Noah Sinclair
The skin around our nails, known as the cuticle, is essential for protecting the nail matrix (where our nails grow from) and the nail bed from damage, dirt, and debris. However, when left unattended, cuticles can grow and cover parts of the nail plate, a condition called Pterygium Inversum Unguis (PIU). While the exact causes of PIU are not fully understood, it is associated with various factors, including poor nail care, chronic stress, and underlying health conditions such as psoriasis and eczema.
| Characteristics | Values |
|---|---|
| Skin growing over nails | Pterygium inversum unguis (PIU) |
| Hyponychium overgrowth | |
| Common causes | Neglecting nail care |
| Stress | |
| Health conditions (e.g. Psoriasis, Eczema, Allergic Contact Dermatitis) | |
| Vitamin supplements | |
| Treatment | Consult a dermatologist |
| Avoid cutting or picking the cuticle | |
| Gently push back the cuticle |
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Pterygium inversum unguis (PIU)
PIU is often asymptomatic, but the most commonly reported symptom among those who do experience symptoms is bleeding or pain after clipping the affected nails. The condition can cause pain with manipulation of small objects, typing, and close manicuring of the nail. As of 2014, only 37 cases have been reported in the literature. PIU most commonly affects women aged 20-70.
The best way to address PIU is unclear, and many approaches, such as topical steroids, keratolytics, and electrocautery-assisted surgical excision, have been shown to be ineffective. Treating the underlying cause of PIU is the best course of action. Patients with PIU need to be evaluated to rule out associated rheumatologic diseases and require long-term follow-up examinations to detect the development of connective tissue diseases such as scleroderma.
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Psoriasis
When psoriasis affects the nails, it is known as nail psoriasis. It can cause changes in nail structure, such as pitting, thickness, and colour changes. The skin underneath the nails (nail bed) may change colour, appearing yellow, red, pink, or brown. Nails may develop horizontal grooves (Beau's lines) and become thin and brittle, eventually crumbling.
In some cases, nail psoriasis can lead to onycholysis, where the nail separates from the nail bed. This condition begins with a white or yellow patch at the tip of the nail, which gradually spreads down to the cuticle. Onycholysis can also be caused by nail injuries or other skin conditions such as lichen planus.
Treatment for nail psoriasis includes prescription and over-the-counter medications, such as corticosteroids, calcipotriol (vitamin D derivative), and tazarotene (vitamin A derivative). In more severe cases, healthcare providers may prescribe oral medicines or inject medications directly into the skin around the nails. Phototherapy, using ultraviolet light, is another treatment option.
It is important to note that nail psoriasis is not contagious and cannot be spread through skin-to-skin contact. However, having psoriasis does make individuals more susceptible to nail fungus, as the condition damages the nails, providing a pathway for fungal organisms to get underneath.
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Eczema
Additionally, eczema can cause changes in the nail bed, such as chromonychia, clubbing, koilonychia, subungual exostosis, and yellow nail syndrome. These abnormalities may include pits, grooves, or crumbling nails.
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Stress
The skin around the nails, called the hyponychium, can sometimes overgrow and thicken. This can be caused by long nails, gel or acrylic nails, contact dermatitis, or a nail injury. Pterygium inversum unguis (PIU) is an uncommon condition where the hyponychium attaches to the underside of the nail as it grows, which can be present from birth or acquired later. The acquired form is associated with autoimmune conditions such as lupus, but can also be triggered by external factors.
If you are experiencing skin overgrowth around your nails, it is recommended to consult a dermatologist, as they are specialists in skin and nails.
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Lack of maintenance
Lack of nail maintenance is a common cause of skin overgrowth around the nails. This is particularly true of the cuticles, which are the living tissue attached to the nail plate, situated between the finger's skin and the eponychium (the thick skin under your nail). When left unattended, cuticles can grow beyond the proximal nail fold, which is the skin that borders the bottom of your nail. This can happen when people neglect their nail care routine, which includes keeping the cuticles well-hydrated and gently pushing them back with a cuticle pusher.
Cuticle overgrowth can also be caused by picking or biting hangnails, which are detached segments of the cuticle. To prevent this, it is recommended to hydrate the cuticles with oils, which are more absorbent than creams. It is also important to never cut or remove your cuticles, as this can cause them to grow back quickly. Instead, it is advised to gently push them back, which can stop and prevent cuticles from growing on top of your nail bed.
In addition to a lack of maintenance, skin overgrowth around the nails can be caused by various medical issues, such as psoriasis, eczema, and allergic contact dermatitis. Psoriasis is a chronic skin condition characterised by the rapid multiplication of skin cells, which can lead to a buildup of dead skin cells around the nail root. Eczema, on the other hand, often manifests as dry, red, rough, and itchy patches of skin, which can impact the appearance of the skin adjacent to the nail, including the cuticle.
Finally, while less common, systemic issues in the body might also contribute to cuticle overgrowth. For example, chronic stress can cause the body to release higher levels of the stress hormone cortisol, which can affect various parts of the body, including the skin, hair, and nails.
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Frequently asked questions
Skin growing over nails is typically due to overgrown cuticles. Cuticle overgrowth can be caused by a lack of maintenance, stress, or certain health conditions.
Overgrown cuticles are usually caused by a lack of cuticle maintenance. However, certain health conditions, such as psoriasis, eczema, and allergic contact dermatitis, can also contribute to cuticle overgrowth. Additionally, some vitamins and supplements marketed for nail growth may cause cuticles to grow faster than normal.
To prevent overgrown cuticles, it is important to maintain proper nail care. Avoid cutting or picking at your cuticles, as this can lead to breaks in the skin that may become infected or inflamed. Instead, gently push back your cuticles with a cuticle pusher after soaking your nails in water and applying a cuticle oil. Maintaining proper hydration of the cuticles with oils or moisturisers can also help prevent overgrowth.
