Sophia Delgado
Long nails can be a source of pain and discomfort for some people. While there is little information on why long nails cause pain, some possible causes include paronychia, ingrown nails, nail infections, and physical injuries. Paronychia is a condition that causes swelling and redness around the nail, leading to pain. Ingrown nails occur when the sides of the nail curve into the skin, causing pain and potentially leading to infection. Nail infections, caused by bacteria or fungi, can result in pain, swelling, and discolouration. Additionally, physical injuries to the nail, such as crushing or catching the nail, can cause bruising or bleeding under the nail (subungual hematoma), leading to tenderness and pain. Maintaining proper nail care and hygiene is essential to prevent infections and reduce the risk of pain associated with long nails.
| Characteristics | Values |
|---|---|
| Pain under fingernail | Hematoma, Paronychia, Ingrown nails, Tumors, Fungal infection, Nail biting, Bruising or bleeding under the nail, Nail infections |
| Pain relief | Antibiotics, Steroids, Antifungals, Drainage, Nail removal, Cold compress, Warm soak |
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What You'll Learn
Paronychia
Chronic paronychia is typically caused by a yeast or fungal infection of the soft tissues around the nail, often the Candida albicans fungus, and is treated with antifungal medication. It can also be caused by bacterial infection or irritation from occupational or environmental exposures, such as frequent hand washing, contact with chemicals, or having constantly cold and wet hands. Chronic paronychia usually affects several fingers or toes at once, with each nail fold swollen and lifted off the nail plate. The affected skin may be red and tender, and there may be some pus under the cuticle. The nail plate thickens and becomes distorted, with transverse ridges.
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Subungual hematoma
While small subungual hematomas may not require medical attention, it is important to seek medical advice if the pain is severe or persistent. In most cases, a doctor will recommend simple decompression or trephination to relieve the pressure and pain. This procedure involves creating a small hole in the nail to drain the blood. Cautery, using a heated wire or laser, or a needle can be used to make the hole.
If the bleeding covers a large area of the nail surface, the nail bed may be damaged, and the entire nail may need to be removed. Stitches may be required to repair the nail bed. In some cases, the nail may fall off on its own as the pooled blood separates it from its bed. A new fingernail can regrow within 8 weeks, while a toenail may take up to 6 months.
It is important to note that subungual hematomas can also be caused by non-traumatic factors, such as tumors, melanoma, or splinter hemorrhages. If the hematoma is not advancing distally over time, it is recommended to consult a dermatologist to rule out abnormal tissue growth. Management of subungual hematoma often involves an interprofessional team, including emergency department physicians, nurse practitioners, and surgeons.
To prevent complications, it is crucial to follow up after treatment to ensure the hematoma has resolved and there is no infection. While antibiotics are not currently recommended post-procedure, proper wound care and hand hygiene are essential to prevent infections.
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Tumours
Subungual glomus tumours are a rare cause of nail pain, and they are typically found in the nail bed. They can cause excruciating pain and are often misdiagnosed. The pain is usually described as a throbbing sensation, and it can be aggravated by cold temperatures. Treatment for these tumours includes surgery, radiation therapy, and medication.
Nail pain can be caused by a variety of factors, including trauma, inflammation, infection, tumours, vascular disorders, and papulosquamous diseases. An accurate diagnosis is necessary to determine the appropriate treatment and, if possible, remove the cause of the pain.
Nail infections, or paronychia, can also cause nail pain and are usually treated with 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. Chronic paronychia is more commonly caused by irritation from occupational or environmental exposures and can be caused by fungi, bacteria, or dermatitis.
Other causes of nail pain include ingrown nails, which can occur on both toenails and fingernails, and can be very painful. Nail biting can also cause pain and increase the risk of nail infections.
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Fungal infections
Long nails can become a breeding ground for bacteria and fungi, leading to infections. One such infection is a fungal nail infection, which can cause nail pain and discomfort.
Fungal nail infections occur when fungi infect one or more nails. These infections usually affect toenails, but they can also occur on fingernails. The infection often starts at the edge of the nail, causing it to become thick, discoloured, and brittle. The nail may turn white or yellow and crumble or break easily. In some cases, the whole nail may detach, leading to painful and swollen skin underneath.
Fungal nail infections are typically caused by the same fungus responsible for athlete's foot. Other fungi, such as yeasts and moulds, can also contribute to the infection. These fungi thrive in moist environments, so keeping your nails dry and clean can help prevent fungal growth.
To treat a fungal nail infection, you can start by trying over-the-counter or home remedies. Topical antifungal treatments, which you brush onto the nail, are available at pharmacies. It's important to use these treatments regularly for several months, as directed, to ensure the infection doesn't return.
If pharmacy treatments are ineffective, consult your doctor. They may prescribe antifungal tablets or, in severe cases, recommend removing the nail to eradicate the fungus. Before prescribing medication, your doctor will likely test a sample of your nail to identify the specific type of infection. They may also perform blood tests to ensure your liver is functioning optimally. Antifungal tablets may not be suitable for individuals with certain conditions, such as liver or kidney disease, or for those who are pregnant or breastfeeding.
While fungal nail infections are not considered serious, they can take a long time to treat, and without proper treatment, they can spread to other nails and, in rare cases, cause permanent damage to the nail bed. Therefore, it's important to address these infections promptly and seek medical advice if necessary.
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Ingrown nails
Ingrown toenails can lead to severe complications, especially for those with diabetes or conditions causing poor blood flow to the feet. In such cases, minor injuries may not heal properly and become infected. If left untreated, ingrown toenail infections can spread through the toe and into the bone. Symptoms of an infected ingrown toenail include redness, swelling, and pus.
To prevent ingrown toenails, it is important to trim nails straight across and maintain a moderate length. Wearing properly fitting shoes is also essential to avoid pressure on the toes.
Treatment for ingrown toenails can be done at home or by a healthcare provider. Home treatment includes soaking the foot in warm water mixed with Epsom salt or soapy water twice daily, keeping the foot dry, and gently lifting the edge of the nail to place cotton or dental floss between the nail and skin. This process helps the nail grow above the skin. Applying antibiotic cream, using pain relievers, and wearing roomy shoes are also recommended.
If home remedies do not provide relief, a healthcare provider may employ various techniques, including partially removing the nail, placing a gutter splint under the nail, or performing a nail avulsion to surgically remove part of the nail.
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Frequently asked questions
Nails may ache when they are long due to paronychia, a nail infection that causes swelling and redness or discolouration of the finger, especially around the cuticle. Ingrown nails, which occur when you cut or bite your nail too close to the nail bed, can also be a cause of pain.
Treatments for nail pain depend on the cause and may include home remedies, such as warm soaks, and medical treatments. If you suspect an infection, you should seek medical advice and may be prescribed antibiotics.
To prevent nail pain, avoid nail biting and picking at your cuticles. Keep your nails clean and dry and moisturise your hands to prevent cracked skin, which can lead to infection.
