Object Under Fingernail: Care Instructions

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Overview

Small pieces (splinters) of wood, metal, glass, or plastic can get stuck under a fingernail. Thorns from roses and other plants also can prick or become stuck in the skin. Splinters can cause pain and infection if they are not removed.

If your doctor removed part of your nail, it should grow back normally

As your wound heals, it may get a little red or swollen. But it should get better with time.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• If your doctor told you how to care for your wound, follow your doctor’s instructions. If you did not get instructions, follow this general advice:
  • Wash the wound with clean water 2 times a day. Don’t use hydrogen peroxide or alcohol, which can slow healing.
  • You may cover the wound with a thin layer of petroleum jelly, such as Vaseline, and a nonstick bandage.
  • Apply more petroleum jelly and replace the bandage as needed.
• Your doctor may have used medicine to numb your finger. When it wears off, your pain may come back. Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.
• Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• It may help to prop up your hand on a pillow anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.

When should you call for help?

Call your doctor now or seek immediate medical care if:

• Your finger is cold or pale or changes color.
• You have new pain, or your pain gets worse.
• You have tingling, weakness, or numbness in your finger.
• You have symptoms of infection, such as:
  • Increased pain, swelling, warmth, or redness around the nail.
  • Red streaks leading from the nail.
  • Pus draining from the area.
  • A fever.
• You bleed through your bandage.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You do not get better as expected.
• You think there is still something under the fingernail.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter J299 in the search box to learn more about “Object Under Fingernail: Care Instructions”.

Hyponychium (Under-Fingernail Skin) Thickening Causes and Treatment

Hyponychium (Under-Fingernail Skin) Thickening Causes and Treatment

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Medically reviewed by Stacy Sampson, D. O. — By Kirsten Nunez — Updated on May 5, 2023

There are several possible reasons why skin grows under the fingernail. You can pinpoint the cause by considering other symptoms and general nail care habits.

The hyponychium is the skin just under the free edge of your nail. It’s located just beyond the distal end of your nail bed, near your fingertip.

As a barrier from germs and debris, the hyponychium stops external substances from getting under your nail. The skin in this region contains white blood cells to help prevent infection.

But sometimes the hyponychium can overgrow and become thicker. This can make it painful to trim your nails. Some people also don’t like how it looks.

In this article, we’ll cover the potential causes of overgrown skin under the fingernail and how to treat it.

Hyponychium thickening can affect one, some, or all the fingers. Possible symptoms include:

• hyponychium attached to nail as it grows
• thick, pale skin under nail
• tenderness
• pain, especially while trimming nails

Pterygium inversum unguis

Pterygium inversum unguis (PIU) occurs when the hyponychium attaches to the underside of the nail as it grows. It’s an uncommon condition, but it’s a common cause of skin overgrowth under the fingernail.

Scientists don’t fully understand PIU. However, they do know it can be present from birth or acquired later. The acquired form is associated with:

• injury or trauma to the nail
• contact dermatitis
• frequent gel manicures
• wearing acrylic nails for long periods of time
• using nail hardeners
• nail biting

Acquired PIU may also be seen in conditions like:

• Hansen’s disease (leprosy)
• subungual exostosis (bony overgrowth on fingertip)
• systemic sclerosis
• neurofibromatosis (tumors on nerve tissue)
• stroke

Psoriasis

Psoriasis is a skin condition where skin cells grow too quickly. It can affect any part of the body, including the nails.

Nail psoriasis involves many parts of the nail. In the hyponychium and nail bed, the skin cells grow excessively, causing scaling and buildup. This overgrowth is called subungual hyperkeratosis.

The skin underneath the nail might look:

• thick
• discolored
• chalky

If the skin becomes very thick, it can cause onycholysis, which is separation of the nail plate from the nail bed.

Fungal infection

Another possible cause is a fungal nail infection, also known as onychomycosis. It occurs when a fungus on your skin infects the fingernail. It can thicken both the nail and skin tissue beneath the nail.

Other symptoms of a fungal nail infection include:

• white or yellow-brownish discoloration
• deformed nail shape
• brittle, coarse nails
• pits or indentations on the nails
• lifted nail (due to thickened skin)

The most common form is distal and lateral subungual onychomycosis (DSLO). It starts in the hyponychium and then spreads to the nail plate and nail bed.

The most appropriate treatment depends on the cause. It may include:

• Avoiding certain manicures. If gel manicures or acrylic nails are causing PIU, avoiding these procedures will usually reverse it. Consider switching to regular manicures.
• Corticosteroids. A doctor can prescribe a topical corticosteroid if you have nail psoriasis. This treatment, which is applied to the nails, can help manage skin thickening.
• Antifungal medication. If you have a fungal infection, the thick skin under the nail may get better with antifungal medication. Typically, systemic (oral) medicine is most effective, but it does come with side effects.
• Cuticle oil. Some people apply cuticle oil to try to soften the thickened skin.

If you’re not sure what’s causing skin growth under your nail, visit a dermatologist. This type of doctor specializes in skin and nails. The Healthline FindCare tool can provide options in your area if you don’t already have a doctor.

They can determine the best treatment by examining your nails and other symptoms.

Also see a doctor if the skin is:

• bleeding
• painful
• discolored
• smelly
• swollen

Be sure to consult a doctor instead of a nail technician. Nail technicians aren’t medically trained to treat nail conditions.

The hyponychium is the thick skin under your nail tip. It can overgrow and become even thicker, making it painful to trim your nails.

You’re more likely to have overgrown hyponychium if you get gel manicures, wear acrylic nails, or bite your nails. Nail psoriasis and fungal infections can also cause skin cells to accumulate under your fingernails.

It’s best to avoid picking at the skin. Instead, visit a dermatologist, especially if it’s bleeding, discolored, or swollen.

Last medically reviewed on October 24, 2019

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• Alessandrini A, et al. (2017). Dermoscopy in the evaluation of nail disorders. DOI:
  10.1159/000458728
• Baek JH, et al. (2014). A case of acquired idiopathic pterygium inversum unguis.
  ncbi.nlm.nih.gov/pmc/articles/PMC4069649/
• Brahs AB, et al. (2019). Histology, nail.
  ncbi.nlm.nih.gov/books/NBK539733/
• Cervantes J, et al. (2017). Pterygium inversum unguis secondary to gel polish. DOI:
  10.1111/jdv.14603
• Fıçıcıoğlu S, et al. (2018). Onychophagia induced melanonychia, splinter hemorrhages, leukonychia, and pterygium inversum unguis concurrently. DOI:
  10.1155/2018/3230582
• Fungal nail infections. (2017).
  cdc.gov/fungal/nail-infections.html
• Haneke E. (2017). Nail psoriasis: Clinical features, pathogenesis, differential diagnoses, and management. DOI:
  10.2147/2FPTT.S126281
• Ngan V. (2016). Nail psoriasis.
  dermnetnz.org/topics/nail-psoriasis/
• Onycholysis. (2018).
  health.harvard.edu/a_to_z/onycholysis-a-to-z
• Singal A, et al. (2015). Nail as a window of systemic diseases. DOI:
  10.4103/2229-5178.153002
• Westerberg DP, et al. (2013). Onychomycosis: Current trends in diagnosis and treatment.
  aafp.org/afp/2013/1201/p762.html
• What is psoriasis? (n.d.).
  aad.org/psoriasis-overview

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

May 5, 2023

Written By

Kirsten Nunez

Edited By

Amanda Conover

Copy Edited By

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Oct 24, 2019

Written By

Kirsten Nunez

Edited By

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Medically Reviewed By

Stacy Sampson, D. O.

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Medically reviewed by Stacy Sampson, D.O. — By Kirsten Nunez — Updated on May 5, 2023

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Subungual hematoma. What is subungual hematoma?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Subungual hematoma is a consequence of a mechanical injury to the nail phalanx of the upper or lower limb, in which hemorrhage occurs in the soft tissues of the nail bed. Damage is characterized by pain of varying degrees of intensity, local fever, swelling, the appearance of red, and then cyanotic and black staining of the nail plate. The diagnosis is established on the basis of the anamnesis and clinical picture. In most cases, no treatment is required. Detachment of the nail plate, laceration of soft tissues is an indication for surgical treatment of the damaged area, suturing and dressings.

ICD-10

T14.0 Superficial injury of body region unspecified

• Causes
• Pathogenesis
• Classification
• Symptoms of subungual hematoma
• Complications
• Diagnostics
• Treatment of subungual hematoma
• Prognosis and prevention
• Prices for treatment

General information

Synonymous names are used to designate the pathology: bruising under the nail, “blue nail”. In the course of life, each person receives such bodily injury, sometimes more than once. More often, injuries are recorded in males of working age. The peak of injuries occurs during the warm season and the vacation period, when most people are engaged in construction and repair, work on household plots, and actively relax in nature. The overwhelming majority of cases of subungual hemorrhages remain out of sight of physicians, as patients often consider the damage to be insignificant and simply ignore it.

Subungual hematoma

Causes

In the development of subungual hematomas, physical effects and a number of predisposing factors are important. Thus, the risk of bleeding in response to minor trauma increases in patients taking anticoagulants. Patients with diabetes mellitus and other diseases notice damage late, in which polyneuropathy develops, tactile and pain sensitivity is impaired. The main causes of subungual hematomas include:

• Sharp directed blow. A bruise of the terminal phalanx, depending on the strength of the impact, can lead to damage to the vessels of the skin, crushing of the tissues, the appearance of a laceration, and a fracture of the bone. Each of these lesions is characterized by the accumulation of blood under the nail. Therefore, any injury requires medical attention.
• Prolonged mechanical impact. Wearing improperly sized and full shoes leads to injury to the nail plates and the skin underneath. In fact, a callus develops that fills with serous fluid or blood. In this case, the nail plate may completely or partially exfoliate.

Pathogenesis

The basis for the development of subungual hematoma is a violation of the integrity of blood vessels. The spilled blood impregnates the tissues, including the nail plate. If the volume of blood is insignificant, the structure of the soft tissues is preserved. If the volume and rate of bleeding are significant, then under the pressure of the blood, the soft tissues exfoliate with the formation of a cavity. A hematoma that has formed under the skin near the hole or in the area of ​​​​the nail bed moves in the distal direction as the nail grows. Blood pressure in the area of ​​the hematoma irritates the nerve endings, which provokes pain. A sharp increase in the volume of the hematoma leads to the formation of a subungual space or a breakthrough of blood near the nail folds.

The blood that has soaked into the soft tissues is gradually absorbed. Staining of the nail plate is irreversible. Over time, the blood clot loses moisture, becomes first dark blue, then blackens. In both cases, a spot is formed that moves to the free edge of the nail plate.

Classification

Often the terms “hematoma” and “bruise” are used interchangeably, but this is not entirely correct. The differences between these two conditions relate to the mechanisms of injury, the clinical picture of the disease, the duration of involuntary temporary disability due to damage to the limb, and medical approaches to treatment.

• Subungual bruising. It develops as a result of impregnation of the skin and subcutaneous tissue with blood from damaged vessels. As a rule, it is formed with a slight impact and is characterized by unexpressed symptoms. The patient’s condition quickly returns to normal, the functioning of the limb is restored.
• Subungual hematoma. It differs from a bruise by stratification of tissues with the formation of a cavity filled with blood. Hemorrhagic impregnation also takes place, however, the volume of blood poured out is much greater than with bruising, which increases the likelihood of detachment of the nail and the development of other complications.

Symptoms of subungual hematoma

Characteristic signs of hemorrhage in the subungual area that developed after injury are local hyperemia, fever, edema, and throbbing or bursting pains. The peak of local temperature rise occurs 2-3 hours after the injury. For 2-3 days the pain subsides, the swelling begins to subside.

Immediately after injury, the nail takes on a rich red or cherry-purple color. On the second or third day, the affected area turns blue, after another week or two it acquires an intense black color. The section of the nail soaked in blood gradually moves towards the nail edge and is cut off. Thus, the black spot can persist for 2-3 months.

In cases where the cause of the injury is wearing uncomfortable shoes, there may be slight soreness or discomfort. But more often, discoloration of the nail plate becomes an accidental finding during foot care. Simultaneously with a change in color, exfoliated fragments of the plate, calluses on the skin of the fingers in the area of ​​\u200b\u200bthe nail ridges are often detected.

Complications

Damage to the skin and base of the nail leads to its deformation. The severity and duration of the deformity are determined by whether the growth zone has been affected. Normally, deformed areas are cut off with scissors during a manicure. Injury to the base of the nail plate leads to a permanent deformity that does not disappear with time. The appearance of a crack or chipped nail as a result of mechanical action creates conditions for the penetration of infection and the development of purulent inflammation of damaged tissues. Especially actively multiply microorganisms in the cavity of the hematoma. Insufficient care for a bruised phalanx can cause the development of panaritium.

Diagnostics

In appearance, subungual hematomas have similar features with onychopathy in psoriasis, melanoma. The degree of damage to the finger on impact is not always obvious. In this regard, it is better to consult a surgeon, even if the injury seems not serious. A comprehensive examination of a patient with a phalanx injury includes:

• General examination. The hematoma is indicated by the presence of a previous mechanical impact, an acute course with a rapid increase in symptoms. Palpation of the damaged area is painful. Drainage, which can be performed directly during an outpatient appointment, gives a quick effect.
• X-ray examination. An x-ray of the finger is performed to detect violations of the integrity of the bones and joints of the limb. According to the radiograph, it is possible to judge the presence of a fracture, but it is impossible to draw unambiguous conclusions about the degree of damage to soft tissues (skin, tendons, muscles), and the volume of the hematoma.

Treatment of subungual hematoma

Medical tactics are determined by the severity of the damage. Indications for seeking medical help are intense, unbearable pain in the area of ​​the injured phalanx and the size of the hematoma is more than ¼ of the area of ​​the nail. The volume of medical care is determined by the surgeon based on the data of the examination and x-ray:

• First aid. Proper care of a damaged phalanx allows you to quickly relieve pain, stop or slow down bleeding, and prevent detachment of the nail plate. Immediately after the injury, it is necessary to lower the finger into a container of cold water for 15-20 minutes. Then, if there is an open wound, treat the damaged area with an antiseptic solution and apply a bandage.
• Hematoma drainage. The nail plate above the hematoma is pierced with a needle or burned with a thermocautery. The outflow of blood through a small hole leads to a decrease in pressure on the tissues, a decrease in the intensity of pain. A drained subungual hematoma resolves faster, which is important for patients who do not have cosmetic defects on their hands.
• Removal of the nail plate. The nail plate is removed partially or completely when it is separated from the nail bed. Attempts to save the nail can lead to adverse consequences: exfoliated fragments disrupt the normal functioning of the finger, can cause additional injury in case of accidental separation.
• Surgical treatment of the wound. Crushing of tissues, laceration, bone fracture require PST, which includes the removal of non-viable fragments, suturing, drainage. The purpose of medical manipulations is to create optimal conditions for healing, prevention of dysfunction of the foot or hand, purulent-septic complications.
• Whitening of damaged nails. The nail plate, soaked in blood, grows back within a few months. To eliminate a cosmetic defect in one procedure, injection subungual injection of special bleaches allows. In this case, the black spot is completely discolored. Whitening preparations used externally do not give a noticeable effect.

Prognosis and prevention

In the vast majority of cases, subungual hematoma resolves on its own without treatment. Within a month or two, only a cosmetic defect in the form of a dark spot on the nail reminds of the injury. As a preventive measure, it is recommended to observe safety precautions and accuracy when performing work, closing doors, moving goods. Properly selected sports and casual shoes allow you to maintain healthy feet. To protect the fingers, it is recommended to use special work gloves and various devices that reduce the likelihood of damage to the upper limbs (tacks, clamps, manipulators).

You can share your medical history, what helped you in the treatment of subungual hematoma. A. L. Urakov // International Journal of Applied and Fundamental Research. – 2016. – No. 12 (6).

Minor surgery in the practice of a family doctor/ Bouvy L.A.// Russian Medical Journal. – 1996 – No. 4.

IMPORTANT
Information from this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Elimination of the cause of nail exfoliation, formation of cavities under the nail (onycholysis) in the PODOLAB Podology Center

Onycholysis is a dystrophic lesion of the nail plate with its separation from the nail bed. A “pocket” appears between the plate and the nail bed.

Causes of onycholysis.

• Injuries.

Traumatic lateral onycholysis as a result of wearing narrow shoes Burn injury in the lamp during gel polymerization

Traumatic onycholysis occurs as a result of strong pressure, impact. As a result, the nail plate is deformed, moves away from the bed and a void is formed under the nail. A thermal burn in a lamp during the polymerization of gel polish is also referred to as an injury to the nail apparatus.

• Dermatological diseases: eczema, psoriasis, dermatitis.

Eczema Psoriasis Dermatitis

Onycholysis develops under the influence of dermatosis, leading to disruption of cellular nutrition processes in the affected area.

• Endocrine diseases.

They cause exfoliation of the nail plate as a result of chronic disorders of the endocrine glands.

For example, Plummer’s nail. Often, the manifestations of this symptom begin with the departure of the nail plates, mainly the ring fingers. And then onycholysis can affect the nails of other fingers on the hands.

Plummer’s nail is an endocrine disease syndrome. It occurs in patients with thyroid dysfunction with thyrotoxicosis (hyperthyroidism), when the body contains an excess of thyroid hormones.

• Malfunctions of the digestive system.

Systemic onycholysis may occur due to disorders in the digestive system.

• Fungal onycholysis.

Caused by a fungal infection in the subungual space. A void appears under the nail, and this is an excellent breeding ground for fungi. The big toe is especially prone to infection.

• Bacterial onycholysis

The result of a secondary infection attached to any of the above causes. For example, having received a thermal burn in a lamp, the girl continues to cover the damaged nails with gel polish. After some time, a bacterial infection settles in the cavity under the nail.

• Allergic onycholysis.

Happens when in contact with aggressive household chemicals, when covering nails with low-quality varnishes and gel polishes, while taking medications.

If you have a similar problem, make an appointment with a podiatrist at our center.

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Mechanism of void formation under toenail and handnail.

Causes of onycholysis on the legs:

• Long toenails.

When gel polishing their toenails, girls often forget to cut the length every 2-3 weeks. Due to the excessive length, there is a load on the nail plate from above and from the end.

• Wrong size shoes.

Shoes that are the same length or shorter than the foot put pressure on the big toe. The foot lengthens by 1 cm during walking, which is almost imperceptible to a person. But a regular load from such shoes will lead to a void under the nail.

• The risk of detachment of the nail from the nail bed increases with dress shoes with a narrow forefoot.

When wearing such shoes, the big toe is strongly compressed, the blood circulation of the matrix is ​​disturbed and a void appears under the nail.

Why is there a cavity under the fingernail:

• nail injury;
• chemical burns due to the use of low-quality gel polishes or contact with household chemicals and other aggressive substances;
• thinning of nails as a result of self-removal of artificial coating or sawing of the nail plate with a file (cutter) by a master;
• onychophagia or a mental disorder in which a person bites or picks at the nail beds and the skin around them. As a result, the nail exfoliates from the nail bed;
• trying to push back the hyponychium or clean the dirt under the nails with something sharp;
• dermatological pathologies.

If you find the first symptoms of onycholysis, contact the Podology Center PODOLAB in St. Petersburg. Podiatrists will advise you on this issue. And you will quickly return an attractive appearance to your nails.

How to treat onycholysis?

The sooner you see a podiatrist or dermatologist to identify the cause of a detached nail, the better your chances of successfully fixing the problem.

During the restoration of nails on the fingers or toes, there is a strict ban on any traumatic procedures, nail extensions, the use of decorative varnishes and aggressive chemical liquids.

If fungal spores have got into the cavity under the nail and onycholysis is of an infectious nature, then the treatment of onychomycosis is prescribed by a dermatologist.

If the nail plate on your ring finger periodically leaves, then there is a possibility that you need to seek treatment from an endocrinologist and adjust your hormonal levels.

The specialists of the center will professionally and painlessly treat the nail plate with onycholysis on the legs and arms using modern equipment.

They will also recommend home care to avoid relapses.

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Stories of our clients (onycholysis)

Nail fungus after injury.

A woman came to our center with nail fungus. For a long time, the nail plates were covered with gel polish. Once the nail on the thumb was injured, a cavity formed, into which the infection joined.

The problem was treated by a dermatologist. Oral systemic drugs were prescribed. Treatments in the podologist’s office were carried out with a regularity of 1 time per month until the plate was completely restored.

Injuries to the nail while playing sports in sneakers with a narrow front section.

A sportswoman addressed us to the center. Due to the high load on the feet during training, the nails on the big toes were injured. At the same time, at the initial appointment, it was found that the shoes for sports were chosen incorrectly. This factor led to the formation of a hematoma.

Recommendations on the selection of sports sneakers are given. Treatments in the podologist’s office were carried out with a regularity of 1 time per month until the complete restoration of the nail plate.

Nail dystrophy on the hands of a man.

A man came to the center with a complaint of nail dystrophy on the hands. Diagnosed with psoriasis secondary to the addition of a fungal infection.

The work was carried out in collaboration with a dermatologist.

The treatment of the plates was gentle and only with the permission of the doctor. This is due to the fact that with psoriasis it is possible to provoke the Koebner phenomenon. Stripping of the nail plates in the podologist’s office was carried out once a month until they were completely restored.

Injury to the nail when playing sports (tennis) in the wrong shoes.

A girl complained of thickening of the nail bed from the distal medial part of the big toe.

At the first appointment, we found out that the girl is engaged in table tennis. During classes, a huge load occurs on the thumbs as a result of jumping. Also, the shoes for classes were chosen incorrectly.

Recommendations on the selection of sneakers are given. Orthopedic individual insoles were made in order to unload the foot during classes. Treatments in the podologist’s office were carried out once a month until the nails were completely restored.

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Fungal infection and incorrect shoe size.

A woman came to the center with a fungal infection. The work was carried out in collaboration with a dermatologist.

Oral systemic therapy and topical antifungal drops were prescribed by a physician. Treatments in the podologist’s office were carried out once a month until the nails were completely restored.

A consultation was made to change shoes, which turned out to be 1 size too small, which injured the nail plate and led to the addition of a secondary infection.

Traumatic onycholysis due to narrow toe shoes.

Recommendations for the selection of footwear are given. Individual anatomical insoles were made to increase the foot support area and prevent its excessive elongation during step and run.

A custom silicone interdigital spacer was also made to isolate the second finger from the first. Treatments in the podologist’s office – 1 time per month until the nail is completely restored.

Deformation of the nail bed due to tight shoes

A young girl, a lover of narrow heeled shoes, came to the center. Complaints were about the modification of the nail plate from the lateral side. The client thought she had an ingrown toenail. Fungus testing was negative.

Treatments in the podologist’s office were carried out once a month. Since the nail bed was deformed, various correction systems were installed: titanium threads and 3TO hook braces.

Facing similar problems? Make an appointment with a specialist and we will help you cope with them.

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Prices for the treatment of onycholysis