Nail & Skin Disorders

The Nail Doctor: Leave Scar Tissue to a Doctor’s Care

Scar tissue on the nails, or pterygium, is not just troublesome cuticle material to be removed. It is sometimes indicative of a medical condition that needs to be treated by a physician.

Scar tissue on the nails, or pterygium, is not just troublesome cuticle material to be removed. It is sometimes indicative of a medical condition that needs to be treated by a physician.

Q: I have pterygium under the free edge of some of my nails. Can this tissue ever be removed or somehow relieved? Sometimes my nails are quite painful.

A: A pterygium of the nail is almost always associated with a medical problem. The word pterygium is derived from Greek and means “wing-like.” Apparently to some observers many years ago, the condition resembled a wing; thus, the name. Pterygium is generally thought of as the mild cuticle overgrowth that sticks to the nail plate.

However, there are two types of pterygium. One occurs in the vicinity of the cuticle, and it is due to a permanent scar in the nail growth center, or matrix. The disorder with which pterygium is most commonly associated is lichen planus. This is a rare disease that affects the nails in about 10% of cases. With lichen planus, an inflammation occurs in the matrix, resulting in a permanent scar and thus an abnormal nail. It is usually treated with cortisone, which will prevent further destruction of the nail unit.

The second type is known as inverse pterygium. This is the variety that occurs under the nails near the free edge. Apparently, this is the one you are describing. What happens is that the skin beneath the nail remains attached to the free edge, thereby producing the inverse pterygium. It may be seen in association with impaired circulation or some systemic disorders. Although it does occur occasionally in otherwise healthy individuals, medical consultation is suggested if it persists, especially if it is painful. I suggest you consult a doctor about your condition.

Mild cuticle overgrowth can be removed easily by gentle pushing with a file or cuticle pusher. In more serious cases, however, you should not manipulate the affected nails, and you should recommend the client seek a doctor’s evaluation.

Q: I have noticed some of my older clients have white marks close to the free edges of their nails. These marks aren’t caused by rough treatment of the nail, and the marks do not affect the stability of the nail. None of these clients have separation of the nail from the nail bed. Am I doing something to cause these marks?

A: Leukonychia (white marks on the nails) is almost always due to trauma or injury. Pushing back the cuticles too hard, for example, will result in white marks appearing on the nail plate surface about two months after it is done. This is due to nail matrix (growth center) damage, but fortunately the damage is only temporary because after the matrix heals, a normal nail plate is produced and the nail with white marks grows out.

There is one type of nail fungus infection, called white superficial onychomycosis, which can also cause white marks on the nails. In this situation, however, the white gets worse and spreads across the nail plate. It will not grow out or clear up without appropriate treatment, therefore, I do not believe your clients have this problem.

Finally, there are instances where nail glue used in conjunction with wraps or tips may result in white “larks as well. Here, simply discontinuing the application will gradually provide a cure as the new nail grows in and replaces the old.

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