness, swelling, and pus-filled abscesses under the skin. If left untreated, paronychia can cause the nail to detach from the nail bed and fall off. Repeated or chronic infections can lead to more severe consequences.
It is important to consult a dermatologist or healthcare provider if you are experiencing skin overgrowth under your nails or any related symptoms, as they can help determine the underlying cause and provide appropriate treatment.
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Hyponychium (the quick)
The hyponychium, informally known as the "quick", is the epithelium located beneath the nail plate at the junction between the free edge and the skin of the fingertip. It is the thick skin under the nail tip and is usually a good thing as it protects the nail from harmful substances. The hyponychium forms a seal that protects the nail bed. The onychodermal band is the seal between the nail plate and the hyponychium. It is just under the free edge, in that portion of the nail where the nail bed ends and can be recognised in fair-skinned people by its glassy, greyish colour. It is not visible in some individuals while it is highly prominent on others.
The hyponychium contains white blood cells to help prevent infection. However, sometimes the hyponychium can overgrow and become thicker. This can make trimming nails painful, and some people also don’t like how it looks. Hyponychium thickening can affect one, some, or all the fingers. It may be caused by gel manicures, acrylic nails, or biting your nails. Nail psoriasis and fungal infections can also cause skin cells to accumulate under your fingernails. The most common form of fungal infection is distal and lateral subungual onychomycosis (DSLO). It starts in the hyponychium and then spreads to the nail plate and bed.
If you are experiencing hyponychium thickening, it is recommended to avoid cutting it as this may introduce an infection. Instead, you should consult a doctor for an evaluation. A doctor may prescribe a topical corticosteroid or antifungal medication to help manage skin thickening. Alternatively, you can apply cuticle oil to soften the thickened skin.
The growth rate of nails is related to the length of the terminal phalanges (outermost finger bones). In humans, the nail of the index finger grows faster than that of the little finger; and fingernails grow up to four times faster than toenails. Fingernails grow at an average rate of approximately 3.5 mm per month, whereas toenails grow at around 1.6 mm per month.
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Treatment for thick skin under the nail
The skin under the nail is known as the hyponychium. This skin contains white blood cells to prevent infection. However, the hyponychium can become overgrown and thicker, making nail trimming painful. This condition can affect one, some, or all the fingers. Pterygium inversum unguis (PIU) is a common cause of skin overgrowth under the fingernail. While scientists don't fully understand PIU, they know that it can be present from birth or acquired later. Other causes of thick skin under the nails include fungal infections, psoriasis, and ichthyosis.
If you have thick skin under your nails, it is recommended to visit a dermatologist, especially if the area is bleeding, discoloured, or swollen. A dermatologist can help diagnose and treat the condition. Treatment can include medication or, in some cases, laser treatment. Additionally, keeping the nails and surrounding skin clean, dry, and moisturized can help prevent cracks and infections that can lead to thick skin under the nails.
To prevent and treat dry skin around the nails, it is important to keep the area moisturized. Alcohol and fragrance-free moisturizers are usually better for hydration. Cuticles should be kept pushed back, and any loose or dry pieces should be trimmed away. Wearing moisture-locking gloves, such as cotton gloves, overnight can help seal in the moisturizer and promote healing.
In some cases, thick nails can be a sign of other health conditions, such as diabetes, lung disease, rheumatoid arthritis, or immune disorders. Therefore, it is important to seek a medical diagnosis to rule out any underlying conditions and receive appropriate treatment.
If you are experiencing thick skin under your nails due to overgrowth of the hyponychium, there are some additional steps you can take to manage the condition:
- Avoid picking at the skin.
- Avoid behaviours that can contribute to the condition, such as gel manicures, acrylic nails, or nail biting.
- Consult a dermatologist for specific recommendations and treatment options.
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Nail matrix
The nail matrix is the active tissue that generates cells to form fingernails and toenails. It is the most important structure within the nail unit, responsible for creating new cells that push out old, dead cells to make nails grow. The nail matrix is located at the base of the nail, and it is mostly hidden from view. The only visible part of the nail matrix is the lunula, a white or whitish crescent-shaped area at the base of the nail. However, some people may not have a visible lunula, which is normal.
The nail matrix has two parts: the germinal matrix and the sterile matrix. The germinal matrix is the area of the nail below the lunula, closest to the knuckle, and it contributes about 90% of nail production. It gives a natural curvature to the nail. The sterile matrix is responsible for the remaining 10% of cells that make up the nails, but its primary function is to keep the nail attached to the underlying skin. The nail matrix is made of special cells that constantly produce new nail cells, unlike hair follicles that go through resting periods. Each nail matrix produces 196 layers of cells that combine to form each fingernail or toenail.
The size and shape of the nail matrix determine the characteristics of nail growth, including the thickness, width, and shape of the nail plate. A longer nail matrix will result in a thicker nail, while a flatter matrix will produce a flatter nail. Any damage to the matrix can lead to nail imperfections like white spots or ridges, and it may weaken the nail plate, making it prone to breakage. Minor damage to the nail matrix can cause temporary changes in the nail's appearance, while severe injuries could lead to the nail falling off. In cases of severe nail matrix damage, the nail may not grow back at all.
Several factors can affect the nail matrix, including fungal infections, certain illnesses, injuries, and medications. Toenail fungus, for example, can cause thick, yellow, cracked, or cloudy nails. Serious illnesses like a heart attack, COVID-19, or pneumonia can interrupt nail growth and cause horizontal ridges known as Beau's lines. Injuries to the finger or toe can damage the nail matrix, leading to bruising, ridges, or discolouration, and in some cases, the nail may fall off. Chemotherapy and other medications may also impact the nail matrix, causing slow nail growth, white bands (Mees' lines), or changes in nail colour.
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Nail growth rate
The growth rate of nails varies across individuals and is influenced by several factors, including age, sex, season, exercise level, diet, and genetics. Generally, fingernails grow faster than toenails, with the average growth rate of fingernails being approximately 3.47 to 3.5 mm per month, or about a tenth of a millimeter per day. Toenails, on the other hand, grow at about half the rate of fingernails, averaging around 1.6 mm per month.
The nails on the dominant hand tend to grow faster, possibly due to more frequent use, which increases the risk of trauma and injury. This, in turn, leads to increased blood flow and nutrient supply to the area, promoting nail growth. Additionally, nails tend to grow faster during the summer and slower in colder environments.
Hormones also play a role in nail growth rates. For example, nail growth may accelerate during puberty and pregnancy while slowing down during lactation. Certain medical conditions, such as diabetes, circulatory issues, and fungal infections, can also impact nail growth, often resulting in slower regrowth.
The nail matrix, located under the epidermis at the nail's proximal end, is the growing part of the nail. It consists of active tissue that generates new cells, which harden as they move outward, forming the nail plate. The nail plate is made of a tough protein called alpha-keratin, which gives the nail its rigid structure. The width and thickness of the nail plate are influenced by the size, length, and thickness of the matrix, while the shape of the fingertip bone determines whether the nail plate is flat, arched, or hooked.
The lunula, the whitish crescent-shaped base of the nail, is the only visible part of the nail matrix. It is more noticeable on the thumb and may not be visible on the little finger. The nail bed, located under the nail plate, provides the necessary nutrients for nail growth and health.
While nails typically regrow completely in about six months for fingernails and 12 to 18 months for toenails, certain factors can affect this process. Maintaining nail health through a nutritious diet and good hygiene practices can promote nail growth and prevent brittleness and breakage.
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Frequently asked questions
The hyponychium, informally known as the "quick", is the thick skin under the nail tip. It forms a seal that protects the nail bed from germs and debris.
Skin grows under the fingernail to protect the nail from harmful substances. However, it can become problematic if it overgrows, causing pain and increasing the risk of infection.
Several factors can cause skin to grow under the fingernail, including gel manicures, acrylic nails, nail biting, nail psoriasis, and fungal infections.
Treatment options for overgrown skin under the fingernail include avoiding certain manicures, using corticosteroids or antifungal medications, applying cuticle oil, and consulting a dermatologist.
On average, fingernails grow at a rate of approximately 3 to 3.5 mm per month, while toenails grow at a slightly slower rate of around 1.6 mm per month.
