Nail & Skin Disorders

Under the Microscope: Pterygium

Pterygium is an adhesion between the skin surrounding the nail and the area under the nail plate.

What is it?

Pterygium of the nail can be described as an adhesion between the skin surrounding the nail (dorsal nail fold) and the area under the nail plate, which eventually leads to partial destruction of the nail. Pterygium can appear on the fingernails or the toenails, and it affects both men and women. Techs can best identify pterygium by studying photos of the disease to get acquainted with the triangular, winged shape of the skin that grows into the nail plate.

How do you get it?

There are a number of causes of pterygium. One common cause is the skin disease lichen planus, which along with pterygium of the nail, appears as a purplish rash on the skin and possibly even in the mouth. Other causes of pterygium include blunt force trauma or rheumatic disease. There is also a hereditary form of pterygium.

How is it treated?

Treatment for pterygium begins with topical steroids in the form of creams and lotions, or anti-inflammatory medications. Tier two of treatment moves into cortisone injections at the matrix of the nail (which is very painful for clients). In advanced cases, treatment requires the nail to be removed through surgery.

What can a tech do?

If a nail tech encounters the beginning stages of pterygium, she should refer the client to a dermatologist. If the condition is caught in the early stages, it’s likely that the area will heal. Techs should not try to treat pterygium in any way. Don’t push the cuticle back as this may lead to further scarring, infection, and bleeding. Polish and acrylic products are considered safe to apply, but are not advised, as the product will be applied directly on the skin. This presents two problems: one, the product will have difficulty adhering to the skin; two, nail product should never be applied to the skin, because it is an allergen and could cause a reaction. Techs may simply manicure the section of the nail plate that has not been compromised with pterygium, but avoid filing down the nail plate that is already weak.

What else?

A less common form of pterygium, known as inverse pterygium, can form at the hyponychium (the skin beneath the free edge). It occurs when scar tissue abnormally attaches the hyponychium to the underside of the nail and stretches forward as the plate grows out. The skin in the area is usually sensitive and even painful. Inverse pterygium can look very much like advanced hyponychium, which is a growth of normal tissue under the nail. Doctors are not sure what causes the inflammation and scarring. It could be a hereditary condition or the result of a systemic, auto-immune, or circulatory disorder. In some cases, inverse pterygium can be caused by an allergic reaction to ingredients used in nail enhancements or the solvents used to remove them. If this is the case, enhancements should be removed.
Dr. Andrea Cambio and Dr. Gregg Severs contributed to this article.


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Dr. Andrea Cambio and Dr. Gregg Severs contributed to this article.

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