When a nail feels hot, tender, or actively burning, the sensation can be unsettling. This discomfort, medically known as onychalgia, is a pain signal generated within the highly sensitive nail unit. It is a localized form of neuropathic pain, signaling irritation to the dense network of nerves and blood vessels beneath the nail plate. Understanding the source is the first step toward relief, as causes range from simple injury to complex underlying conditions.
Acute Injuries and Chemical Irritation
The most immediate causes of a burning nail sensation often involve a recent physical event or exposure to an irritant. A sudden crush injury, such as slamming a finger in a door, can cause a painful subungual hematoma, where blood collects beneath the nail plate. This rapid pressure buildup activates sensory nerve endings, resulting in a severe, throbbing pain that is perceived as an intense burn.
Repetitive micro-trauma, often from ill-fitting footwear, can also lead to chronic inflammation and burning, particularly on the toes. Chemical exposure is another common culprit, causing contact dermatitis when the skin and nail matrix react to aggressive substances. This often follows the use of harsh cleaning agents, strong nail polish removers, or a thermal burn from the heat generated during the curing process of gel manicures.
Persistent Infections and Inflammatory Skin Issues
A burning sensation that lingers for days or weeks often points toward an established infection or a chronic inflammatory skin disorder. Paronychia is a common infection of the nail folds, typically caused by bacteria or fungi. Acute bacterial paronychia usually presents suddenly with intense redness, swelling, and a painful, burning sensation due to the presence of pus.
Chronic paronychia is frequently caused by yeast, such as Candida, and develops slowly, often affecting people whose hands are frequently wet. The persistent inflammation separates the skin and the nail plate, creating an entry point for microorganisms and maintaining the deep burning feeling. Inflammatory skin diseases like nail psoriasis or eczema can also target the nail matrix, leading to pitting, discoloration, and chronic, deep-seated pain.
Burning Sensations Due to Nerve Issues
Sometimes, the burning feeling is not due to local damage but is a misfiring signal from the nervous system. This neuropathic pain can manifest as sharp, shooting, or burning sensations. Peripheral neuropathy, a condition involving damage to the nerves outside the brain and spinal cord, is a common systemic cause, frequently seen in individuals with diabetes. The nerve damage often causes a burning and tingling feeling that affects the hands and feet in a “stocking and glove” pattern.
Nerve compression syndromes, such as carpal tunnel syndrome in the wrist, can cause referred burning pain in the fingers by irritating the median nerve. A rare but highly painful cause is a glomus tumor, a small, benign growth beneath the nail bed. These tumors are highly sensitive to temperature change and pressure, often causing intermittent, severe, and cold-intolerant burning pain in the fingertip.
When to Seek Medical Attention
While mild, temporary burning often resolves on its own, medical evaluation is necessary if the burning is severe, persistent, or accompanied by visible signs of a spreading infection. Red flags include the presence of pus, rapidly increasing swelling, red streaks extending from the nail up the finger or toe, or a fever.
A visit is also warranted if the pain lasts longer than a week without improvement or if you notice changes in the nail’s appearance, such as significant discoloration, thickening, or detachment from the nail bed. A general practitioner can provide an initial assessment. However, cases involving persistent skin changes or complex pain may require a referral to a dermatologist for nail issues, or a podiatrist for foot-related concerns.