Many things can damage the nail bed, the skin beneath the nail plate, including trauma from accidents and injuries, as well as taking drugs that impact the nail bed. The appearance of the fingernails and toenails can indicate underlying health problems, though, including abnormalities that affect the nail bed, so physicians often inspect the nail beds during routine exams to make a more accurate diagnosis. Disorders impacting the nail bed include onychogryphosis, lichen planus and psoriasis.
Onychogryphosis
Onychogryphosis most often impacts the big toenail, although any nail on the hands or feet can be affected. This nail deformation presents as a thickening of the nail, and the nail takes on a hooked curve, which makes it look claw-like. According the The Merck Manuals Online Medical Library, a nail affected by onychogryphosis may injure adjacent toes when it occurs in the feet. Treatments include thinning the nail through cutting, filing or nail removal. The cause of this disorder varies, but often comes from damage to the nail bed from repetitive injuries.
Lichen planus
According to the American Academy of Dermatology, lichen planus, a common inflammatory disease of the mouth and skin, affects 1 to 2 percent of the U.S. population. Physicians diagnose this disorder most often in middle aged adults and classify it most often as an autoimmune disease. No cure exists, but treatment includes the use of topical corticosteroid creams or other anti-inflammatory drugs, as well as antihistamines. When lichen planus affects the nail bed, scarring occurs, which leads to the formation of pterygium, an injury that results in the loss of the nail.
Psoriasis
Psoriasis, a non-contagious disorder of the skin, occurs when the immune system causes the growth cycle of skin cells to increase speed. The National Psoriasis Foundation reports that as many as 7.5 million Americans have psoriasis, although not all have the variety that can affect the nail bed. The Merck Manuals library notes that those affected with psoriasis can develop a variety of nail problems including irregular pits in the surface of the nail, yellow-brown spots between the nail plate and nail bed and separation of the nail plate from the nail bed.
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