Nail Problems and Injuries
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.
- 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.
- 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.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Symptoms of infection may include:
- Increased pain, swelling, warmth, or redness in or around the area.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
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.
- Try to drain blood from under the nail if you have pain. 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.
- Try soaking your toe and using a small pad of wet cotton to help an ingrown toenail heal on its own.
- Trim a hangnail so you don't 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.
Try a nonprescription medicine to help treat your fever pain:
Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
Be sure to follow these safety tips when you use a nonprescription medicine:
Symptoms to watch for during home treatment
Call your doctor 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 doctor 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.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor 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 medicines?
- Do you have any health risks?
Current as of: July 1, 2021
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine