Nail Problems and Injuries

Overview

Minor fingernail and toenail problems are common. At one time or another, almost everyone has caught a nail on something, causing it to rip. Or they have smashed a finger in a door, leaving blood under the nail. These kinds of injuries can be quite painful, but they usually aren't serious. You can often relieve pain and prevent infection of minor nail problems at home.

Normally, fingernails grow about one-tenth of a millimeter each day. Toenails grow at about one-half or one-third the rate of the fingernails. Aging and diseases that decrease blood flow to the hands and feet may slow nail growth.

Common nail changes

Common changes to nails include:

Splitting, peeling, or brittle nails.

These are common problems that develop when your hands are often exposed to water, strong soaps, and other chemicals. You may be able to prevent some of these problems if you use lotion and avoid putting your hands in water often.

Color changes.

• Little white marks (leukonychia) often appear after minor injuries. They may last for weeks or months. They usually go away on their own.
• It's common for a nail to turn black after an injury. The black or purple-black color is caused by blood under the nail. It will go away as the injury heals.
• Black, brown, or purple discoloration under a nail that has not been injured may be caused by melanoma.

Changes in the shape or texture of nails.

These may occur for many reasons. Some nail changes, such as the forming of ridges, are normal with aging. Thick, brittle, or dark nails are more common in older adults who have poor circulation.

Ingrown nails.

These are often caused by improper trimming, tight shoes, or heredity. Your nails may grow into the skin that surrounds them. This can cause pain, swelling, and infection. In rare cases, an abscess may form under a nail (subungual abscess).

Separation from the nail bed.

After your nail separates from its nail bed, no matter what the reason, it won't reattach. Nails grow back slowly. It takes about 6 months for fingernails and up to 18 months for toenails to grow back attached to the nail bed.

Infection and allergic reactions.

These are common problems caused by artificial nails. Remove the artificial nail if it causes problems.

Fungal nail infections.

They can vary in appearance depending on the type of fungus or the location of the infection. The infected toenail usually turns white or yellow. It's not unusual for fungal nail infections to follow athlete's foot infections.

Other causes of nail problems

Nail problems can also be caused by:

• An injury to a nail.
• Hangnails. A hangnail may lead to a minor infection next to your nails (paronychia). This can cause the skin around the nails to become swollen and tender.
• Nail-biting. It can lead to fingertips that are red and sore and cuticles that bleed. Nail-biting also increases the chance of bacterial infections around your nail beds and in your mouth.
• Side effects of medicines, such as chemotherapy and antimalarial medicines.
• Diseases of the skin, such as psoriasis and eczema.
• Skin growths, such as warts, cysts, and moles.
• Other diseases such as Addison's disease, peripheral arterial disease, and HIV infection.

Self-Care

Home treatment can help relieve pain, prevent infection, and promote healing. Try these tips to help relieve pain from an injury to the nail.

• Apply ice, and prop up the injured nail.

  Do this as soon as you can after the injury.

• Trim a torn or detached nail, and tape the nail in place.
• Try to drain blood from under the nail if you have pain.

  Do not drain blood from under your nail if you have diabetes, peripheral arterial disease, or an immune system problem, or if you think a bone is broken.

• If you have an ingrown toenail, try soaking your toe.

  You can also use a small pad of wet cotton. This helps the ingrown toenail heal on its own.

• Trim a hangnail.

  You don't want the hangnail to tear your skin.

• Take off an artificial nail if you are having problems with it.
• Try gloves or lotions to protect weak, brittle, or splitting nails.
• Watch for any signs of a skin infection around a nail.

Caring for a torn or detached nail

Home treatment often helps relieve pain, promote healing, and prevent infection. Treatment may involve removing the nail, keeping the area dry to prevent infection, and waiting for a new nail to grow. The infection or skin condition that caused the separated nail will also need to be treated.

• File any sharp edges smooth, or trim the nail. This will help prevent catching the nail and tearing it more.
• Trim off the detached part of a large tear, or leave the nail alone.
  • Cover the nail with tape or an adhesive bandage until the nail has grown out enough to protect the finger or toe.
  • If you trim off the detached nail, you will have less worry about the nail catching and tearing.
  • If you leave the detached nail in place, it will eventually fall off when the new nail grows in.
• Use scissors to remove the detached part of the nail if the nail is partly attached.
• Soak your finger or toe in cold water for 20 minutes after trimming the nail.
• Apply a thin layer of petroleum jelly, such as Vaseline, and cover the area with a nonstick bandage.

To prevent infection:

• Soak your foot or hand in a solution of 1 tsp (5 mL) of salt dissolved in 4 cups (1 L) warm water for 20 minutes, 2 or 3 times each day, for the next 3 days. Reapply petroleum jelly, and cover with a fresh adhesive bandage.
• Keep the nail bed dry, clean, and covered with petroleum jelly and an adhesive bandage until the nail bed is firm or the nail has grown back. Apply a new adhesive bandage whenever the bandage gets wet.
• Watch for signs of infection such as increasing heat, redness, pain, tenderness, swelling, or pus.
• Remove an artificial nail if it separates from the nail bed. If you leave it on, the long, artificial nail can tear the nail bed.

Have a doctor trim your nail if you:

• Aren't comfortable trimming the nail yourself.
• Have diabetes, peripheral arterial disease, or an immune system problem. These problems may cause reduced blood flow and loss of feeling in the feet. Untreated nail injuries can lead to infection, foot ulcers, and other serious problems.

Treating a nail infection

Try home treatment if you think you have an infection in the skin around your nail.

• Apply a thin layer of antibiotic ointment to the nail and cover with a nonstick bandage.
• Soak your foot or hand 2 to 3 times each day.

  After soaking, apply a thin layer of antibiotic ointment and a bandage.

• Apply heat.

  Put a warm water bottle, heating pad set on low, or warm cloth on your finger or toe.

• Do not try to remove any part of the affected nail.
• Remove an artificial nail if you think you have an infection around or under a nail.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New or worse signs of infection, such as redness, warmth, swelling, pus, or a fever.
• Symptoms occur more often or are more severe.

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