Nail Anatomy

NAIL ANATOMY
Sidra Kanwal
Introduction to Nails
Definition: Nails are keratinized
appendages of the skin that protect the
distal phalanges and enhance fine motor
skills.
Key Functions:
• Protection of the fingertip.
• Enhancement of touch sensitivity.
• Support for precise movements.
• Indicators of systemic and dermatologic
diseases.
Anatomy of the Nail Unit
The nail unit comprises six key components:
 Nail Plate
Structure:
• The hard, translucent part of the nail made of
tightly packed keratinized cells.
• Composed of three layers:
1. Dorsal layer: Thin, compact, and most exposed.
2. Intermediate layer: Thickest, with tightly bound
keratin.
3. Ventral layer: Adherent to the nail bed.
Clinical Relevance:
Changes in thickness, texture, or color often indicate
pathology.
Nail Matrix
 Location: Beneath the proximal nail fold
and extends distally under the lunula.

 Function: Produces keratinized cells that
form the nail plate.

 Clinical Importance:
 Damage to the matrix affects nail growth and
appearance.
 Longitudinal ridging, pitting, or dystrophy often
originate here.
Nail Bed
 Structure: Vascular connective tissue
under the nail plate.

 Function:
 Provides adherence and support to the nail
plate.
 Contributes to nail plate growth by producing
keratin.
 Clinical Significance:
 Splinter hemorrhages or nail bed melanomas
often manifest here.
Lunula
 Appearance: White, crescent-shaped
area at the proximal nail plate.

 Role: Visible part of the matrix
responsible for early keratinization.

 Clinical Relevance: Changes in the
lunula may indicate systemic conditions

(e.g., anemia, cardiovascular issues).
Eponychium (Cuticle)
 Description: Thin layer of skin covering
the proximal nail plate.

 Function: Acts as a barrier, protecting
the matrix from infections.

 Pathology: Trauma or improper care can
lead to paronychia or infections.

Hyponychium
 Location: Skin under the free edge of
the nail plate.

 Function: Forms a seal between the nail
plate and fingertip to prevent microbial

invasion.
 Clinical Significance: Fungal infections
(onychomycosis) often involve this area.

Nail Growth
Source:
 Growth originates from the nail matrix.
Rate:
 Fingernails: ~3 mm/month.
 Toenails: ~1 mm/month.
Factors Influencing Growth:
 Age (slower with age).
 Nutritional status (e.g., deficiencies in
biotin or iron).
 Systemic conditions (e.g., hypothyroidism
slows growth).
Blood Supply and
Innervation
Vascular Supply:
 Nail bed and matrix are richly
vascularized, contributing to the nail’s

pink appearance.
 Arterial supply: Digital arteries.
 Venous drainage: Digital veins.

Innervation:
 Supplied by digital nerves, contributing to
high sensory input.

Clinical Implication:
 Vascular changes manifest as cyanosis,
pallor, or splinter hemorrhages.

Clinical Relevance of Nail
Anatomy
Diagnostic Clues
 Pitting: Associated with psoriasis or eczema.
 Clubbing: Indicates hypoxia (e.g., lung
disease, cyanotic heart conditions).
 Beau’s Lines: Transverse depressions linked
to systemic illness or trauma.
 Onycholysis: Separation of the nail plate
from the bed seen in fungal infections or
trauma.
 Terry’s Nails: White nails linked to liver
disease or heart failure.
Common Nail Disorders
Infections:
 Onychomycosis: Fungal infection
affecting the plate and bed.

 Paronychia: Infection of the periungual
tissue.
Trauma-Related Disorders:
 Subungual hematoma: Bleeding under
the plate.
 Nail dystrophy: Repeated trauma to the
matrix or plate.
Tumors and Cancers:
• Subungual melanoma: Pigmented lesions that
may extend to the cuticle (Hutchinson's sign).
• Glomus tumor: Painful, often subungual
growths.
Nail Care and Preservation
Best Practices:
 Avoid excessive moisture or drying
agents.
 Trim nails straight across to prevent
ingrown nails.
 Use moisturizers and cuticle oils to
maintain flexibility.
Medical Management:
 Proper treatment of systemic illnesses
improves nail health.

 Antifungal treatments for onychomycosis.
 Biopsies for suspicious lesions.

Fun Facts for Clinicians
 Nails grow faster on the dominant hand.
 Lunula size varies between individuals
but is more prominent on thumbs.
 Fingernails grow faster than toenails due
to greater vascular supply.
THANK YOU

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NAIL ANATOMY

and extends distally under the lunula.

form the nail plate.

under the nail plate.

area at the proximal nail plate.

responsible for early keratinization.

lunula may indicate systemic conditions

the proximal nail plate.

the matrix from infections.

lead to paronychia or infections.

the nail plate.

plate and fingertip to prevent microbial

(onychomycosis) often involve this area.

 Nutritional status (e.g., deficiencies in

vascularized, contributing to the nail’s

 Venous drainage: Digital veins.

high sensory input.

pallor, or splinter hemorrhages.

affecting the plate and bed.

improves nail health.

 Biopsies for suspicious lesions.

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