The Basic Structure of Skin : Nails

The Basic Structure of Skin : Nails

September 07, 2020

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Although nails are often considered cosmetic, the reality is that they can be a reflection of our health.  Learning about normal healthy nails is a good starting point.

The key thing to remember about nails is that the nail plate itself is composed of a hardened protein called keratin. The pink hue that we see associated with a healthy nail plate is actually a window to the hue of the nail bed underneath and its vasculature.
The whitish half moon base of the nail plate is the visible part of the nail matrix. The amount of this visible can vary widely depending on where your cuticle ends.  Some people may believe that the cuticle should be pushed back to reveal this half moon.  The reality is that doing so can often cause more damage to the overall health of the nail plate itself.
The next part of the nail is the pinkish area which overlies the nail bed. This is followed by the free edge of the nail plate will appear whitish as it is just the keratin itself with no underlying skin so you can see how it is somewhat translucent.

A nice healthy nail will have a pinkish or mauve hue as it reflects the color of the nail bed underneath. When you apply pressure to this area, you should be able to make this color disappear temporarily and reappear rapidly once pressure is released. This is a sign that you are well hydrated and have good blood flow to your tissues! By applying pressure you are pushing blood away from the tissues and then releasing pressure allows it to flow back in- this is referred to as the capillary nail refill test. If you cannot quite get a good glimpse of this, try using a drinking glass to apply gentle pressure and then release.  This way you can witness the pale hue quickly turn pink once the blood flow returns.

The most important advice I have for my patients to maintain healthy nail growth is to protect your cuticles! This is the skin around your nails.
Remember the nail plate is just keratin that grows out of the nail matrix. The cuticle is the skin right on top of the nail matrix. Protecting your cuticle will protect your nail growth.  The cuticles serve as a barrier to protect your matrix from bacteria, fungus, yeast, inflammation and trauma.

Many people are shocked to hear this but I do not recommend cutting or removing your cuticles. Once you do this, you open your nail matrix up to not only infections but other problems such as grooves and irregularities in the nail growth. 

There is a myth that pushing your cuticles back will make your nails grow faster. Pushing them back just gives the appearance of longer nails for cosmetic purposes. It’s ok to gently push this skin back if this is what you are trying to achieve- there’s just no need to cut it!

Keeping your skin well moisturized, especially around the nails and especially in the winter when we are all prone to dry cracked hands, will help keep your cuticles healthy and support healthy nail growth.
Applying petroleum jelly to your cuticles every night will help keep them hydrated. Any thick moisturizer can serve the same purpose.
One of the most important pieces of advice I have for people that get manicures is to speak up if your manicurist is particularly aggressive with your cuticles!  The damaging effects will take months to recover from as most fingernails take 3-6 months to grow out while toenails can take as long as 6-12 months to grow out.

Remember, nails are not just cosmetic. Often they can cause a lot of practical problems for people- getting caught on clothing, soreness, pulling back on socks and shoes.

Nail health is important because if we do not address these issues early on, the damage to the main matrix can result in permanent nail damage. The most common nail concern tends to be nail fungus. Even though we have some treatments for this, many people do not realize that if the fungus damages your nail matrix, even if you treat the fungus the nail may stay permanently thickened and difficult to manage.

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