The nail bed is the soft tissue beneath the nail plate, the visible, hard part of your nail. This underlying tissue is an important component of the nail unit, providing structural support and nourishment for healthy nail growth. It contains a rich network of nerves and blood vessels that maintain the integrity and function of the digit.
Visual Cues of Nail Bed Damage
Damage to the nail bed often presents with distinct visual changes. One common indicator is discoloration beneath the nail, known as a subungual hematoma. This occurs when blood vessels under the nail bed leak, causing blood to pool and appear red, purple, blue, brown, or black. The color may change over time as the blood clots and degrades.
Changes to the nail plate itself can also signal underlying nail bed issues. Onycholysis, for example, is the separation of the nail plate from its bed, manifesting as a white, yellow, green, or gray discoloration in the detached area. The border where the nail has lifted often appears irregular. If the nail grows with unusual ridging, thickening, or texture changes, this might indicate scarring or damage to the nail bed affecting new nail formation.
Signs of infection can accompany nail bed damage, appearing as pus or swelling around the nail. This condition, often termed paronychia, involves redness, warmth, and tenderness, sometimes with a visible collection of pus around the nail fold or cuticle. If the nail plate is severely injured or removed, visible lacerations or cuts on the exposed nail bed indicate damage.
Common Causes of Injury
Nail bed injuries result from physical impact or stress. Direct trauma is a frequent cause, such as crushing injuries where a finger or toe is caught in a door, or when heavy objects are dropped onto the nail.
Repetitive stress also contributes to nail bed injury over time. This includes wearing ill-fitting shoes that constantly press on the toenails, or engaging in sports activities like running or hiking that subject the nails to repeated impact. Even minor actions like repetitive tapping of fingernails can eventually lead to separation from the nail bed.
Exposure to certain substances compromises nail bed health. Harsh chemicals or aggressive nail products, including those used in manicures and pedicures, can weaken the nail’s attachment and cause damage. Improper techniques during manicures, such as aggressive pushing back of cuticles or using tools under the nail, can also injure the delicate nail bed. Infections, whether fungal or bacterial, can directly affect the nail bed, leading to changes like thickening, discoloration, or detachment by compromising the nail’s structural integrity.
When Professional Medical Care is Needed
Seek professional medical care for a nail bed injury to ensure proper healing and prevent long-term complications. If there is severe pain or significant swelling that does not subside with minor care, medical evaluation is needed. The presence of pus, increasing redness, warmth, throbbing pain, or red streaks extending from the nail suggests an infection requiring medical attention.
A large subungual hematoma, particularly if it covers more than 25% to 50% of the nail bed or causes intense pressure and pain, requires assessment by a healthcare provider. If a significant portion of the nail has detached or been avulsed from the nail bed, or if there is a visible laceration or deep cut on the nail bed itself, medical intervention is needed. Bleeding that does not stop also indicates a need for professional care.
If the nail grows back deformed after an injury, or if problems with the nail persist for several months, a medical consultation can help determine if further treatment or repair is needed. An inability to move the affected digit, or if jewelry cannot be removed due to swelling, points to a more severe underlying injury, potentially including a fracture, requiring immediate medical attention.