Caleb Foster
There are several reasons why something might be growing under your nail. Firstly, it could be an overgrowth of the hyponychium, the skin just under the free edge of your nail, which can be painful and increase the chance of infection. Secondly, it could be a fungal infection, which can cause the nail to become thick, fragile, and separate from the nail bed, with a brownish, whitish, or
| Characteristics | Values |
|---|---|
| Condition | Pterygium inversum unguis (PIU) |
| Cause | Autoimmune conditions such as lupus, psoriasis, or external factors |
| Location | Hyponychium (skin just under the free edge of the nail) |
| Symptoms | Thickened skin, scaling, nail separation, pain, increased chance of infection |
| Treatment | Antifungal medication, cuticle oil, drainage procedure |
| Prevention | Good hygiene, avoiding nail biting/cutting cuticles, trimming nails carefully |
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What You'll Learn
- Mycotic nails, a fungal infection that causes nails to thicken and separate from the nail bed
- Pterygium inversum unguis (PIU), a condition where the hyponychium attaches to the underside of the nail
- Paronychia, a bacterial or fungal nail infection that can cause pain and discolouration
- Onycholysis, when the nail lifts up and is no longer attached to the nail bed
- Beau's lines, deep grooves across the width of the nail caused by interruptions to nail growth
Mycotic nails, a fungal infection that causes nails to thicken and separate from the nail bed
The hyponychium is the skin just under the free edge of your nail. It acts as a barrier to protect your nail from germs and debris. However, the hyponychium can sometimes overgrow and become thicker, which can be painful and increase the risk of infection. Pterygium inversum unguis (PIU) is an uncommon condition that causes skin overgrowth under the fingernail when the hyponychium attaches to the underside of the nail as it grows.
Mycotic nails, also known as onychomycosis, are a type of fungal infection that affects the toenails or fingernails. This infection can cause the nails to become thick, fragile, and separated from the nail bed, with discoloration ranging from brown to white to black. It is caused by various fungal organisms, most commonly dermatophytes, which account for 80 to 90% of cases. Other causes include nondermatophyte molds, yeast, and certain species such as Epidermophyton floccosum and Trichophyton rubrum.
Mycotic nails are more common in individuals with diabetes, psoriasis, or athlete's foot, and the likelihood of developing this condition increases with age. Older adults may experience complications such as cellulitis and foot ulcers in individuals with diabetes. It is essential to seek medical attention for accurate diagnosis and treatment. Laboratory confirmation of the infection is crucial, and this can be done through methods like a potassium hydroxide preparation with direct microscopy or fungal culture of nail clippings.
Treatment options for mycotic nails include oral antifungal medications, such as terbinafine, which is preferred over topical therapy due to its higher effectiveness and shorter treatment duration. Topical treatments, such as ciclopirox, efinaconazole, and tavaborole, are also available but are less effective and may have more drug-drug interactions. Preventative measures, such as avoiding walking barefoot in public places and disinfecting shoes and socks, can help reduce the relapse rate, which is around 20-25%.
It is important to note that nail abnormalities can also be caused by other conditions, such as nail psoriasis, peripheral artery disease, and eczema, which can affect nail growth and cause changes in texture and color. Additionally, certain medications, chemotherapy, and illnesses like COVID-19 can also impact nail growth and appearance.
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Pterygium inversum unguis (PIU), a condition where the hyponychium attaches to the underside of the nail
The hyponychium is the thick skin under your nail tip. It acts as a barrier to protect your nail from harmful substances and infections. However, sometimes the hyponychium can overgrow and become thicker, making it difficult to trim your nails. This condition is known as Pterygium Inversum Unguis (PIU) and is characterised by the attachment of the hyponychium to the underside of the nail as it grows. It is an uncommon condition but a frequent cause of skin overgrowth under the fingernail.
PIU can be present from birth or acquired later in life. The acquired form is often associated with autoimmune conditions such as lupus, but it can also be triggered by external factors. One possible external factor is gel manicures, as the chemicals in the gel may contribute to hyponychium thickening. Other external factors include wearing acrylic nails and nail-biting. Additionally, certain nail conditions can also lead to PIU. For example, nail psoriasis, a condition where skin cells grow rapidly, can affect the hyponychium and nail bed, causing scaling and buildup. This overgrowth is known as subungual hyperkeratosis. If the skin becomes excessively thick, it can lead to onycholysis, resulting in the separation of the nail plate from the nail bed.
Fungal nail infections, or onychomycosis, can also contribute to PIU. These infections thicken both the nail and the underlying skin tissue. The most common type of fungal infection is distal and lateral subungual onychomycosis (DSLO), which originates in the hyponychium and then spreads to the nail plate and bed. To address PIU caused by manicures or acrylic nails, avoiding these procedures is usually sufficient to reverse the condition. Antifungal medication and cuticle oil are also recommended treatments for thick skin under the nail caused by fungal infections.
While the exact causes of PIU are not fully understood, it is important to consult a doctor if you are concerned about hyponychium overgrowth. Nail technicians are not medically trained to treat nail conditions, so seeking medical evaluation is essential. By understanding the underlying causes and symptoms of PIU, effective treatment options can be explored to manage this uncommon but impactful condition.
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Paronychia, a bacterial or fungal nail infection that can cause pain and discolouration
Paronychia is a bacterial or fungal nail infection that causes inflammation of the nail folds, including the tissue bordering the root and sides of the nail. It can affect both the fingernails and toenails. The condition may occur spontaneously or following trauma or manipulation, such as manicures, pedicures, or nail biting. Paronychia usually results from bacteria entering broken skin near the cuticle and nail fold, causing an infection. The most common bacterial causes of paronychia are Staphylococcus aureus and Streptococcus pyogenes. However, it can also be caused by fungal infections, particularly Candida species, which can lead to whitish-yellowish discolouration of the nail.
The symptoms of paronychia include pain, redness, and swelling. Acute paronychia develops rapidly, usually affecting a single nail, while chronic paronychia develops more slowly and can last six weeks or longer, sometimes affecting multiple nails. In some cases, pus may build up under the skin, forming a white to yellow abscess that may require drainage. If left untreated, paronychia can cause nail abnormalities, such as ridges or waves, and the nail may become dry, brittle, and detached from the nail bed.
The treatment for paronychia involves addressing the underlying infection. Most bacterial paronychia can be effectively treated with oral antibiotics, such as tetracycline or doxycycline. Soaking the infected area in warm water several times a day can help drain pus and promote healing. Topical antiseptics may be prescribed for minor infections. In severe cases, surgical drainage of the abscess may be necessary.
Chronic paronychia is often associated with mechanical or chemical factors, such as frequent exposure to water or chemicals, and is more common in individuals with hand dermatitis or constantly cold and wet hands. It can also be caused by fungal infections, particularly Candida species. While the exact causes of chronic paronychia are not fully understood, it is important to note that it may be related to occupational or environmental factors.
To prevent paronychia, it is essential to maintain good nail hygiene. This includes avoiding nail biting, cuticle picking, and cutting nails too short. When trimming cuticles, it is crucial to avoid cutting too close to the nail fold. Additionally, proper hand and nail washing can help reduce the risk of infection.
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Onycholysis, when the nail lifts up and is no longer attached to the nail bed
Onycholysis is a condition where the nail separates from the nail bed. It is characterised by the nail lifting from the nail bed and may appear white or yellow. It usually occurs due to an injury to the nail or nail bed, but can also be caused by fungal infections, yeast infections, bacterial infections, psoriasis, thyroid disease, eczema, lichen planus, certain medications, vitamin deficiencies, or reactions to nail products. Onycholysis is generally not painful, but the underlying cause may be irritating or painful.
The treatment for onycholysis aims to address the underlying cause and promote healthy nail growth. It is important to keep nails short and trimmed to prevent further damage and allow new growth. Aggressive clipping or trimming is not recommended, as it can cause pain and increase the risk of infection. Instead, gently clip away the separated portion of the nail as it grows out, allowing new, healthy nail growth to replace it. This process can take several months for fingernails and even longer for toenails.
To support nail health during onycholysis, it is recommended to wash the nails and surrounding skin gently with mild soap and water daily, ensuring that the area is dried thoroughly afterward. Keeping the nails clean and dry helps prevent the buildup of dirt and debris under the lifted nail, reducing the risk of infection. It is also advisable to avoid harsh nail products, artificial nails, and nail biting, as these can further irritate the nail bed and hinder the recovery process.
In the case of fungal or yeast infections causing onycholysis, antifungal medications or oral antifungal treatments may be prescribed to address the underlying issue. Additionally, maintaining good hygiene practices, such as wearing clean socks and exposing your feet to dry air, can help prevent the spread of the infection to other nails.
While onycholysis itself is not a medical emergency, it is always a good idea to consult a doctor or dermatologist to determine the underlying cause and receive appropriate treatment.
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Beau's lines, deep grooves across the width of the nail caused by interruptions to nail growth
Beau's lines are horizontal ridges or indentations that appear on fingernails or toenails. They are deep grooves that run across the width of the nail and are often a sign of an underlying health issue or physical trauma. These lines can vary in depth and width, indicating the severity and duration of the disturbance in nail growth.
Beau's lines are caused by interruptions to nail growth, which can be due to various factors such as illnesses, injuries, or other underlying conditions. Illnesses that can cause Beau's lines include heart attacks, high fever, strep infections, and chronic conditions like diabetes, thyroid disorders, and peripheral artery disease. Injuries that may result in Beau's lines include pinching or crushing the finger, dropping something heavy on the toe, or exposure to extreme cold. Certain medications, especially chemotherapy, can also cause Beau's lines. Nutritional deficiencies, such as a lack of zinc or protein, can interrupt nail growth and lead to the development of Beau's lines.
The appearance of Beau's lines can provide clues about the underlying cause. For example, multiple lines on each nail may indicate that an illness or trauma occurred more than once, while thicker lines may suggest a prolonged illness or trauma. Beau's lines can also vary in size and placement, sometimes covering only part of a nail or spanning its full width. They can appear on a single nail or multiple nails, and their position can indicate how long ago the disturbance in nail growth occurred.
While there is no specific treatment for Beau's lines, addressing the underlying cause can prevent their recurrence. Healthcare providers may recommend treatments for the underlying condition, such as applying creams or moisturisers for eczema or psoriasis, controlling blood sugar for diabetes, or discussing treatment options for peripheral artery disease. Beau's lines will gradually disappear as the nails grow out, and new, smooth nails will replace them.
If you notice Beau's lines on your nails, it is important to consult a healthcare provider to identify the underlying cause and determine the appropriate course of action. They will examine the nails, review your health history, and assess nail growth to diagnose and treat the condition effectively.
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Frequently asked questions
The root of the nail is called the nail matrix. It grows out of a small pocket under your skin.
The nail matrix is made of special cells that constantly make new nail cells and push old ones out.
Minor damage to your nail matrix can temporarily change your nail's appearance. A severe injury could cause your nail to fall off.
The skin under your nail, called the hyponychium, sometimes thickens and becomes overgrown. If this happens, consult a dermatologist.
If you have a bruise under your nail, you may benefit from a procedure called nail trephination, which drains the trapped blood and helps the new nail grow in correctly.
