Ava Monroe
Fingernail and toenail abnormalities can indicate a variety of issues, from infections to injuries, and sometimes reflect underlying medical conditions. While some nail abnormalities are harmless, others may require medical attention. Recognising the signs of nail damage and understanding potential causes can help individuals identify when to seek professional advice or treatment.
| Characteristics | Values |
|---|---|
| Colour | Black and blue, purple-black, white, brown, salmon |
| Texture | Thick, crumbly, brittle |
| Shape | Curved inwards, half-white and half-brown, deep lines or grooves |
| Other | Debris under the nail, swelling, mild nail dystrophy, permanent shortening of forearm muscles |
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What You'll Learn
Subungual hematoma
A subungual hematoma is a type of nail bed injury that occurs when blood gets trapped under your nail bed, causing a build-up of pressure that can be extremely painful. It usually happens when the nail gets crushed or hit by a heavy object, resulting in blood leaking from small blood vessels under the nail bed. This can cause throbbing pain and the nail may turn black or blue, resembling a bruise under the nail.
While small subungual hematomas may not require medical attention, more severe cases can lead to complications. The intense pain and pressure caused by the pooled blood can be alleviated through a procedure called decompression or trephination, which involves draining the blood to relieve pressure and pain. This can be done through cautery, using a heated wire or laser to burn a hole, or by using a needle to puncture the nail and release the blood.
In some cases, if the nail bed is injured, the doctor may need to remove the entire nail and use stitches to repair the area. The recovery process can take several weeks, and the new nail may take up to 8 weeks to regrow for fingernails and 6 months for toenails. Even with proper treatment, there is a possibility that the new nail may not grow back normally.
It is important to note that if you have a darkened area under your nail without any apparent injury, it is recommended to consult a doctor to rule out other possible causes. Additionally, if you experience a severe blow to a finger or toe, seek immediate medical attention as there may be broken bones or serious damage to the nail bed or surrounding tissues.
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Nail bed laceration
A nail bed laceration is an injury where the nail and the underlying nail bed are cut. This type of injury is usually caused by a sharp object like a saw or a knife, but it can also be caused by a crushing injury. If you have a nail bed laceration, it will likely bleed, and you will be able to see the cut through your nail. As the injury heals, a large bruise may appear.
Nail bed injuries are common and can usually be treated at home. However, if the injury is severe, it may require medical attention. In the case of a nail bed laceration, a doctor may use stitches to repair the wound and reattach the nail if possible. Antibiotics may also be prescribed to prevent infection.
If the nail bed matrix is damaged, a doctor may remove part or all of the nail. The nail bed will then be repaired, and a synthetic nail may be attached. This nail will be gradually pushed forward as the new nail grows. In some cases, a surgeon may be required if the injury is severe.
The recovery time for a nail bed injury can vary depending on the severity of the injury. On average, it takes about a week for a fingernail to start growing back and three to six months for it to fully grow back. However, in more severe cases, it may take up to nine months for a full recovery.
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Nail bed avulsion
A dead fingernail can be the result of a nail bed avulsion, which is when your nail and part of your nail bed are pulled away from the rest of your finger. This commonly occurs when your finger gets stuck or jammed in something, and it often happens to the ring finger. Nail bed avulsions are very painful and cause the finger to swell. They can also result in throbbing pain and the nail turning black and blue.
The treatment of a nail bed avulsion aims to provide protection and support while a new nail grows. It typically takes about a week for a fingernail to start growing back and three to six months for it to grow back completely. In the case of toenails, it can take 12 to 18 months for them to grow back fully. It's important to note that injured nails may look different when they grow back, and complications such as hook nail or split nail can occur.
To promote healing and reduce the risk of infection, proper wound care at home is crucial. The wound should heal within a few weeks, and you may experience soreness, swelling, colour changes, and bloody crusting on or around the wound for two to three days, which is normal. Antibiotics may be prescribed to prevent infection, and an X-ray may be recommended to check for any bone fractures. Depending on the severity of the injury, the recovery time can range from six to nine months.
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Fungal nail infections
A fungal nail infection, or onychomycosis, can leave you with brittle, discoloured nails that are often difficult to trim. The infection occurs when a crack in your nail or the skin around it allows fungi to enter and grow. Fungi thrive in dark, warm, and moist environments, so toenails are more prone to infection than fingernails.
The symptoms of a fungal nail infection vary depending on the type of infection. In the early stages, you may notice a white or yellow spot under your nail, which can spread and turn your entire nail white, yellow, green, or black. The nail may thicken, curl, or loosen from the nail bed, becoming brittle and crumbling when touched. The nail may also become misshapen or distorted, and you may experience pain or discomfort when applying pressure to the affected area. In some cases, the infection may cause a bad smell or even make it difficult to walk.
To prevent fungal nail infections, it is recommended to wear well-fitting shoes made of natural materials and clean cotton socks, which allow your feet to breathe. Avoiding walking barefoot in communal areas, such as gym showers, swimming pools, and locker rooms, can also help reduce the risk of infection.
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Nail abnormalities
Healthy nails are smooth, evenly coloured, and free of spots or discolouration. However, there are many reasons why nails may become damaged or change in appearance.
Nail Bed Injuries
Nail bed injuries are common and can usually be remedied at home. A subungual haematoma, for example, occurs when blood gets trapped under the nail bed, causing a blueish-black appearance. This is usually the result of a heavy object crushing the nail.
In more severe cases, a doctor may need to remove part or all of the nail. Antibiotics may be required to prevent infection, and an X-ray may be ordered to check for bone fractures.
- Discolouration: Dark or white streaks, or changes in nail colour, can be caused by viral warts, infections, or certain medications. Yellow nail syndrome, for instance, is associated with lung disorders and lymphedema.
- Depressions: Small indentations or pits on the nail surface are known as nail pitting. This is common in people with psoriasis or alopecia areata.
- Ridges: Tiny, raised lines that develop across or up and down the nail are usually harmless and may be the result of aging. However, in some cases, they can indicate an iron deficiency or nail-patella syndrome.
- Separation: When the nail plate separates from the nail bed, it causes a white discolouration known as onycholysis. This can be due to infection, trauma, or products used on the nails.
- Beau's Lines: Depressions that run across the fingernail can be a sign of malnourishment or a high fever caused by diseases such as measles, mumps, or scarlet fever.
- Clubbing: Clubbing is when nails thicken and curve around the fingertips, caused by low oxygen in the blood.
- Koilonychia: Also known as "spooning", this disorder is characterised by fingernails with raised ridges that scoop outward. It is associated with iron deficiency anaemia.
- Leukonychia: Non-uniform white spots or lines on the nail are usually harmless but can be associated with poor health, nutritional deficiencies, infectious diseases, metabolic diseases, or certain drugs.
- Mees' Lines: Transverse white lines can be a sign of arsenic poisoning.
- Chronic use of nail polish: This is the second most common cause of fungal nails.
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Frequently asked questions
A fungal infection can cause the nail to thicken and discolour, usually to a brownish hue.
An injured nail bed can cause a subungual hematoma, which looks like a blueish-black bruise under the nail.
Fingernails that are half white and half brown can indicate kidney failure. If your fingernails curve inwards like spoons, it may be a sign of lupus erythematosus.
Chronic use of nail polish can trap moisture and encourage fungal growth. People often use nail polish to hide discolouration, providing an environment for the fungus to thrive.
Brittle nails are common with ageing. Regular moisturising can help protect the nails.
