Caleb Foster
Our nails can tell us a lot about our health. Changes in nail colour or growth could indicate a medical condition, poor nutrition, or even excessive stress. One common issue is the overgrowth of the hyponychium, the area of epithelium underlying the free edge of the nail plate. This can be caused by wearing long nails for too long, nail injury, nail psoriasis, or fungal infections. Thickened skin under the nail may be treated with antifungal medication or cuticle oil.
| Characteristics | Values |
|---|---|
| Name of skin under nails | Hyponychium |
| Hyponychium's function | Acts as a barrier from germs and debris |
| Hyponychium's location | Under the free edge of the nail plate |
| Hyponychium's composition | Epithelial tissue |
| Hyponychium's attachment | To the underside of the nail |
| Hyponychium thickening causes | Genetic factors, long nails, contact dermatitis, nail injuries, nail psoriasis, fungal infections, nail biting |
| Hyponychium thickening treatment | Antifungal medication, cuticle oil, cuticle remover |
| Nail composition | Dead, compacted cells; translucent keratin protein |
| Nail growth rate | 3.5 mm/month for fingernails, 1.6 mm/month for toenails |
| Factors affecting nail growth rate | Age, sex, season, exercise, diet, hereditary factors, nutrition, nail care habits |
| Nail colour indicators | Yellow, brown, or green nails indicate a fungal infection; yellow nails may indicate thyroid issues, psoriasis, or diabetes |
| Nail abnormalities | Beau's lines, discoloration, thinning, thickening, brittleness, splitting, grooves, small white spots, clubbing, flatness, spooning, onychogryphosis, onycholysis, onychomycosis, onychodystrophy, onychocryptosis |
| Nail nutrient deficiencies | Insufficient vitamin B12 causes darkened nails; insufficient vitamins A and B cause fragile nails; inadequate omega-3 fatty acids cause dry and brittle nails; low dietary protein causes anemia and white nail beds |
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What You'll Learn
Skin growth under nails
The hyponychium is the area of epithelium, or thickened skin, located underneath the free edge of the nail plate, near the fingertip. It acts as a barrier to protect the nail from germs, debris, and other external substances. The skin in this region contains white blood cells to help prevent infection.
However, the hyponychium can sometimes overgrow and become thicker, which can be uncomfortable and unsightly. This condition can affect one, some, or all the fingers. Overgrown hyponychium can make trimming nails painful and increase the risk of infection. Pterygium inversum unguis (PIU) is an uncommon condition where the hyponychium attaches to the underside of the nail as it grows, leading to skin overgrowth under the fingernail. While scientists don't fully understand PIU, it is believed to be present from birth or acquired later, often associated with autoimmune conditions such as lupus or external factors like nail psoriasis and fungal infections.
There are several possible causes of hyponychium overgrowth. According to celebrity manicurist Brittney Boyce, the most common reason is the attachment of the hyponychium to the underside of the nail during growth. Other factors include wearing long gel or acrylic nails for extended periods, contact dermatitis, nail injuries, and nail-biting. Nail psoriasis, a condition where skin cells grow too quickly, can also lead to subungual hyperkeratosis, causing scaling and buildup under the nail.
If you are experiencing skin growth under your nails, it is recommended to consult a dermatologist, especially a board-certified one, who specialises in treating skin, hair, and nails. They can determine the underlying cause and provide appropriate treatment options. Some possible treatments for thickened skin under the nail include antifungal medication and the application of cuticle oil or remover to soften the skin.
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Hyponychium
The hyponychium is the thickened portion of the epithelium underlying the free edge of the nail plate. It is also known as the "quick", as in the phrase "cutting to the quick". The hyponychium is located just beyond the distal end of the nail bed, near the fingertip. It acts as a barrier to prevent germs, bacteria, allergens, pathogens, and debris from getting under the nails. The skin in this region contains white blood cells to help prevent infection.
In some cases, the hyponychium may thicken or become discoloured, which could indicate an infection. Other possible causes of hyponychium thickening include damage from trauma, exposure to chemicals, an underlying systemic condition, or an allergic reaction. Pterygium inversum unguis (PIU) occurs when 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. PIU can be present from birth or acquired later, with the acquired form most commonly associated with autoimmune conditions such as lupus.
Nail psoriasis and fungal infections can also cause skin cells to accumulate under the fingernails. This overgrowth is called subungual hyperkeratosis and can lead to onycholysis, the separation of the nail plate from the nail bed. To treat hyponychium thickening, it is recommended to avoid cutting the hyponychium as this can introduce an infection. Instead, a cuticle remover or cuticle oil can be used to soften the thickened skin.
Certain manicures, such as gel manicures or acrylic nails, can cause PIU and hyponychium overgrowth. Biting your nails and picking at the skin can also lead to an overgrowth and increase the risk of infection. Good nail hygiene is essential for maintaining the hyponychium's integrity, including regular cleaning of the nail area and keeping it free from dirt and debris.
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Pterygium inversum unguis (PIU)
PIU is an uncommon disorder that primarily affects women aged 20-70. It is characterised by the attachment of the hyponychium (the skin just under the free edge of the nail) to the underside of the nail as it grows. The hyponychium acts as a barrier to germs and debris, preventing them from getting under the nails. However, in PIU, the overgrowth of the hyponychium can cause discomfort and increase the risk of infection.
The best approach to addressing PIU is unclear, as many treatments have been shown to be ineffective. Topical steroids, keratolytics, and electrocautery-assisted surgical excision have all been reported to be unsuccessful in managing PIU. The most effective strategy is to treat the underlying cause of the disorder. Patients with PIU should be evaluated for associated rheumatologic diseases, and long-term follow-up examinations are necessary to detect the development of connective tissue diseases such as scleroderma.
The term 'Pterygium inversum unguis' was first described in 1973 by Caputo and Prandi, and only 37 cases had been reported in the literature as of 2014. The rarity of this condition contributes to the lack of understanding of its exact origin and optimal treatment. Future investigations involving a larger number of cases will help clarify the pathogenesis of PIU and determine more effective forms of therapy.
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Nail matrix
The nail matrix is the area where your fingernails and toenails start to grow. It is located at the base of the nail and is responsible for nail plate growth. The nail matrix creates new skin cells, pushing out old, dead skin cells to make your nails.
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 produces about 90% of nail cells. The sterile matrix is responsible for the remaining 10% of cells, but its main function is to keep the nail attached to the underlying skin. The nail typically changes colour beyond the germinal matrix as it extends to the sterile matrix because the cells no longer have nuclei, making the nail appear more transparent.
The nail matrix is made of special cells that constantly produce new nail cells. Each nail matrix produces 196 layers of cells that combine to make each of your fingernails and toenails. The proximal nail matrix produces the dorsal nail plate, while the distal matrix makes the ventral nail plate, with a possible minor contribution from the nail bed. Fingernails grow at approximately 3 mm per month, while toenails grow at around 1 mm per month.
Injuries and certain health conditions can damage the nail matrix and interfere with nail growth. Minor damage to the nail matrix can temporarily change the appearance of the nail. A severe injury could cause the nail to fall off. Once the nail matrix heals, the nail will usually start to grow again, although it may take several weeks. In cases of severe nail matrix damage, the nail may not grow back.
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Nail care
The hyponychium is the area of epithelium, or thickened skin, located at the base of the nail underneath the skin. It acts as a barrier to protect the nail from germs and debris. However, the hyponychium can sometimes overgrow, causing the skin under the nails to thicken and making nail trimming painful. This can be caused by various factors, including wearing nails too long, contact dermatitis, nail injury, nail psoriasis, and fungal infections.
To prevent the buildup of dirt under nails, it is recommended to keep nails short and evenly trimmed. Short nails are less likely to collect bacteria and dirt. It is also important to maintain daily nail care and to check your nails regularly for any signs of infection or fungus. When washing your hands, pay attention to your nails and ensure that you get soap and water under them. You can also use a nail brush or a soft-bristled toothbrush to gently scrub under your nails.
If you notice thickened skin under your nails, this can be treated with antifungal medication or cuticle oil. Cuticle oil can be applied to soften the thickened skin, and it can be gently pushed back after showering using a cuticle pusher. It is important to be gentle when treating the hyponychium and to consult a doctor or dermatologist if you are unsure about the cause of the skin growth.
Additionally, maintaining a healthy diet with sufficient vitamins and nutrients can promote nail health and prevent issues such as excessive dryness, darkened nails, and fragile nails. Vitamins B12 and folate, for example, play a role in red blood cell production and oxygen transportation to nail cells, and inadequate intake can result in nail discolouration. Omega-3 fatty acids are also important for nail health, as a lack of them can contribute to dry and brittle nails.
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Frequently asked questions
The hyponychium is the area of epithelium, or thickened skin, located underneath the free edge of the nail plate. It is sometimes called the "quick", as in the phrase "cutting to the quick".
There are several reasons why the hyponychium might overgrow. The most common reason is because the hyponychium attaches to the underside of the nail as it grows. It may be genetic, or caused by wearing your nails long with gel or acrylic nails for too long, contact dermatitis, nail injury, nail psoriasis, or fungal infections.
To treat overgrown hyponychium, you can try using a cuticle remover or cuticle oil to soften the thickened skin. If you think your overgrown hyponychium is caused by a fungal infection, you may need to take antifungal medication.
