Ava Monroe
There are several reasons why you might experience a nail growing under your nail. This phenomenon is known as onycholysis, which is when a nail separates from its nail bed. It is often caused by injury to the nail, but it can also be caused by a fungal infection, yeast infection, or skin conditions such as psoriasis. Certain medications, illnesses, and skin conditions can also interfere with nail growth, causing nails to thicken, change colour, or stop growing. In some cases, nail separation may be a sign of a more serious underlying health issue.
| Characteristics | Values |
|---|---|
| Condition | Pterygium inversum unguis (PIU), Onycholysis, Nail matrix injury, Hyponychium overgrowth |
| Symptoms | Bruising, ridges, discolouration, nail fall, thick skin, pain, irritation, bleeding, nail separation |
| Causes | Nail injury, fungal infection, psoriasis, lupus, eczema, long nails, gel or acrylic nails, contact dermatitis, certain medications, peripheral artery disease |
| Treatment | Antifungal medication, cuticle oil, nail trephination, surgery, chemotherapy, radiation, custom-made insoles, diluted tea tree oil, hairdryer, builder gel |
| Prevention | Proper nail cutting, avoiding bandages, gloves, creams, wearing clean socks, exposing feet to dry air, wearing shoes of the right size, avoiding water for long periods, manicures |
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Hyponychium overgrowth
The hyponychium is the skin just under the free edge of your nail. It acts as a barrier to protect your nails from germs and debris. The skin in this region contains white blood cells to help prevent infection. However, the hyponychium can sometimes overgrow and thicken, which can be painful and may increase the risk of infection.
Pterygium inversum unguis (PIU) is an uncommon condition that causes the hyponychium to attach to the underside of the nail as it grows. It is a common 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 can also be triggered by external factors.
Nail psoriasis and fungal infections can also lead to hyponychium overgrowth. Psoriasis is a skin condition where skin cells grow rapidly and affect the nails. This can cause scaling and buildup under the nails, known as subungual hyperkeratosis. If the skin becomes very thick, it can lead to onycholysis, or the separation of the nail from the nail bed. Onycholysis can also be caused by nail injuries, yeast infections, or thyroid disease.
To treat hyponychium overgrowth, it is important to soften the skin and gently ease it off the natural nail. Soaking the nails in carrier oils such as olive oil, argan oil, or jojoba oil can help soften the skin. It is recommended to consult a dermatologist, especially if there is bleeding, discolouration, or swelling. Antifungal medication and cuticle oil may also help manage the condition.
Additionally, certain behaviours can increase the likelihood of hyponychium overgrowth. These include getting gel manicures, wearing acrylic nails, or biting your nails. Maintaining proper nail care practices and avoiding aggressive nail clipping can help prevent issues with the hyponychium.
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Onycholysis
The causes of onycholysis are varied and can be primary (idiopathic or of unknown cause) or secondary to another cause. Secondary causes include trauma, skin disease, nail infections, tumours, or systemic events. It can also be caused by a reaction to detergents, such as using detergent-based shampoos or soaps, or washing dishes with bare hands. Onycholysis can also be a symptom of an underlying health condition, such as peripheral artery disease, hyperthyroidism, hypothyroidism, reactive arthritis, porphyria cutanea tarda, or a serious illness like COVID-19, pneumonia, or a heart attack. It can also be caused by certain medications, such as chemotherapy, or by skin conditions like severe eczema.
The condition can also be caused by a fungal infection, which can lead to thickened skin accumulating under the nail. Antifungal medications, such as oral pills or tea tree oil diluted with a carrier oil, can help treat the infection and thicken the skin. It is important to keep the nail dry while it heals.
Treatment for onycholysis aims to address the underlying cause. This may involve ceasing or changing medications, treating a nail infection, or managing an associated systemic condition. It is recommended to keep nails short and trimmed, avoid activities that may harm the nails, and minimise the use of nail enamel, enamel remover, solvents, and detergents.
The condition usually lasts several months, as the nail will not reattach to its nail bed. However, symptoms should resolve once a new nail grows to replace the old one. Fingernails take 4 to 6 months to fully regrow, while toenails can take 8 to 12 months.
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Nail matrix injury
The nail matrix is the area where your fingernails and toenails start to grow. It is responsible for nail growth and plays a vital role in maintaining the nail's health and appearance. The nail matrix has two parts: the germinal matrix and the sterile matrix. The germinal matrix is located at the base of the nail and is responsible for about 90% of nail growth. The sterile matrix lies underneath the nail and is responsible for the remaining 10% of nail cells, but its main function is to keep the nail attached to the underlying skin.
Injuries and certain health conditions can damage the nail matrix and interfere with nail growth. Minor matrix damage can cause temporary changes to the nail's appearance, such as ridges or discolouration. A severe injury could cause your nail to fall off, and in cases of severe nail matrix damage, the nail may not grow back.
Fungal infections, such as toenail fungus, can infect the nail matrix and cause nail discolouration and thickening of the skin under the nail. Bacterial infections of the nailbed can also lead to inflammation, pain, and nail matrix damage.
Other factors that can affect the nail matrix include certain medications, illnesses, and skin conditions. Chemotherapy and other medications can cause Beau's lines (horizontal ridges in the nails) and slow nail growth. Serious illnesses like a heart attack, COVID-19, or pneumonia can also interrupt nail growth and cause Beau's lines. Skin conditions such as severe eczema can affect the nail matrix and temporarily interfere with nail growth, resulting in Beau's lines, pitting, and texture or colour changes.
In some cases, nail matrix injuries may require medical treatment. If you have a bruise under your nail, a procedure called nail trephination can be performed to drain the trapped blood, providing pain relief and helping the new nail grow correctly. This procedure must be done within 48 hours of the injury. If cancerous cells are detected in the nail matrix, surgery may be necessary to remove the affected area.
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Skin conditions
One of the most common skin conditions that can cause nail abnormalities is eczema. Severe eczema can affect your nail matrix and temporarily interfere with nail growth. You might notice Beau's lines (horizontal ridges), pitting (small, pinhole-like dots), and texture or colour changes.
Another skin condition that can affect nail growth is psoriasis. Psoriasis is characterised by rapid skin cell growth and can affect any part of the body, including the nails. Nail psoriasis can cause scaling and buildup under the nail, known as subungual hyperkeratosis. In some cases, severe psoriasis can lead to onycholysis, where the nail separates from the nail bed.
Additionally, certain skin conditions can cause overgrowth of the hyponychium, the skin just under the free edge of the nail, near the fingertip. This overgrowth can make trimming nails painful and may increase the risk of infection. Pterygium inversum unguis (PIU) is an uncommon condition where the hyponychium attaches to the underside of the nail during growth. While scientists don't fully understand PIU, it is associated with autoimmune conditions like lupus and can be triggered by external factors such as contact dermatitis.
If you suspect that a skin condition is causing issues with your nails, it is best to consult a dermatologist, who can examine your nails and determine the appropriate treatment.
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Nail infections
The hyponychium is the skin just under the free edge of the nail. It acts as a barrier to protect your nail from germs and debris. However, the hyponychium can sometimes overgrow, leading to pterygium inversum unguis (PIU), a common cause of skin overgrowth under the fingernail. This condition can be present from birth or acquired later due to autoimmune conditions such as lupus or external factors.
One possible treatment for PIU is the application of cuticle oil to soften the thickened skin. Antifungal medication may also be prescribed if a fungal infection is present. However, it is important to consult a doctor or dermatologist instead of a nail technician for proper treatment.
Another condition that can cause nail issues is onycholysis, which is the separation of the nail from the nail bed. It can be caused by nail injury, fungus, or psoriasis. While onycholysis is not painful, it can be a sign of an underlying yeast infection or thyroid disease. Treatment for onycholysis focuses on addressing the underlying cause and promoting new nail growth. It is important to keep nails short and trimmed, avoid aggressive clipping, and maintain proper nail hygiene to prevent the spread of infection.
Fungal nail infections are characterized by thick, discoloured, and brittle nails that are prone to breaking. They are typically treated with antifungal medications, which may need to be taken for several months. In some cases, severely infected nails may need to be removed under local anaesthesia.
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Frequently asked questions
You may be experiencing onycholysis, which is when your nail separates from its nail bed. It is often caused by an injury to your nail but can also be caused by fungi, yeast growth, or psoriasis. Treatment may involve cutting away the separated nail as it grows out, taking antifungal medication, or discontinuing the use of certain nail products.
Nail abnormalities can be caused by various factors, including fungal infections, certain medications, and skin conditions such as eczema. Additionally, peripheral artery disease (PAD) can reduce blood flow to the nails, slowing nail growth.
It is recommended to consult a healthcare professional to determine the underlying cause of the nail abnormality. Treatment options may include antifungal medications, discontinuing certain nail products, or, in the case of subungual melanoma, surgery may be required. Keeping your nails trimmed and avoiding biting them can also help prevent issues.
