Health Library Nail Problems and InjuriesFrom Healthwise

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 has smashed a finger in a door, leaving blood under the nail. These kinds of injuries can be quite painful but are usually not 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 include:

• Splitting, peeling, or brittle nails. These are common problems that develop when your hands are frequently exposed to water, strong soaps, and other chemicals. You may be able to prevent some of these problems if you use lotion and avoid repeatedly putting your hands in water.
• Color changes.
  • Little white marks (leukonychia) often appear after minor injuries. They may last for weeks or months and usually go away on their own.
  • It is common for a nail to turn black after an injury. The black or purple-black color is caused by blood under the nail and 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, which may occur for a variety of reasons. Some nail changes, such as the formation of ridges, are normal with aging. Thick, brittle, or dark nails are more common in older adults who have poor circulation.
• Ingrown nails, which are often caused by improper trimming, tight shoes, or heredity. Your nails may grow into the surrounding skin, causing pain, swelling, and infection. In rare cases, an abscess may develop under a nail (subungual abscess).
• Separation from the nail bed. Once your nail separates from its nail bed, for whatever reason, it will not 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.
• Fungal nail infections, which can vary in appearance depending on the type of fungus infecting the nail or the location of the infection. It is not unusual for fungal nail infections to follow athlete's foot infections. For more information, see the topic Fungal Nail Infections.

Nail problems can also be caused by:

• An injury to a nail.
• Hangnails, which may lead to a minor infection next to your nails (paronychia), causing the skin around the nails to become swollen and tender.
• Nail-biting, which 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. Nail-biting can also cause dental problems and infections of the gums.
• Side effects of medicines, such as chemotherapy and antimalarial medications.
• Diseases of the skin, such as psoriasis or eczema.
• Skin growths, such as warts, cysts, or moles.
• Other diseases such as Addison's disease, peripheral arterial disease, or HIV infection.

Review the Check Your Symptoms section to determine if and when you need to see a health professional.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• A cut on your finger or toe: Go to the topic Cuts.
• A scrape on your finger or toe: Go to the topic Scrapes.

	Yes	Did you injure your nail?
When to See a Doctor See significance of a nail injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Is blood under a nail causing severe pain and you are unable or unwilling to drain the blood from the nail? Yes Do you still have severe pain after you have drained the blood from under your nail? Call your health professional today if you answer "Yes" to any of the following questions. Yes Is blood under a nail causing moderate pain and you are unable or unwilling to drain the blood from the nail? Yes Do you still have moderate pain after you have drained the blood from under your nail? Yes Has more than half of your nail turned black after an injury? Yes Do you have moderate to severe pain that has not gotten better with home treatment? Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease that causes problems with your immune system? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you unable to remove an object from under your nail?
When to See a Doctor See significance of inability to remove an object under a nail if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Are you unable to remove an object from under your nail? Note: You may be unable to remove an object because: Of the location and depth of the wound. Of uncertainty about the depth of the wound. Removing the object will cause severe pain. Yes Do you think an object is still under your nail and you are unable to remove it? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Has your nail torn or separated from the nail bed?
When to See a Doctor See significance of a torn nail or nail separated from the nail bed if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have moderate to severe pain that has not gotten better with home treatment? Yes Have you severely torn or separated a nail and you are unable to take care of it with home treatment? Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease that causes problems with your immune system? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have a nail that has been separated from the nail bed for longer than 48 hours? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you have unexplained separation of a nail from the nail bed? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have an ingrown nail?
When to See a Doctor See significance of an ingrown nail if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease that causes problems with your immune system? Yes Is an ingrown nail causing moderate to severe pain that has not gotten better with home treatment? Yes Do you have increased pain, swelling, redness, or warmth around an ingrown toenail? Yes Is the area around an ingrown toenail increasingly tender to the touch? Yes Do you have red streaks extending from an ingrown toenail? Yes Do you have pus in or around an ingrown toenail? Yes Do you know or think you have a fever? Yes Is an ingrown nail cutting deeply into your skin? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 0.25 in. (0.5 cm) around the nail for longer than 24 hours? Yes Is an ingrown nail causing mild to moderate pain that has not improved with 48 to 72 hours of home treatment? Yes Have you had a swollen gland (lymph node) in the elbow, armpit, or groin for longer than 24 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have signs of a skin infection around or under your nail?
When to See a Doctor See significance of an infection around or under your nail if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease that causes problems with your immune system? Yes Do you have increased pain, swelling, redness, or warmth around or under a nail? Yes Is the area around a nail increasingly tender to the touch? Yes Do you have red streaks extending from a nail? Yes Do you have pus in or around a nail? Yes Do you know or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 0.25 in. (0.5 cm) around the nail for longer than 24 hours? Yes Is an ingrown nail causing mild to moderate pain that has not improved with 48 to 72 hours of home treatment? Yes Have you had a swollen gland (lymph nodes) in the elbow, armpit, or groin for longer than 24 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have a fungal nail infection?
When to See a Doctor See significance of a fungal nail infection if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you think you have a fungal nail infection? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have unexplained color changes to your nails?
When to See a Doctor See significance of color changes in nails if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do your nails look blue, blue-gray, black, or brown and you don't know why? Yes Do you have an unexplained green, white, or yellow appearance to a nail? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do your nails have a pale white appearance, not just specks of white? Yes Do your nails have a black appearance without any known injury? Yes Do your nails have a yellow or brown appearance? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have changes in the shape or texture of your nails?
When to See a Doctor See significance of changes in the shape or texture of nails if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Are your nails curved, pinching your skin, and causing pain? Yes Are your nails spoon-shaped? Yes Do you have pits or ridges in your nails along with other symptoms, such as yellowing, thickening, or separation of the nail from the nail bed? Yes Do you have changes in the shape or texture of your nails, such as clubbing? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a growth on, under, or next to a nail?
When to See a Doctor See significance of a growth on, under, or next to a nail if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had a new painful growth on, under, or next to a nail for 24 hours or longer? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had any growth on, under, or next to a nail for more than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Were you cut by something clean and your last tetanus shot was longer than 10 years ago? Note: Something is clean if it does not have dirt, soil, spit, or feces on it. Examples include a broken water glass, a kitchen knife, or sewing scissors. Yes Were you cut by something dirty and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Examples include a garden tool, a dirty nail, or a piece of glass that has been buried in the dirt. Yes Are you not sure if you were cut by something clean or dirty and your last tetanus shot was longer than 5 years ago? Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots (primary vaccination series)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Injury to a finger: Go to the topic Finger, Hand, and Wrist Injuries.
• Injury to a toe: Go to the topic Toe, Foot, and Ankle Injuries.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment can help relieve pain, prevent infection, and promote healing. To relieve pain from an injury to the nail, try the following:

• Apply ice and elevate the injured nail area as soon as possible after the injury.
• Trim a torn or detached nail and tape the nail in place.
• Drain blood from under the nail. Note: 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.

Consider trying home treatment for the following problems:

• An ingrown toenail
• A hangnail
• Problems with an artificial nail
• A weak, brittle, or splitting nail
• An infection of the skin around a nail

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate the symptoms if any of the following occur during home treatment.

• Signs of infection develop.
• Symptoms become more severe or frequent despite home treatment.

To prevent common nail problems:

• Apply hand cream frequently throughout the day. Be sure to massage the cream into the nail and cuticle.
• Wear gloves when you are working in your garden or when the weather turns cold.
• Wear cotton-lined rubber gloves or disposable plastic gloves to protect your hands from overexposure to water, detergents, and other chemicals.
• Trim your fingernails weekly, after bathing, when they are softer.
  • Do not trim nails too short.
  • Use an emery board and sharp manicure scissors or clippers to trim your fingernails. Nails that are smooth and well-cared for are less likely to become damaged.
• Trim toenails monthly, after bathing.
  • Cut them straight across and leave the nails a little longer at the corners so that the sharp ends don't cut into your skin.
  • If you have a chronic disease, such as diabetes, peripheral arterial disease, or a disease that causes problems with your immune system, discuss with your health professional the best way to trim your toenails before trimming them yourself.
• Be especially careful when trimming your baby's nails.
• Avoid trimming your cuticles. Even a minor cut alongside your nail can cause infection.
• Do not bite or pick at your nails.

To prevent a fungal nail infection:

• Keep your feet clean and dry. Dry feet are less likely to become infected. Apply powder to your feet when needed.
• Wear clean, dry socks. Change your socks once a day or more frequently if they become wet.
• Wear roomy shoes that allow air to circulate around your feet.
• Wear shower sandals or shower shoes when you use public pools, spas, and showers.

To prevent problems with artificial nails:

• Test for a reaction to the artificial nail by having just one nail applied. Wait several days to see whether redness, itching, pain, or rash around or under the nail or separation of the nail from the nail bed develops.
• Do not apply an artificial nail if the nail or the skin around the nail looks irritated or infected.
• If an artificial nail does separate from the nail bed, dip your fingertip into rubbing alcohol for 15 seconds before reattaching the artificial nail. This will clean the space between the nails.
• Do not wear artificial nails for longer than 3 months at a time. Give your natural nails a month to rest before reapplying artificial nails.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• When did your nail problem begin?
• Was there an injury?
• Have you had a nail problem like this in the past? If so, how was it treated?
• Did you try any home treatment? If so, what? Did it help?
• Has anything improved your nail problem or made it worse?
• Are you taking any medications?
• Do you have any health risks?

• Athlete's Foot
• Cuts
• Finger, Hand, and Wrist Injuries
• Fungal Nail Infections
• Psoriasis
• Stress Management
• Toe, Foot, and Ankle Injuries
• Warts and Plantar Warts

Author:	Susan Van Houten, RN, BSN, MBA	Last Updated: January 12, 2007
Medical Review:	Martin Gabica, MD - Family Medicine William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
© 1995-2008 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.