Ava Monroe
There are several reasons why a nail may grow under a nail, and it is a fairly common condition. This phenomenon is called onycholysis, which is when a nail separates from its nail bed. It can be caused by a nail injury, fungus, or psoriasis, and can also be triggered by external factors such as wearing gel or acrylic nails for too long. Onycholysis can be treated by cutting away the separated nail as it grows out, or by taking antifungal medication.
| Characteristics | Values |
|---|---|
| Medical term | Onycholysis |
| Description | A nail separates from its nail bed |
| Cause | Nail injury, fungus, or psoriasis |
| Treatment | Cut the nail away as it grows out, antifungal medication, or surgery |
| Prevention | Keep nails trimmed short, avoid biting nails, be careful when cleaning underneath nails |
| Related conditions | Paronychia, Beau's lines, peripheral artery disease, eczema, nail psoriasis, subungual hyperkeratosis |
| Other causes of nail abnormalities | Illnesses (e.g., heart attack, COVID-19, pneumonia), chemotherapy, peripheral artery disease, skin conditions (e.g., eczema), nail products |
| Skin growth under the nail | Hyponychium, an uncommon condition called Pterygium inversum unguis (PIU) |
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What You'll Learn
Onycholysis (nail separation)
Onycholysis is a common nail disorder characterised by the detachment of the nail from the nail bed. It usually starts at the tip and/or sides of the nail. While onycholysis is typically painless, it can be painful if acute or inflammatory. The condition may be idiopathic or secondary to trauma, skin disease, nail infections, tumours, or systemic events. It can affect both sexes, all ages and races, but it is most frequently observed in adult women.
The word onycholysis comes from the Ancient Greek words "ónuks", meaning nail, and "lúsis", meaning disintegration. Onycholysis can affect a single nail or multiple fingernails and/or toenails. The distal part of the nail is most commonly affected, lifting the free edge; sometimes, the nail may detach laterally or proximally. The nail surface may appear normal or pitted, indented, or crumbly.
The underlying cause of onycholysis can be challenging to identify. It may be caused by a nail injury, fungus, yeast growth, or psoriasis. In some cases, onycholysis can indicate a more serious underlying condition, such as a yeast infection or thyroid disease. Determining the cause of onycholysis is crucial for effective treatment.
Treatment for onycholysis aims to address the underlying cause and promote the growth of a new nail attached to the nail bed. Keeping nails short and trimmed is recommended to prevent further trauma and potential infection. Avoiding nail biting is essential, as it can spread the problem and potentially affect the mouth. It is also important to avoid irritants such as nail enamel, enamel remover, solvents, detergents, and chemicals. Antimicrobial soaks, such as dilute vinegar, can be used to minimise the risk of secondary infection. In some cases, antifungal medications may be necessary.
The recovery time for onycholysis varies, with fingernails taking 4 to 6 months to fully regrow and toenails taking twice as long. Early detection and appropriate treatment are crucial, as the longer onycholysis persists, the less likely the new nail growth will reattach due to permanent damage to the nail bed.
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Hyponychium overgrowth
The hyponychium is the thick skin under the free edge of a fingernail. Pterygium inversum unguis (PIU) is an uncommon condition that is a common cause of hyponychium overgrowth. It occurs when the hyponychium attaches to the underside of the nail as it grows. While scientists don't fully understand PIU, they know that it can be present from birth or acquired later. The acquired form is most commonly associated with autoimmune conditions such as lupus but can also be triggered by external factors.
Nail psoriasis involves many parts of the nail, including the hyponychium and nail bed, where skin cells grow excessively, causing scaling and buildup. This overgrowth is called subungual hyperkeratosis. Nail psoriasis and fungal infections can also cause skin cells to accumulate under fingernails.
If you are experiencing hyponychium overgrowth, it is not recommended to cut the area, as this risks introducing an infection. Instead, you can try softening the skin and gently easing it off the natural nail from underneath. Soak the nails in a carrier oil such as olive oil, argan oil, or jojoba oil. Then, turn your hands so you can see the hyponychium – the free edge of the natural nail may have become less white and more clear, which is normal. Using the rounded end of an orange wood stick, gently release the edge of the hyponychium from the underside of the natural nail.
You are more likely to have overgrown hyponychium if you get gel manicures, wear acrylic nails, or bite your nails. If the skin becomes very thick, it can cause onycholysis, which is the separation of the nail plate from the nail bed. Onycholysis can also be caused by a nail injury, fungus, or psoriasis. Treatment for onycholysis may involve cutting away the separated nail as it grows out, taking antifungal medications, or stopping the use of certain nail products.
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Nail matrix injuries
The nail matrix is the area where your fingernails and toenails start to grow. It is responsible for nail growth and is located at the base of the nail. The nail matrix creates new skin cells, pushing out old, dead skin cells to make your nails. A healthy nail matrix is essential for healthy nails.
Injuries and certain health conditions can damage the nail matrix and interfere with nail growth. Mechanical injuries are a common cause of nail matrix damage. This can include a sharp injury, such as a strong blow, pinching the fingertip in a door, crushing, or crushing with a heavy object. In the case of severe mechanical trauma, the damaged nail matrix may present symptoms such as a hematoma under the nail plate and oozing pus. Bruising, ridges, or discolouration may also occur, and in severe cases, the nail may fall off.
Minor damage to the nail matrix can temporarily change the appearance of the nail. This can include indentations, cracks, and changes in texture. Nail growth disorders can also occur, with inhibited growth or asymmetric nail growth. Onychomadesis, or the peeling of the nail plate and layering of subsequent nails, can also occur.
In addition to mechanical injuries, certain habits and improperly performed care procedures can also result in matrix damage. This can include cuticle picking, improper use of a drill, and cuticle cutting with a cuticle pusher.
Treatment for a nail matrix condition depends on the cause. For bruising under the nail, a procedure called nail trephination can be performed to drain trapped blood and provide pain relief. This must be done within 48 hours of injury. In the case of subungual melanoma, surgery is required to remove the affected area.
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Nail infections
Onychomycosis, also known as tinea unguium, is a common fungal nail infection. It often appears after an injury to the nail, but it may have other causes, including fungi. It is characterized by nail thickening, discoloration, and crumbling or breaking of the nail. It usually affects the toenails, but it can also occur on the fingernails. The infection typically starts at the edge of the nail and gradually spreads. While it is not a serious health concern, fungal nail infections can be challenging to treat and may take a long time to resolve.
Fungal nail infections are often caused by the same type of fungus that causes athlete's foot. This fungus thrives in warm, dark, and moist environments, such as the feet. Communal spaces like gyms and showers increase the risk of contracting this infection due to the possibility of direct contact with the fungus.
Symptoms of a fungal nail infection include thickening, discoloration (white, yellow, or green), and brittleness of the nail. In some cases, the nail may crumble or break off, leading to pain and swelling of the surrounding skin.
Treatment for fungal nail infections typically involves the use of topical antifungal medications, which need to be applied regularly for several months. If topical treatments are ineffective, oral antifungal tablets may be prescribed by a healthcare professional. It is important to note that oral antifungal medications may not be suitable for individuals with certain medical conditions.
In addition to medical treatments, preventive measures play a crucial role in managing and avoiding fungal nail infections. Keeping your nails trimmed and avoiding nail biting are important habits to adopt. Maintaining clean and dry nails is essential, especially when wearing closed shoes or walking barefoot in communal areas.
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Skin conditions
Skin growing under the nails is called hyponychium. It is the tissue under the free edge of the nail that acts as a seal to prevent pathogenic bacteria from entering the finger. The skin in this region contains white blood cells to help prevent infection. However, sometimes the hyponychium can overgrow and become thicker, which can be painful and may increase the chance of infection.
There are three main reasons for hyponychium:
- Genetic factors: For some people, hyponychium seems to be genetic.
- External factors: Wearing your nails long with gel or acrylic nails for too long, contact dermatitis, or some sort of nail injury can cause hyponychium.
- Skin conditions: Nail psoriasis and fungal infections can also cause hyponychium.
One of the most common causes of skin overgrowth under the fingernail is a condition called Pterygium inversum unguis (PIU). It can be present from birth or acquired later. The acquired form is most commonly associated with autoimmune conditions such as lupus but can also be triggered by external factors.
Severe eczema can also affect the nail matrix and temporarily interfere with nail growth. You might see Beau's lines (horizontal ridges in your nails), pitting (small, pinhole-like dots), and texture or colour changes.
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Frequently asked questions
The hyponychium is the tissue under the free edge of the nail. It acts as a barrier to prevent bacteria from entering the finger.
Pterygium inversum unguis (PIU) is an uncommon condition but a common cause of skin overgrowth under the fingernail. It can be present from birth or acquired later, often associated with autoimmune conditions such as lupus. Other causes include nail injury, wearing long gel or acrylic nails, contact dermatitis, nail biting, nail psoriasis, and fungal infections.
If a fungal infection is the cause, antifungal medication can help. Cuticle oil can also be applied to soften the thickened skin.
If you are unsure about the cause of the skin growth under your nail, it is recommended to visit a dermatologist.
