Sophia Delgado
The medical term subungual refers to the area under the nail. It is derived from the Latin sub meaning under or below, and ungual meaning nail. This term is used in medical contexts to describe conditions or procedures that involve the area beneath the nail, such as subungual hematomas, which is bleeding that occurs underneath the nail.
| Characteristics | Values |
|---|---|
| Term | Subungual |
| Root Words | Sub- (under or below) |
| Ungual (nail) | |
| Conditions | Subungual hematoma (bleeding under the nail) |
| Other Conditions | Inflammation of soft tissue around a nail (paronychia) |
| Profuse sweating (diaphoresis) | |
| Fungal infection (mycosis) | |
| Fatty mass within a sebaceous gland (steatoma) | |
| Inflammatory disease of the joints and collagen of the skin (systemic lupus erythematosus) |
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What You'll Learn
Subungual hematoma
A subungual hematoma is a collection of blood under a fingernail or toenail. It is usually caused by a crush injury to the distal phalanx, such as getting a finger pinched in a doorway or hitting the toe against the front of a shoe. Subungual hematomas can also be caused by more serious injuries, such as a severe blow to a finger or toe, which may result in broken bones or damage to the nail bed and surrounding tissues.
The main symptom of a subungual hematoma is intense pain and throbbing due to the pressure of blood collecting between the nail and the nail bed. The nail may appear discoloured—reddish, purple, brown, or black—and this variation in colour is related to the duration and stage of healing. As the injury heals, a clear proximal margin will appear in the nail plate as the discoloured nail grows outwards and is replaced by a new, healthy nail.
Small subungual hematomas may not require medical treatment. To reduce swelling and minor pain, the area can be iced and elevated, and over-the-counter anti-inflammatories can be taken. If the injury is acutely painful, the hematoma can be drained by making a small hole in the nail (a procedure called trephination) within 48 hours of the injury. This releases the pressure and provides relief. Trephination can be performed by a doctor using a heated wire (electrocautery device), a laser, or a needle to burn or puncture a hole through the nail. The hole is then covered with a sterile dressing and kept dry.
In more severe cases, especially if there is damage to the nail bed or surrounding tissues, the entire nail may need to be removed and the nail bed repaired with stitches. If the nail is to be removed, a digital nerve block is recommended to numb the affected area. Even with proper treatment, there is a possibility that the new nail may grow back abnormally. Subungual hematomas typically resolve slowly, with fingernails taking up to 8 weeks to regrow and toenails taking up to 6 months.
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Inflammation of soft tissue
Paronychia is an infection and inflammation of the soft tissue under the nails. It is caused by bacteria entering broken skin near the cuticle and nail fold, which is the skin at the base of the nail where the skin and nail come together. This can happen due to an injury, such as biting nails or picking at cuticles, or from an ingrown toenail. It can also be caused by prolonged contact with water or other liquids, or from contact with corrosive substances. Certain jobs that require working with water, such as bartenders and dishwashers, have a higher risk of developing paronychia.
The symptoms of paronychia include pain, swelling and tenderness around the nail, with skin that is red and warm to the touch. There may also be pus-filled blisters, especially with a bacterial infection. The nail may also look detached, abnormally shaped, or have an unusual colour.
To treat paronychia, it is recommended to soak the infected area in warm water for about 10 to 15 minutes, multiple times a day. This helps to reduce swelling and pain. Antibiotics may also be prescribed to clear up the infection. In more severe cases, a procedure may be required to drain the pus and abscess, and sometimes, part of the nail may need to be removed.
It is important to practice good nail hygiene and avoid biting or picking at nails and cuticles to prevent paronychia. Nails should be trimmed regularly, and cuticles should not be cut or removed as they help seal the space between the nail and the skin. Using hand lotion can also help keep cuticles soft and hydrated, preventing them from cracking.
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Removal of dead tissue
The term subungual pertains to under the nails. The hyponychium is the skin just under the free edge of the nail, located beyond the distal end of the nail bed, near the fingertip. It acts as a barrier to germs and debris, containing white blood cells to prevent infection. Pterygium inversum unguis (PIU) is a condition where the hyponychium attaches to the underside of the nail as it grows, leading to skin overgrowth under the nail.
Dead tissue under the nails, or the cuticle, can be removed for cosmetic or medical reasons. The cuticle is the dead skin on the nail plate, and removing it allows nail polish to bond directly to the nail. It is important to protect live skin with a liquid latex barrier, such as Simply Peel™, before applying a cuticle remover. This barrier prevents damage to the live skin and nail plate.
Once the liquid latex barrier is dry, apply a cuticle remover, such as Simply Gone™, to the nail plate. Use a tiny amount, about the size of a quilting pin head, and spread it over the nail with the tip of the bottle. Repeat this process for all five fingers on one hand. Remember not to leave the cuticle remover on for longer than 1-2 minutes.
Using a cuticle removal tool, gently scrape the cuticle away, stopping at the proximal fold. Glide the tool against the surface of the nail plate. The cuticle remover will have dissolved the cuticle, so downward pressure is unnecessary and may cause damage. Wipe the removed cuticle and cream buildup from the tool onto a paper towel. Repeat the process for the remaining hand.
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Increased cell growth
The term "subungual" pertains to under the nails. Now, onto the topic of increased cell growth under nails.
The nail matrix, located at the base of the nail, is responsible for producing new nail cells. Each nail matrix produces 196 layers of cells that combine to form each fingernail and toenail. This process of new cell generation is continuous, and the nail matrix is constantly making new nails, unlike hair follicles that go through periods of rest.
Several factors can influence the rate of cell growth and nail health. Age is one such factor; research suggests that nail growth rate is slower in aged nails compared to younger nails, likely due to reduced stem cell activity. Additionally, certain health conditions and medications can impact the nail matrix and slow down nail growth. For example, chemotherapy and peripheral artery disease can lead to slower nail growth.
Injuries to the nail matrix can also affect nail growth. Bruises, pinching, crushing injuries, or dropping something heavy on the toe can damage the nail matrix. In such cases, a procedure called nail trephination can be performed to drain trapped blood, relieve pain, and promote correct nail growth. This procedure must be done within 48 hours of the injury, before the blood clots.
Furthermore, skin conditions like eczema and nail psoriasis can interfere with nail growth. Eczema can cause Beau's lines (horizontal ridges), pitting, and texture or color changes. Nail psoriasis can lead to white lines, pitting, and crumbling of the nails.
Fungal infections, such as onychomycosis, can also impact nail growth. These infections can thicken the nail and the skin tissue beneath it, leading to potential separation of the nail plate from the nail bed (onycholysis).
In summary, while the nail matrix typically facilitates continuous nail growth, various factors, including age, health conditions, medications, injuries, skin conditions, and fungal infections, can lead to increased cell growth or alterations in nail appearance and growth rate.
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Inflammatory disease of the joints
Inflammatory arthritis is joint inflammation caused by an overactive immune system. It is relatively uncommon compared to osteoarthritis, which is often described as a "wear-and-tear" disease. Inflammatory arthritis usually affects multiple joints throughout the body at the same time but can also involve just one joint. It is caused by an increase in cytokines, which leads to degradation of articular cartilage and a decrease in growth factors. This results in painful swelling, synovitis, cartilage damage, bone damage, ligament damage, and nerve damage in and around the affected joints.
There are several types of inflammatory arthritis, including gout, pseudogout, rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Gout is caused by an excess of uric acid in the body, which leads to the development of uric acid crystals in the joints. Pseudogout, on the other hand, is caused by an inflammatory reaction to deposits of calcium crystals. Rheumatoid arthritis is a chronic, systemic autoimmune disease characterized by the simultaneous inflammation of multiple joints, leading to joint damage. Ankylosing spondylitis is a chronic inflammatory condition affecting the spine and bone-to-tendon attachment area within the sacroiliac joint, resulting in back pain and progressive spinal stiffness.
The treatment goals for inflammatory arthritis aim to eliminate joint pain and prevent permanent joint damage. Early diagnosis and aggressive treatment targeting inflammation are crucial to limit joint damage and other negative effects. Several treatment options are available, including disease-modifying medications, nonsteroidal anti-inflammatory drugs, and biologic DMARDs (disease-modifying antirheumatic drugs). In some cases, surgery may be necessary to repair, replace, or fuse severely damaged joints.
In addition to joint pain and stiffness, people with inflammatory arthritis may experience systemic inflammatory changes, such as fever, fatigue, weakness, and loss of appetite. These symptoms can spread beyond the joints and affect other organs, including the eyes, heart, lungs, and kidneys. It is important to note that inflammatory arthritis is not limited to adults; juvenile idiopathic arthritis (JIA) is an autoimmune, non-infectious, inflammatory joint disease that affects children.
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Frequently asked questions
Subungual. The prefix "sub-" means under or below, and ungual refers to the nail.
The term subungual refers to the area below the nail.
Subungual hematoma is bleeding that occurs underneath the nail.
Paronychia is the inflammation of soft tissue around a nail.
Albinism.
