
There are many reasons why someone's fingernails might become mangled. This could be due to an injury, such as a bruise under the nail, a cut to the nail, or a fracture of the bone underneath. It could also be the result of an infection, such as a fungal infection, or a skin disease like eczema or psoriasis. In some cases, it may be a sign of a more serious medical condition, such as melanoma or thyroid disease. Other factors that can contribute to nail abnormalities include malnutrition, vitamin deficiencies, and certain medications or treatments, such as chemotherapy.
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What You'll Learn

Nail injuries
A nail injury occurs when any part of the nail, including the nail bed (the skin underneath the nail), the cuticle (the base of the nail), or the skin around the sides of the nail, becomes injured. This can happen when the nail is cut, torn, smashed, or bruised, or when it is torn away from the skin. Common causes of nail injuries include smashing the finger in a door, hitting it with a hammer or another heavy object, or cutting it with a sharp object.
Nail bed injuries are a common type of fingertip injury, often occurring when the nail is caught between two objects or hit by a heavy object. They can also be caused by cuts from sharp objects such as knives or saws. These injuries can be minor or very painful and uncomfortable, sometimes limiting finger movement. In rare cases, they can cause nail deformities such as hook nail or split nail.
To treat a nail injury at home, it is important to stop any bleeding and clean the wound. If the nail is torn or jagged, it should be trimmed to prevent further injury. If the nail has lifted off the nail bed, it can be replaced and held in place with a bandage. However, nails will not reattach themselves to the nail bed after separation, and a new nail will slowly regrow over time. It is important to keep your tetanus vaccination up to date and monitor for any signs of infection, such as redness, swelling, or discolouration.
If the injury is more serious, or if there is a potential fracture, it is recommended to seek medical attention at an urgent care centre or emergency room.
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Infections
Bacterial infections, such as Staphylococcus aureus, can also cause nail problems. These infections typically start in the fold of skin at the base of the nail and can lead to inflammation and pus. Candida, a yeast-like organism, is another common cause of infection around the nail, known as paronychia, which can cause nail abnormalities such as inflammation and changes in nail appearance.
Viral infections, such as warts, can also affect the nails, causing changes in shape or ingrown skin under the nail. Certain infections, particularly those affecting the heart valve, may lead to red streaks in the nail bed, known as splinter hemorrhages. Additionally, disorders that impact blood oxygen levels, such as heart and lung diseases, can result in clubbing, where nails thicken and curve around the fingertips.
In some cases, infections elsewhere in the body can also lead to nail abnormalities. For example, subungual melanoma, a type of skin cancer, can appear as a dark streak down the length of the nail. Hutchinson's sign, a darkening of the cuticle, may indicate an aggressive form of melanoma. Therefore, it is important to pay attention to any changes in the nails and seek medical advice if concerned.
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Skin diseases
Several factors can cause fingernail abnormalities, including skin diseases such as eczema and psoriasis.
Eczema
Eczema is a common skin condition that can cause nail problems such as Beau's lines—depressions that run across the fingernail. These lines can occur due to a lack of proper nutrition, illness, injury to the nail, or as a side effect of chemotherapy. Eczema can also lead to nail brittleness and thinning, which can be a normal part of ageing or a sign of underlying conditions like iron deficiency anaemia or thyroid problems.
Psoriasis
Psoriasis is an autoimmune condition that can affect the nails, causing pitting, nail plate splitting from the nail bed (onycholysis), and long-term destruction of the nail plate (nail dystrophy). Psoriasis often occurs alongside other conditions like arthritis and can lead to nail thickening and yellowing, with white spots and streaks.
Other Skin Diseases
- Infections: Fungal infections, such as tinea, and bacterial infections, such as Staphylococcus aureus, can cause nail problems. Fungal infections are spread through cracks or cuts in the fingers or toes, leading to thick, yellow nails with white spots and streaks. Bacterial infections can cause nail discolouration, inflammation, and pain.
- Viral Warts: Periungual warts, which appear around the nails, can cause nail deformities and ingrown skin under the nails.
- Melanoma: Subungual melanoma, a type of skin cancer near the nail and fingertip, can cause dark streaks down the length of the nail. Hutchinson's sign, a darkening of the cuticle, may indicate an aggressive melanoma.
- Nail Abnormalities: Conditions like koilonychia (spoon-shaped nails) and leukonychia (white nail syndrome) can be associated with skin diseases. Koilonychia may indicate iron deficiency, while leukonychia can be linked to arsenic poisoning, heart disease, renal failure, pneumonia, or hypoalbuminemia.
- Trauma: Continuous mild trauma, such as finger-tapping or using nails as tools, can lead to nail injuries and deformed nail growth. More severe trauma, such as dropping a heavy object on the toe, can cause nail bed injuries and nail deformities.
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Malnutrition
Yellow nails, which are thickened and tend to crumble, can be associated with malnutrition. Very pale, whitish nails can also indicate malnutrition, as well as anemia, heart or liver disease. These nail changes can be a valid indicator of poor nutritional status, and it is important to consult a doctor if you notice any abnormalities. Maintaining a healthy diet and ensuring proper absorption of nutrients are crucial for nail health.
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Medication
Certain medications can cause changes in nail colour. For example, lithium, a medication for bipolar disorder, has been linked to nail thickening, yellowing, and surface roughness. Melanocytic stimulation from drugs like zidovudine and hydroxyurea can result in brown or black bands on the nails. Anticonvulsants like valproic acid have also been associated with nail discolouration and roughness.
In some cases, medication can lead to nail growth abnormalities. Drugs like fluconazole, itraconazole, levodopa, and retinoids may increase nail growth rate, while others, such as antiretroviral drugs, ciclosporin, heparin, lithium, and methotrexate, may slow it down. These changes in nail growth can also be accompanied by nail separation from the nail bed, known as onycholysis, which can be painful and cause white, yellow or brown discolouration.
It is important to note that drug-induced nail changes are typically cosmetic and may resolve after discontinuing the medication. However, some symptoms may be more serious or long-lasting, and it is always advisable to consult a healthcare professional for specific treatment recommendations based on your symptoms. Preventative measures, such as wearing protective gloves during wet work, can also help maintain nail health while taking medications that may impact nails.
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Frequently asked questions
Common causes of fingernail problems include injury, infection, and skin diseases such as eczema and psoriasis.
Nail injuries can range from a bruise under the nail to the separation of the nail from the nail bed. Nail injuries can be caused by bumping or hitting your nails, wearing shoes that are too small, keeping your nails in water for too long, or even regular manicures.
Signs of a nail injury include discoloration, dents, crumbling, and pain.
Common nail infections include fungal infections, bacterial infections, and viral warts.
Signs of a nail infection include changes in color, texture, and shape, as well as painful areas of infection under the nail or in the surrounding skin.











































