What is a Nail Bed?
The nail bed is the skin that is present directly underneath the nail plate. Just like other skins, the nail bed is also made up of two types of tissues: the epidermis, which is the layer present just underneath the nail plate and the deeper layer of dermis, which is the living tissue consisting of capillaries and glands. The nail bed along with nail matrix is responsible for pushing the new nail forwards. There are tiny longitudinal "grooves" known as matrix crests which connect the epidermis to the dermis. As a person ages, there is thinning of the nail plate which makes these grooves more visible.
Damage to the nail bed can occur from a variety of causes and a damaged nailed can be quite painful and prevents the patient from using their fingers or toes. A damaged nail bed should not be ignored and treatment should not be delayed. If a damaged nail bed is ignored, then it can lead to some permanent or painful and chronic deformity of the nail plate. So, it is important to seek treatment for a damaged nail bed.
Causes of Damaged Nail Bed
Damage to the nail bed commonly occurs as a result of compression of the nail bed between the broken or bent nail and the distal phalanx of the finger. The cause for this is localized trauma. The common sites of injury are distal and middle thirds of the nail bed. About half of the injuries consist of fracture of the tuft, distal phalanx or both. If the nail is crushed between the bone and a larger object, then this can cause multiple fragments or stellate laceration of the nail bed. Injury from a sharp object can result in piercing of the nail resulting in a clean tear of nail bed. If our finger or toes gets jammed in the doorway accidently, then it also results in a damaged nail bed. Tear to the tendons which are responsible for bending or straightening the fingertip can also cause damage to the nail bed.
Diagnosis of Damaged Nail Bed
Medical history of the patient consists of medical history of the patient where the patient is asked about the mechanism of the injury and timing of the injury. The damaged nail bed is then examined to look for exposure of bone, signs of contamination, evidence of fingertip contusion and viability of surrounding skin. Radiographic tests help in determining the extent of the damage to the nail bed.
Treatment of Damaged Nail Bed
The nail bed often gets damaged as a result of accidents, such as the fingertip or the toe getting caught in the door. Other than this, any type of crushing, pinching or sharp cut to the fingertip can cause nail bed damage.
If there is some crushing injury to the fingertip, then it causes a very painful pooling of blood under the nail. This is known as subungual hematoma. If there is a severe injury to the nail, then it causes the nail to crack into pieces. There can be tearing off of a part of the nail or even fingertip along with other injuries to the finger.
The patient is asked questions of how the injury has occurred. X-rays are taken to look for fractured bones. The injured nail is closely examined to assess the complete extent of the injury to the nail bed. For this local anesthesia can be given. Certain medical conditions like diabetes can affect the healing process of the damaged nail bed and is discussed with the patient during the treatment.
The aim of treatment of damaged nail bed is restoring the injured finger and nail to its previous condition. If there is subungual hematoma where there is collection of blood under the nail, then it is drained via a small hole in the nail. This relieves the pressure and gives the patient relief from pain. If there is a severe injury, then splinting or surgery may be required.
There are some nail bed injuries which can be fully healed and the nail can return to its normal state. However, in case of severe injuries, where the base of the nail bed (crescent-shaped) gets damaged, patient may end up with a permanently deformed nail. The healing time is around 3-6 months for a damaged nail bed. It can take around 6 months for a finger nail to completely grow from the cuticle to the tip of the finger and it can take thrice as long for a toenail to completely grow out.
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