Caleb Foster
The nail is an infolding of skin at the end of each digit, consisting of the nail plate, proximal nail fold, matrix, nail bed, and hyponychium. The nail plate is made of a hard substance called keratin, which is produced by the matrix. The growth rate of nails depends on factors such as age, sex, and season, with fingernails generally growing faster than toenails. Nails are susceptible to various abnormalities, including discolouration, shape changes, and lesions, which can indicate underlying medical conditions. For example, Lindsay's nail, characterised by a brown distal band, is associated with chronic renal failure, while Muehrcke's nail, with its pale transverse bands, indicates low serum albumin levels. Nail abnormalities can also result from traumatic events or diseases such as scleroderma and Raynaud's phenomenon.
| Characteristics | Values |
|---|---|
| Definition | A protective plate found at the tip of the digits (fingers and toes) of all primates, corresponding to the claws in other tetrapod animals |
| Composition | A tough rigid protein called alpha-keratin, a polymer also found in the claws, hooves, and horns of vertebrates |
| Structure | Consists of the nail plate, the nail matrix, and the nail bed below it, and the grooves surrounding it |
| Nail Matrix | The active tissue (or germinal matrix) that generates cells. The cells harden as they move outward from the nail root to the nail plate |
| Nail Growth Rate | In humans, fingernails grow at an average rate of approximately 3.5 mm per month, while toenails grow at approximately half that rate. Actual growth rate depends on age, sex, season, exercise level, diet, and hereditary factors |
| Nail Care | Includes trimming, shaping, and cuticle maintenance. Topical treatments such as moisturizers can also be applied |
| Nail Abnormalities | Discoloration, abnormalities of the nail plate surface, cuticle and nail fold, nail shape, loss of nails, lesions around nails, nail pitting, transverse ridging, longitudinal ridging, distal notching, nail erosion, yellow nail syndrome, green nails, onycholysis, nail plate crumbling, onychoschizia (distal lamellar or splitting/brittle nails) |
| Nail Diseases | Paronychia, eczema, psoriasis, alopecia areata, parakeratosis pustulosa, shrimp nail, lichen planus, fungal nail infection, Darier disease, squamous cell carcinoma, melanoma, onychomycosis, onychogryphosis, onychauxis, angel-wing deformity |
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Nail abnormalities
Healthy nails are smooth and have consistent colouring. However, the appearance of nails can change due to injury, infection, or other health conditions. While some changes are harmless, others may require medical attention.
Nail Discolouration
Nail discolouration can be indicative of various medical conditions. Yellow nail syndrome, for instance, is associated with lymphatic obstruction in cardiopulmonary disease. Nails that are brown in colour may be due to staining from nicotine, potassium permanganate, or nail varnish, or may be a result of chemotherapy. Green nails are often a sign of a Pseudomonas or Candida infection.
Nail Depressions
Depressions that run across the nail are known as Beau's lines and can be a sign of malnourishment or previous severe illness. Beau's lines can also be caused by diseases that cause a high fever, such as measles, mumps, and scarlet fever. Mees' lines are transverse white bands that frequently affect multiple nails and are classically associated with arsenic poisoning.
Nail Separation
Nail separation, or onycholysis, can be a sign of hyperthyroidism. Nails may become loose and rapidly damaged, with debris collecting beneath them.
Nail Shape
Koilonychia, or "spoon-shaped" nails, may be a sign of hemochromatosis or anemia. Clubbing, a process that takes years, is when nails thicken and curve around fingertips, which can suggest pulmonary disease or inflammatory bowel disease.
Nail Thinning and Crumbling
Nail thinning, or onychoschizia, is often a result of water or detergent damage. Nail crumbling is typical of psoriasis and fungal nail infections.
Nail Ridges
Vertical ridges may develop with age, and horizontal ridges, or leukonychia, are usually harmless and the result of minor trauma. However, longitudinal ridges may be indicative of myxoid cysts or warts overlying the proximal nail matrix.
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Nail discolouration
Healthy nails are typically smooth and have consistent colouring. Any abnormalities, such as discolouration, spots, or nail separation, can sometimes be harmless, but they can also indicate a more serious underlying condition.
Yellow Nails
Yellow nail syndrome is characterised by thickened nails that seem to have stopped growing. It is usually caused by lymphatic obstruction in cardiopulmonary disease. However, yellow nails can also be caused by fungal infections, the overuse of nail polish, or smoking.
Green Nails
Green nails are often associated with a Pseudomonas or Candida infection.
Brown Nails
Brown nails can be caused by staining from nicotine, potassium permanganate, or nail varnish. They can also be a side effect of chemotherapy.
White or Dark Streaks
White or dark streaks on the nails can be a sign of melanonychia, a condition in which melanin is present in the nail plate. This can sometimes be malignant, so an accurate diagnosis is vital.
Beau Lines
Beau lines are transverse depressions that affect all nails and are caused by acute systemic illnesses that interrupt nail growth. They can be caused by local or systemic conditions.
If you notice any discolouration or other abnormalities in your nails, it is important to consult a doctor or dermatologist to rule out any serious conditions.
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Nail care
Understanding Nail Structure
Before delving into nail care, it's important to understand the basic structure of a nail. The nail plate, also known as the nail bed, is the hard, protective layer of the nail. The cuticle is the thin layer of skin at the base of the nail, and the nail fold is the skin that surrounds the nail plate.
Daily Nail Care Tips:
- Moisturize Your Hands: Regularly moisturizing your hands is essential for nail care. Use a good hand lotion or cream after washing your hands to keep them soft and supple. This will also help prevent your cuticles from becoming dry and cracked.
- Protect Nails from Water: Prolonged exposure to water can weaken nails, making them prone to splitting, peeling, or breaking. Wear gloves when washing dishes or cleaning to minimize water contact with your nails.
- Avoid Using Nails as Tools: Refrain from using your nails as tools to open cans, remove staples, or scratch off labels. Such actions can cause chipping, splitting, or lifting of the nail bed.
- Trim and File Nails Regularly: Keep your fingernails and toenails neatly trimmed and filed. Use a glass nail file, as it is gentler on the natural nail and very precise. Always file in one direction to prevent nail damage.
- Care for Your Cuticles: Avoid cutting or removing your cuticles, as this can lead to infections. Instead, gently push back your cuticles, and apply cuticle oil daily to keep them soft and healthy.
Weekly Nail Care Routine:
- Remove Old Polish: If you wear nail polish, start by removing it with a gentle nail polish remover. Avoid using acetone-based removers, as they can dry out your nails.
- Soak and Trim Toenails: Soak your feet in warm salt water to soften the nails before trimming. This is especially helpful for thick and difficult-to-cut toenails.
- Exfoliate and Moisturize: Exfoliate your hands and nails to remove dead skin cells. Then, apply a generous amount of hand lotion or moisturizer to keep your hands and nails hydrated.
- Apply Nail Hardener and Polish: After pushing back your cuticles, apply a nail hardener to strengthen your nails. If desired, finish with a coat of your favorite nail polish color.
Common Nail Conditions:
It's important to be aware of certain nail conditions that may indicate underlying health issues. Some common nail abnormalities include discolouration, pitting, transverse ridging, and longitudinal grooves. These issues can be indicative of various medical conditions, including eczema, psoriasis, onychomycosis, and even more serious ailments. Therefore, it's advisable to consult a dermatologist if you notice any persistent abnormalities in your nails.
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Nail growth
Fingernails grow at an average rate of 3.47 millimetres per month, or about a tenth of a millimetre per day. The specific growth rate depends on several factors, including age, hormone levels, and overall health. For example, nail growth is said to peak during puberty and decline as hormone levels balance out with age. Blood circulation also slows with age, which may contribute to slower nail growth in older individuals.
The rate of nail growth further depends on which finger the nail is on. Typically, the nails on the dominant hand grow faster, as do the nails on longer fingers. The little finger tends to have the slowest rate of nail growth. Toenails grow much slower than fingernails, with an average growth rate of 1.62 millimetres per month.
Trauma to the nail, such as frequent nail clipping or biting, can stimulate circulation in the nail bed and may result in faster nail growth. Gentle massage can also promote circulation to the nails, which may be beneficial for individuals with circulatory issues such as diabetes. Maintaining proper nail grooming and regularly moisturising the cuticles can help prevent nail damage and infection.
Nutrition is crucial for nail health and growth. A balanced diet that includes protein, water, fruits, vegetables, and a variety of vitamins and minerals is essential. For example, individuals who do not get enough iron may experience brittle or dented nails. While there is no proven way to accelerate nail growth, certain dietary changes and supplements can strengthen the nails and promote overall nail health.
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Nail diseases
The health of your nails can indicate your overall health. Healthy nails are usually smooth and consistent in colour. Specific types of nail discolouration and changes in growth rate can be signs of lung, heart, kidney, and liver diseases, as well as diabetes and anemia.
Onycholysis
Onycholysis is when the toe or fingernail separates from the nail bed. It typically occurs slowly over time and could be due to an underlying health condition or injury. It can result in discolouration of the nail, turning it green, yellow, or opaque. It can also cause additional skin tissue under the nail, nail pitting, nail thickening, or bending of the nail edges.
Paronychia
Paronychia is an infection that can cause transverse ridging of the nail.
Nail Psoriasis
Nail denting or crumbling can be caused by nail psoriasis. It occurs when psoriasis affects the skin of the nail bed or near the nail beds.
Onychoschizia
Onychoschizia is the medical term for brittle, splitting nails. It is often caused by repeatedly wetting and drying the nails. It can also be caused by iron deficiency or underlying illness.
Onychogryphosis
Onychogryphosis is a condition where the nail becomes overgrown and thick, often affecting the big toe. It can cause one portion of the nail to grow longer than the other, resembling a ram's horn.
Yellow Nail Syndrome
Yellow nail syndrome refers to multiple yellow nails due to lymphatic obstruction in cardiopulmonary disease.
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Frequently asked questions
A nail is made of a tough, rigid protein called alpha-keratin.
Nails are protective plates that cover the dorsal surface of the distal end of each terminal phalanx of fingers and toes.
Unguis is the medical term for a nail.
Nail care involves trimming, shaping, and cuticle maintenance. It is important to avoid biting nails and picking hangnails to prevent bacterial infections.
Some nail abnormalities include discolouration, abnormalities of the cuticle and nail fold, abnormalities of nail shape, and lesions around nails.
