Noah Sinclair
Our nails can be a breeding ground for bacteria, yeast, and fungi, which can cause various illnesses. The space under our nails is a perfect environment for the growth and proliferation of these minute life forms, thanks to the physical protection provided by the nail and the moisture. This is why it is important to keep our hands clean, with special attention to the bottom of our nails.
| Characteristics | Values |
|---|---|
| Skin under the fingernail | Pterygium inversum unguis (PIU) occurs when the hyponychium attaches to the underside of the nail as it grows. |
| The hyponychium is the thick skin under your nail tip and acts as a barrier from germs and debris. | |
| The skin in this region contains white blood cells to help prevent infection. | |
| The hyponychium can overgrow and become thicker, making nail trimming painful. | |
| You’re more likely to have overgrown hyponychium if you get gel manicures, wear acrylic nails, or bite your nails. | |
| Germs and bacteria | Bacteria often get stuck under the nails and can be transferred to the mouth, causing infections of the gums and throat. |
| Germs like Klebsiella (bacteria that cause pneumonia and urinary tract infections), Candida parapsilosis (a yeast that causes wound and blood stream infections), Salmonella, and E. coli can be found under the fingernails. | |
| Staphylococcus aureus, which can cause skin infections like boils and abscesses, is the most common type of bacteria found under the fingernails. | |
| Bacteria found under nails can also cause severe vomiting and diarrhea. |
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What You'll Learn
Bacteria, fungus, and yeast
The space under your fingernails is a breeding ground for bacteria, fungus, and yeast. While washing your hands is one of the best ways to prevent the spread of germs, it is difficult to sterilise the area under your nails. This is because the space between the skin and nail creates an ideal environment for the growth of bacteria, fungi, and yeast, thanks to the physical protection provided by the nail and the moisture.
Bacterial infections of the nails are typically caused by gram-negative bacteria, such as Pseudomonas aeruginosa, which can cause a green or black discolouration of the nails, and Klebsiella spp. Bacterial infections can also be caused by gram-positive bacteria like Staphylococcus aureus. These bacteria can enter the skin through cuts or breaks in the cuticle, leading to infections such as paronychia, which is characterised by a painful, red, swollen area around the nail. Pus-filled blisters may also be present, especially with bacterial infections.
Fungal infections of the nails, or onychomycosis, occur when fungi infect the skin and nail, causing thickening of the nail and the skin tissue beneath it. The most common type of onychomycosis is distal and lateral subungual onychomycosis (DSLO), which starts in the hyponychium (the thick skin under the nail tip) and then spreads to the nail plate and bed. Nail psoriasis, a skin condition where skin cells grow too quickly, can also lead to fungal infections under the nails.
Yeast infections of the nails are often associated with fungal infections, particularly with Candida species, including Candida parapsilosis, Candida guilliermondii, and Candida albicans. These yeast infections can cause discolouration of the nails, with non-albicans Candida species manifesting as a greenish-black discolouration.
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Staphylococcus aureus
Staph bacteria are normally found on the skin and in the noses of healthy individuals, but they can become pathogenic when they enter the body through cuts or wounds, including those found under the fingernails. Staph infections under the fingernails can lead to various conditions, such as paronychia, an inflammation of the skin around the nail, which can be acute or chronic. Chronic paronychia, in particular, may be associated with Staphylococcus aureus and is characterised by a gradual process, often starting in one nail fold and spreading to others. The affected skin may be red and tender, with pus formation under the cuticle, and the nail plate may thicken and become distorted with transverse ridges.
The space under the fingernails provides an ideal environment for the growth and proliferation of Staphylococcus aureus due to the physical protection offered by the nail and the presence of moisture. This makes it challenging to eradicate the bacteria through simple handwashing, and even healthcare professionals wearing gloves may not completely prevent the spread of this bacterium. However, keeping nails short and clean is essential for reducing the risk of Staphylococcus aureus colonisation under the fingernails.
Additionally, certain factors can increase the risk of Staphylococcus aureus infections under the fingernails. For example, individuals with diabetes or conditions affecting blood circulation are more susceptible to severe and chronic paronychia. Furthermore, artificial nails, such as gel manicures or acrylic nails, have been linked to higher bacterial counts and poor handwashing practices, potentially increasing the risk of Staphylococcus aureus transmission. In contrast, natural nails with polish tended to have lower bacterial counts, suggesting that nail polish on its own may not significantly impact the bacterial ecosystem under the fingernails.
In summary, Staphylococcus aureus is a common bacterium that can colonise the space under the fingernails, taking advantage of the protective and moist environment. Its presence can lead to infections such as paronychia, especially in individuals with certain underlying conditions or those who practice poor hand hygiene. Maintaining short and clean nails is crucial for reducing the risk of Staphylococcus aureus infections, and in more severe cases, medical treatments such as antibiotics or, in rare instances, surgical intervention, may be necessary.
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Pterygium inversum unguis (PIU)
The condition can be congenital, present at birth, or acquired later in life. The exact cause of PIU is unknown, but it is believed that congenital PIU arises from an early abnormality in the fetal ridge and groove formation. Acquired PIU may be idiopathic or secondary to other factors. Secondary PIU is associated with connective tissue disorders, autoimmune conditions such as lupus, and external factors like the use of nail fortifiers, stroke, neurofibromatosis, and leprosy.
PIU often presents asymptomatically, but when symptoms do occur, they include pain and bleeding when clipping the nails. The condition can cause discomfort when manipulating small objects, typing, or manicuring the nails. The best course of treatment for PIU is unclear, as many approaches, such as topical steroids, keratolytics, and electrocautery-assisted surgical excision, have proven ineffective. Treating the underlying cause of PIU is the recommended strategy. Patients with PIU should be evaluated for associated rheumatologic diseases and require long-term follow-up examinations to monitor for the development of connective tissue diseases.
It is important to note that PIU is a rare disorder, and the presence of skin overgrowth under the fingernails can also result from other conditions, such as nail psoriasis and fungal infections. These conditions can lead to the accumulation of skin cells under the fingernails, causing thickening and overgrowth. Proper nail care habits and maintaining good hand hygiene are essential to prevent the overgrowth of skin and the accumulation of bacteria under the fingernails.
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Paronychia
The symptoms of paronychia include pain, redness, and swelling around the nail. The skin may be warm to the touch, and there may be pus that builds up under the skin. If left untreated, the nail can start to grow abnormally and may have ridges or waves. It may look yellow or green, and it can be dry and brittle. The nail can even detach from the nail bed and fall off.
There are two types of paronychia: acute and chronic. Acute paronychia usually develops over a few hours or days and is limited to one nail. It is most frequently caused by a bacterial infection, especially Staphylococcus aureus, Streptococcus pyogenes, or Pseudomonas. It can also be caused by the cold sore virus, Herpes simplex (herpetic whitlow), or the yeast Candida albicans. Symptoms of acute paronychia include painful redness and swelling of the lateral nail fold.
Chronic paronychia, on the other hand, develops more slowly and usually lasts six weeks or longer. It may start in one nail fold but often spreads to several other fingers or toes. It is usually caused by mechanical or chemical factors and sometimes by infectious agents like a fungal infection, particularly Candida species. The affected skin may be red and tender, and there may be pus (white, yellow, or green) under the cuticle. The nail plate thickens and becomes distorted, often with transverse ridges. The main complication of chronic paronychia is nail dystrophy.
Treatment for paronychia typically involves antibiotics to kill the infection. In some cases, pus may need to be drained, and the fluid may be cultured to identify the specific bacteria causing the infection. Keeping the hands dry and warm and avoiding wet work can help prevent paronychia. It is important to keep the fingernails clean and well-trimmed to reduce the risk of infection.
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Nail biting
The habit is typically triggered by stress, anxiety, boredom, or insecurity. It serves as a coping mechanism for these emotions, and most nail biting is done automatically without much conscious thought. While it may not cause permanent damage, it can have adverse effects on both physical and mental health.
To break the habit of nail-biting, one can try a range of strategies. These include using bitter-tasting nail polishes, wearing gloves or nail stickers, and finding alternative ways to occupy the hands and mouth, such as chewing gum or fiddling with a stress ball. Additionally, keeping nails trimmed short can reduce the satisfaction derived from biting them. For chronic nail biters, dental deterrent devices can be used to prevent damage to the nails and cuticles, and parental education is crucial for young nail biters to maximise the effectiveness of treatment programs.
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Frequently asked questions
The hyponychium is the thick skin under your nail tip. It acts as a barrier from germs and debris, preventing external substances from getting under your nails.
Pterygium inversum unguis (PIU) is an uncommon condition that causes the hyponychium to attach to the underside of the nail as it grows. It can be present from birth or acquired later, with the latter being associated with autoimmune conditions such as lupus.
Nail biting can create tiny cracks in the nails or cuts in the skin, allowing bacteria to enter and cause infections such as paronychia. It can also lead to the overgrowth of the hyponychium, making nail trimming painful.
Paronychia is nail inflammation that may result from trauma, irritation, or bacterial/fungal infection. It can affect one or multiple fingers/toenails and is characterised by pain, swelling, and tenderness around the nail.
To prevent infections, avoid nail biting and maintain hand hygiene by regularly cleaning under your nails with a soapy nail brush or a higher-grade sanitiser. For mild cases of paronychia, soak the infected area in warm water for about 15 minutes a few times a day. More severe infections may require antibiotics or drainage of pus.
