Caleb Foster
There are several reasons why you might have a nail growing over your nail. This condition is called onycholysis, and it occurs when your nail separates from its nail bed. Onycholysis can be caused by injuries to the nail or nail matrix, fungal infections, or psoriasis. It can also be caused by an overgrowth of the hyponychium, the skin just under the free edge of your nail, which can be triggered by autoimmune conditions such as lupus or psoriasis. If you notice any changes to your nails, it is recommended to consult a dermatologist to determine the underlying cause and receive appropriate treatment.
| Characteristics | Values |
|---|---|
| Condition | Pterygium inversum unguis (PIU) |
| Description | Skin overgrowth under the fingernail |
| Causes | Unknown, but associated with autoimmune conditions such as lupus, or triggered by external factors like psoriasis |
| Treatment | Consult a dermatologist, do not cut the overgrown skin |
| Prevention | Keep nails trimmed short, avoid biting nails, be careful when cleaning underneath nails, avoid chemicals or products that can irritate nails, wear gloves during activities that may damage nails |
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What You'll Learn
Onycholysis (nail separation)
Onycholysis, derived from the Ancient Greek words "ónuks" meaning nail and "lúsis" meaning disintegration, is a common medical condition characterised by the detachment of the nail from the nail bed. This condition typically affects a single nail, usually starting at the tip and/or sides, and can occur on both fingernails and toenails. It is most frequently observed in adult women.
There are various causes of onycholysis, including trauma or injury to the nail or nail matrix (the area where nails start to grow), fungal infections, reactions to chemicals in nail products, and skin conditions such as psoriasis. In rare cases, it can be caused by severe eczema or even nail matrix melanoma, a type of skin cancer that affects the nail matrix. Additionally, certain health conditions like hyperthyroidism, hypothyroidism, reactive arthritis, and porphyria cutanea tarda can also contribute to onycholysis.
The treatment for onycholysis depends on the underlying cause. If the condition is caused by an injury, the nail will usually grow out, and trimming the affected nail as it grows out is recommended. For fungal infections, oral or topical antifungal medications may be prescribed. In cases where the condition is caused by a reaction to nail products, discontinuing the use of those products is advised. Preventative measures include keeping nails trimmed short, avoiding nail biting, being cautious when cleaning underneath nails, and wearing gloves during activities that may damage nails.
It is important to note that there is no cure for the section of the nail that has already detached from the nail bed, and reattachment is not possible. However, treatment can help ensure that new nail growth remains attached to the nail bed. Onycholysis is usually painless, but it can be painful in acute or inflammatory cases. If left untreated, onycholysis can lead to secondary infections, discolouration, and cosmetic concerns.
If you are experiencing onycholysis, it is advisable to consult a healthcare professional for proper diagnosis and treatment. They will be able to determine the underlying cause and provide guidance on managing and treating the condition effectively.
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Hyponychium (under-fingernail skin) thickening
The hyponychium is the skin just under the free edge of your nail, near your fingertip. It acts as a barrier to protect your nail from germs, bacteria, allergens, and pathogens. However, in some cases, the hyponychium may thicken, which can be uncomfortable and unsightly. This condition is called inverse pterygium or pterygium inversum unguis (PIU).
There are several possible causes of hyponychium thickening. One common cause is nail care habits, such as getting gel manicures, wearing acrylic nails, or biting your nails. Certain chemicals in gel manicures may trigger hyponychium thickening, although this is not yet proven. Additionally, keeping your nails too long for extended periods can also contribute to the problem.
Another cause of hyponychium thickening is nail psoriasis, a skin condition where skin cells grow too quickly, leading to scaling and buildup under the nail. This overgrowth is called subungual hyperkeratosis. Nail fungus infections can also cause the hyponychium and nail to thicken, resulting in a condition called onychomycosis.
In some cases, the hyponychium may thicken due to an underlying autoimmune condition, such as lupus, or an allergic reaction. Trauma or injury to the nail bed can also lead to hyponychium thickening. This includes physical injuries, such as bumping or hitting your nails, as well as chemical irritation from nail products like nail polish, gloss, hardeners, and removers.
If you are experiencing hyponychium thickening, it is recommended to consult a dermatologist for an evaluation. While it may be tempting to cut the overgrown skin, this is not advised as it can introduce an infection. Instead, softening the thickened skin with a cuticle remover or oil and gently pushing it back after showering can help reduce the growth. Maintaining good nail hygiene by regularly cleaning the nail area and keeping it free from dirt and debris is also crucial.
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Nail matrix damage
The nail matrix is the area where your fingernails and toenails start to grow. It creates new cells that become your fingernails or toenails. The nail matrix has two parts: the germinal matrix and the sterile matrix. The germinal matrix is under the base of your nail, and the sterile matrix lies underneath your nail. About 90% of your nail growth comes from your germinal matrix, while the remaining 10% comes from the sterile matrix, which is also responsible for keeping your nail attached to the underlying skin.
Injuries and certain health conditions can damage your nail matrix and interfere with nail growth. Trauma to the nail can cause the production of new nail cells to stop for as long as three weeks. Nail growth will usually resume at a faster rate and steady after about 100 days. You may notice the nail appears thicker than usual. If you have a deep cut or trauma to the germinal matrix at the base of the nail, it’s possible the nail may never grow back.
Minor damage to your nail matrix can temporarily change your nail’s appearance. You might notice a change in how your nail feels to the touch. A severe injury could cause your nail to fall off. Once your nail matrix heals, your nail will usually start to grow again. It may take several weeks before you see your new nail appear. In cases of severe nail matrix damage, some or all of your nail may not grow back.
Some conditions that can affect the nail matrix include severe eczema, psoriasis, and subungual melanoma (nail matrix melanoma). If you notice any changes to your nails, such as dents, horizontal ridges or lines, pain or soreness, splits or cracks, spots or streaks of colour, or texture changes, it’s recommended that you seek help from a healthcare provider or a board-certified dermatologist.
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Nail infections
One common nail infection is onycholysis, which is the separation of the nail from the nail bed. Onycholysis can be caused by injuries to the nail or the nail matrix, the area where nail growth begins. Such injuries can result from bumping or hitting the nails, wearing tight shoes, or prolonged exposure to water. Manicures, especially those involving forceful trimming, buffing, and polishing, can also lead to onycholysis. Additionally, chemical exposure to nail products like nail polish, nail gloss, and nail hardeners can contribute to this condition. Onycholysis can also be caused by fungal infections, resulting in thick, yellow nails with white spots and streaks. Treatment for onycholysis may involve cutting away the separated nail, taking antifungal medications, or discontinuing the use of certain nail products.
Another nail infection is paronychia, characterised by redness and swelling around the nail. This infection can be treated with soaks and antibiotics if diagnosed early. However, if an open sore develops, more extensive treatment is required. Paronychia can cause the nail to turn greenish-black when left untreated, indicating a worsening bacterial infection.
Yellow nail syndrome is another nail infection that results in thickened, yellow nails that seem to stop growing. This condition can be indicative of underlying health issues such as lung disease or rheumatoid arthritis. It is important to seek medical attention for this infection to address any potential internal causes.
In some cases, nail infections can be associated with autoimmune conditions or skin disorders. For example, pterygium inversum unguis (PIU) is a condition where the hyponychium, the skin under the free edge of the nail, attaches to its underside as it grows. While PIU can be present from birth, it can also be triggered by autoimmune conditions like lupus or skin conditions like psoriasis. Psoriasis involves excessive skin cell growth, leading to scaling and buildup under the nail, known as subungual hyperkeratosis. Similarly, eczema can affect the nail matrix, causing Beau's lines, pitting, and texture or colour changes.
To prevent and manage nail infections, it is crucial to maintain proper nail care practices. Keeping nails trimmed and avoiding aggressive clipping can help prevent injuries and create an environment that discourages bacterial growth. Avoiding nail-biting and being cautious when cleaning underneath the nails are also essential. Additionally, wearing gloves during activities that may damage the nails, such as washing dishes or playing sports, can provide protection. Consulting a dermatologist for any persistent or concerning nail changes is always recommended to ensure proper diagnosis and treatment.
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Psoriasis
Skin growing over the nail can be caused by a condition called Pterygium inversum unguis (PIU), where the hyponychium, or the skin just under the free edge of the nail, attaches to the underside of the nail as it grows. This condition can be present from birth or acquired later, with the latter being associated with autoimmune conditions such as lupus or psoriasis.
- Discoloration: The nail bed may exhibit yellow, red, pink, or brown colours, known as salmon patches or oil drop spots.
- Pitting: Small dents or pits can form on the nails, ranging from 0.4 to 2 millimetres in size, and can be shallow or deep.
- Changes in nail structure: Horizontal ridges or grooves known as Beau's lines may appear. Nails may become thin and brittle, leading to crumbling.
- Nail separation: Onycholysis, or nail separation, can occur when the thick layer of skin under the nail's tip peels and separates from the nail bed.
- Nail thickening: Nails may thicken, leading to discomfort, tenderness, or pain.
While there is no cure for nail psoriasis, various treatments can help alleviate symptoms, including corticosteroids, calcipotriol, and tazarotene. These treatments are typically applied directly to the nails once or twice a day for at least six months. In some cases, two medications may be combined for better results. It is important to consult a dermatologist to receive a correct diagnosis and determine the most effective treatment.
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Frequently asked questions
This could be due to a condition called Pterygium inversum unguis (PIU), where the hyponychium (the skin just under the free edge of your nail) attaches to the underside of the nail as it grows. It may be present from birth or acquired later, often associated with autoimmune conditions such as lupus, or triggered by external factors.
The exact cause of PIU is not fully understood. However, it is known that it can be present from birth or acquired later in life. If acquired, it is commonly associated with autoimmune conditions such as lupus, but it can also be triggered by external factors.
Treatment for PIU is typically not necessary unless it becomes thick or overgrown, which can cause pain and increase the risk of infection. In such cases, it is recommended to consult a dermatologist for evaluation and treatment options.
Yes, there are several other potential causes for nail overgrowth or abnormalities, including:
- Nail psoriasis: A skin condition where skin cells grow rapidly and affect the nails, causing scaling and buildup (subungual hyperkeratosis).
- Onycholysis: A condition where the nail separates from the nail bed due to injury, fungus, or psoriasis.
- Nail matrix damage: Severe damage to the nail matrix can interfere with nail growth and, in rare cases, prevent the nail from growing back.
- Health conditions: Various health issues can cause nail changes, including eczema, psoriasis, and yellow nail syndrome, which is associated with lung disease and rheumatoid arthritis.
