Liam Carter
Fingernails and toenails are formed in the nail matrix, which consists of the germinal matrix and the sterile matrix. Injuries to the nail matrix can cause onycholysis, or nail separation, and may result in the loss of the nail. In most cases, the nail will grow back with proper medical care, although it may take up to 6-9 months for fingernails and 12-18 months for toenails to fully regrow.
| Characteristics | Values |
|---|---|
| Nail matrix healing time | Several weeks |
| Nail growth time after healing | 4-6 months for fingernails, 12 months for toenails |
| Nail growth percentage from germinal matrix | 90% |
| Nail growth percentage from sterile matrix | 10% |
| Nail separation from nail bed | Onycholysis |
| Onycholysis causes | Injury, fungal infection, chemical reaction |
| Onycholysis treatment | Antifungal medication, cutting away separated nail |
| Nail bed injury treatment | Home remedies, medical treatment, antibiotics |
| Nail bed injury healing time | 7-10 days |
| Nail growth time after severe injury | 6-9 months |
| Factors affecting nail growth | Illness, injury, medication |
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What You'll Learn
Nail injuries and their treatment
A nail injury can occur when any part of the nail, nail bed, cuticle, or the skin around the sides of the nail is damaged. This can be caused by smashing or cutting the finger, or by dropping something heavy on the toe. In some cases, a nail injury can cause the nail to fall off.
Treatment for nail injuries
The treatment for a nail injury depends on the type and seriousness of the injury. Mild nail injuries can often be treated at home, while more serious injuries may require a visit to an urgent care centre or emergency room.
Home treatment
If you are able to stop the bleeding quickly and the nail is still attached to the nail bed, you may be able to treat a nail injury at home. Here are some general steps to treat a nail injury:
- Remove all jewelry from your hand, using soap if necessary to help rings slip off.
- Gently clean any minor cuts or scrapes with soap and water.
- Apply a bandage if needed.
- Prop the injured arm or leg on pillows so that the nail is higher than your heart to help reduce swelling.
- Apply ice (inside a cloth) for 20 minutes every 2 hours on the first day, then 3 to 4 times a day after that.
- Take over-the-counter pain relievers such as ibuprofen or acetaminophen to reduce pain and swelling.
- Keep the wound moist with petroleum jelly and cover with gauze or a bandage. Repeat this process daily while the wound heals.
- Wrapping the wound with an elastic bandage can also help protect the nail.
- Keep your nails short to prevent them from catching on objects and causing further injury.
Medical treatment
For more serious nail injuries, it is important to seek medical attention. At an urgent care centre or emergency room, healthcare professionals will stop the bleeding and clean the wound. The nail and affected area will usually be numbed with medicine before treatment. Treatment may involve:
- Creating a small hole in the nail to drain blood and fluid, relieving pressure and pain.
- Removing part or all of the nail if the bone is broken or the bruise is very large.
- Closing cuts in the nail bed with stitches.
- Reattaching the nail with special glue or stitches, or replacing it with a special type of material if it cannot be reattached.
- Prescribing antibiotics to prevent infection.
- Placing a wire in the finger to keep a broken bone in place.
Nail injuries and nail regrowth
In the case of a lost nail, it typically takes about 7 to 10 days for the nail bed to heal. A new fingernail will take about 4 to 6 months to grow back, while a toenail can take up to 12 to 18 months. The new nail may have grooves, ridges, or misshapen areas, which could be permanent.
It is important to note that certain injuries or conditions can affect nail regrowth. For example, severe damage to the nail matrix, the area where nails form, can interfere with nail growth and may result in permanent nail loss. Additionally, fungal infections, chemical exposure, and skin conditions can cause nail separation, requiring treatment to promote regrowth.
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Illnesses and their impact on nail growth
Illnesses and injuries can damage the nail matrix, affecting nail growth and appearance. In most cases, nails will grow back with proper medical care, although this can take several weeks or months.
Injury-Related Nail Loss
Injuries to the nail matrix can cause nails to fall off. This can be caused by pinching, crushing, or dropping something heavy on the nail. Treatment depends on the type and severity of the injury. In some cases, the nail may need to be removed, and the nail bed repaired. The nail will typically grow back within 4 to 6 months for fingernails and 12 months for toenails.
Onycholysis
Onycholysis is a condition where the nail separates from the nail bed. It is often caused by injury but can also be triggered by fungal infections, psoriasis, reactions to medications, and exposure to chemicals in nail products. Treatment may involve cutting away the separated nail as it grows out, or antifungal medications may be prescribed.
Illness-Related Nail Abnormalities
Certain illnesses can impact nail growth and cause abnormalities in shape, thickness, or colour. For example, a serious health event like a heart attack, COVID-19, or pneumonia can cause Beau's lines (horizontal ridges in the nails). Peripheral artery disease can also cause nail abnormalities due to reduced blood flow to the legs and feet.
Nutritional Deficiencies
Nutritional deficiencies, such as iron deficiency, can lead to brittle nails that break easily. Eating a variety of whole foods, including fruits, vegetables, and whole grains, can help ensure adequate nutrient intake for nail health.
Fungal Infections
Fungal infections can occur when fungi get trapped between the nail and nail bed, causing the nails to become thick and yellow, with white spots and streaks. Treatment typically involves the use of antifungal medications, which may be prescribed by a healthcare provider.
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Nail matrix damage
The nail matrix is the area where your fingernails and toenails start to grow. It is the "factory" where your body makes new nails. The nail matrix has two parts: the germinal matrix, which is responsible for about 90% of nail growth, and the sterile matrix, which is responsible for the remaining 10% of cells and keeps the nail attached to the underlying skin.
Injuries and certain health conditions can damage the nail matrix and interfere with nail growth. Minor damage to the nail matrix can cause temporary changes to the nail's appearance, such as dents, horizontal ridges, spots or streaks of colour, texture changes, and soreness. Severe injuries, such as crushing injuries or deep cuts, may result in long-term or permanent damage to the nail matrix. In these cases, the nail may fall off and may not grow back.
After an injury, it is common for nails to show temporary changes as they heal, such as bruising, ridges, or a rough surface. These typically resolve over time as the damaged nail grows and new, healthy cells replace the affected area. Toenails, in particular, can take up to 12 to 18 months to grow back completely.
It is rare for the nail matrix to be permanently damaged, preventing the nail from growing back. With the right treatment, healthy nails can often grow back. If the nail matrix does not heal properly, ongoing care or reconstructive approaches may be needed.
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Onycholysis and fungal infections
Onycholysis is a common nail disorder in which the nail plate separates from the nail bed. It is most frequently seen in adult women, but it can affect both sexes, all ages, and races. Onycholysis can be primary (unknown cause) or secondary to trauma, skin disease, nail infections, tumours, or systemic events.
Fungal infections are a common cause of onycholysis. They occur when fungi get between the nail and the nail bed, typically through cracks or cuts in the finger or toe. Nails affected by fungal infections become thick and yellow and may show white spots and streaks. Treatment for fungal infections includes oral and topical antifungal medications. Oral antifungal medications are liquid medicines or pills/tablets, such as terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan). Topical antifungal medications come in the form of creams, ointments, or gels that are rubbed directly onto the nails. It is important to complete the full course of antifungal medication to prevent the fungus from returning and becoming harder to treat.
In addition to antifungal medication, onycholysis treatment involves cutting away the separated nail as it grows out. Fingernails typically take 4 to 6 months to fully regrow, while toenails can take 8 to 12 months or longer. To support nail regrowth, it is recommended to keep nails short and trimmed and avoid activities that may harm them, such as aggressive nail clipping or biting. It is also important to avoid potential irritants, such as nail polish, enamel remover, solvents, and detergents. Wearing gloves can help protect nails from these irritants. Additionally, diluted vinegar soaks can be used to minimise the risk of secondary infection.
While onycholysis due to fungal infections can be treated, it is important to note that nail injuries and certain health conditions can cause permanent damage to the nail matrix, resulting in the nail not growing back. Severe injuries or illnesses can lead to nail loss, and in some cases, the nail may not regrow even with proper medical care. However, such cases are rare, and healthy nail regrowth is often possible with appropriate treatment.
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Nail bed injuries and their healing process
Nail bed injuries are common and can occur in many ways, including when a heavy object crushes or hits the fingers or toes, or when a sharp object cuts the fingers or toes. Nail bed injuries can be minor or very painful and uncomfortable, even limiting finger movement. They can almost always be treated, but in rare cases, they can cause nail deformities.
There are a few types of nail bed injuries, some of which can be treated at home, while others require medical attention. A subungual hematoma, for example, looks like a bruise and occurs when small blood vessels under the nail bed leak, causing blood to pool between the nail and the nail bed. This usually happens when the tips of the fingers or toes are crushed or subjected to heavy impact. If the subungual hematoma is small (one-fourth the size of your nail or less), it can be treated at home. However, if it covers more than a quarter of the nail, medical treatment is necessary.
Another type of nail bed injury is a nail bed laceration, which occurs when the nail and the underlying nail bed are cut, usually by a sharp object such as a knife or saw, or in the case of a crushing injury. This type of injury will likely bleed, and as it heals, a large bruise may appear. Cuts in the nail bed will usually be closed with stitches, and the nail will be reattached with special glue or stitches. If the nail cannot be reattached, a special type of material may be used to replace it while the nail bed heals. Antibiotics may also be prescribed to prevent infection.
Avulsion injuries are another type of nail bed injury, caused by crush or grinding-type injuries. These injuries can result in the partial or total loss of the nail bed. If the nail plate is still partially attached, it may be removed using a blunt instrument, and the nail bed can be sutured and splinted for three weeks to allow the fractures to heal.
The healing process for nail bed injuries can vary depending on the severity of the injury. In some cases, the nail may fall off, and it can take about 7 to 10 days for the nail bed to heal. A new fingernail will typically take 4 to 6 months to grow back, while toenails can take 12 months or more. The new nail may have grooves, ridges, or misshapen areas, which may be permanent. With proper treatment, the nail growth rate will eventually return to normal. Full recovery from a nail bed injury can take 6 to 9 months, depending on the severity of the injury.
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Frequently asked questions
Yes, in most cases, your nail will grow back after it's been damaged. The nail matrix, the part of your body that makes new nails, can usually heal and generate new nail growth. However, severe damage to the nail matrix can cause permanent damage, preventing your nail from growing back.
If the inside bottom part of your nail, known as the cuticle, is damaged, you should take steps to prevent infection and promote healing. Remove any jewellery from the affected area, clean the area with soap and water, and trim any sharp edges from the nail. Cover the nail with tape or an adhesive bandage and keep the area dry to prevent infection. You should also elevate your hand or foot above the level of your heart to reduce throbbing and swelling.
It takes a significant amount of time for nails to grow back. Fingernails typically take about 4 to 6 months to grow back, while toenails can take up to 12 to 18 months. During this time, you can expect the new nail to have grooves, ridges, and be somewhat misshapen.
