How to cite: Avila-alvarez A M, Gomez-Vargas L M, Velez-Pelaez M C. The Nail Bed: Theories of Its Functioning and Therapeutic Mechanisms of Dermabrasion. J Skin Stem Cell. 2022;9(1):e123012.https://doi.org/10.5812/jssc-123012.
Introduction: The nail bed is a fundamental structure of the nail unit given its close relationship with the nail plate, the distal matrix, and the hyponychium. How it interacts with these structures is still a matter of study.
Case Presentation: We describe clinical cases of patients with traumatic destruction of the nail bed treated with mechanical dermabrasion in a reference center. Both clinical cases had a satisfactory response to the treatment, which supports the proposed theories about the functioning of the nail bed.
Pigmented Lesion On Nail Bed: Pseudo Hutchinson Sign
The nail bed is a specialized epithelium attached to the ventral portion of the nail plate. Its appearance is a sequence of ridges and grooves that perfectly correspond to the nail plate (1) (Figure 1). It is not yet clear whether the migration of the nail bed is due to the movement of the cells that compose it or to the growth of the nail plate that slides longitudinally over it, "stretching" it (2). What is clear, in functional terms, is that if the nail bed changes, the shape of the nail also changes and that a large part of the nail dystrophies corresponds to an underlying alteration of the nail bed. Thus: (1) if the nail bed presents a shortening, keratinization, or what is known as "disappearing nail bed" (3), the nail is necessarily forced to thicken since the mitotic activity of the matrix is the same, but the space to deposit its product is less in length (Figure 2); (2) if the nail bed is thin or depressed, the nail increases its thickness and fills the space. If the nail bed is thick, the nail in this portion will be thin (Figure 3).
Red arrow: The distal portion of the nail bed has disappeared; it has become keratinized. Blue arrow: Thickening of the nail plate.
A, Nail plate thickened towards the nail folds; B, View of the nail unit without the nail plate showing depression of the nail bed towards the nail folds.
Nail Bed Injuries: Types, Causes And Treatment
This behavior allows us to conclude that if we have a flat nail bed with normal morphology and extension, the shape and adhesion of the nail will also be adequate. To illustrate this theory, we use the example of two patients seen in our nail unit service.
A patient consulted after 11 months of blunt trauma to the left thumb with complete loss of the nail plate and injury to the nail bed (Figure 4A). Mechanical dermabrasion on the nail bed was performed at medium speeds with diamond tips, seeking to sweep away the hyperkeratosis and recover the flat morphology of the nail unit. Improvement was seen since the third postoperative day (Figure 4B), and almost complete recovery was obtained after six months (Figure 4C). These changes favor the observations of the dynamic and migratory nature of the nail bed cells.
A, Hyperkeratotic and disappeared nail bed in the distal portion, adhered dystrophic nail plate in the central region, distorted lunula, and rounded fingertip; B, Day 3 after the procedure. Flattening of the nail bed and change in the morphology of the fingertip; C, Sixth months after the procedure. Considerable improvement in the shape of the nail and almost complete recovery of the nail bed and the shape of the fingertip. Triangular lunula can be observed.
Splinter Hemorrhage Causes, Treatment
A patient consulted five months after trauma with a hydraulic jack in the right thumb, he presented destruction of the nail bed and alteration of the morphology of the nail plate (Figure 5A and B).
A and B, Initial clinical and dermatoscopic view. A distally small portion of preserved nail plate; in the proximal and medial aspect depressed and folded nail bed with areas of hyperkeratosis. Rounded fingertip. C and D, Clinical and dermatoscopic view nine months postoperatively. Recovery of the nail plate, normal shape of the fingertip, and healthy visible portion of the lunula.
Mechanical dermabrasion was performed, with the technique described in the previous case, to flatten and “stretch” the nail bed and allow better adherence to the nail plate. After nine months of treatment and follow-up, almost complete improvement of the nail was achieved, leaving only a minimal portion of nail bed hypertrophy (Figure 5B and C).
Fixing Damaged Nails. What Are The Best Treatments? By K.waller
Historically for the repair of nail bed defects, particularly large ones, surgical methods such as suturing the nail bed, the use of acrylate-based glues (4), or even skin grafts (5) have been the first-line treatments, especially in acute events. The cases described in this article allow us to broaden our perspective and consider other therapeutic options in the approach to nail dystrophies.
Taking into account the premises proposed during the introduction, these results allow a deeper understanding of the functioning of the nail unit, which is, without a doubt, a dynamic structure that responds to forces applied to it. We further hypothesize that mechanical dermabrasion is useful not only for its effect on nail bed hyperkeratosis, but that there must also be an additional effect of the heat and vibration produced during the procedure, which can stimulate the regeneration of the underlying onychocytes. More research is required to understand further the complex response of the nail bed to this therapy, and it would be interesting to carry out a subsequent controlled study to evaluate the efficacy of dermabrasion for the management of this difficult-to-treat entity.
With the previous findings, we present a less invasive technique for recovering the lost nail bed based on its dynamic response to external stimuli and forces.
Nail Lifting (onycholysis) Condition, Treatments And Pictures For Adults
Copyright © 2022, Journal of Skin and Stem Cell. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.Anonychia congenita is a condition that affects the fingernails and toenails. Individuals with this condition are typically missing all of their fingernails and toenails (anonychia). This absence of nails is noticeable from birth (congenital). In some cases, only part of the nail is missing (hyponychia) or not all fingers and toes are affected. All of the other tissues at the tips of the fingers and toes, including structures that usually support the nail and its growth (such as the nail bed), are normal.
Mutations in the RSPO4 gene cause anonychia congenita. The RSPO4 gene provides instructions for making a protein called R-spondin-4. R-spondin-4 plays a role in the Wnt signaling pathway, a series of steps that affect the way cells and tissues develop. Wnt signaling is important for cell division, attachment of cells to one another (adhesion), cell movement (migration), and many other cellular activities. During early development, Wnt signaling plays a critical role in the growth and development of nails. R-spondin-4 is active in the skeleton and contributes to limb formation, particularly at the ends of the fingers and toes where nail development occurs.
RSPO4 gene mutations lead to the production of a protein with little or no function. As a result, R-spondin-4 cannot participate in the Wnt signaling pathway and nails develop improperly or not at all.
Tumor: Nailbed Ablation And Skin Graft
Anonychia congenita can also be part of syndromes that affect multiple parts of the body, including Coffin-Siris syndrome and nail-patella syndrome. When anonychia congenita is part of a syndrome, it is caused by mutations in the gene associated with that syndrome.
Anonychia congenita resulting from RSPO4 gene mutations is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition.
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Nail Clinic: Onycholysis: What It Looks Like, Causes, And Treatment
The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.Some people are unhappy with their shorter nail beds because they feel it makes their nails look too short. While you can’t change the size of your nail beds, the good news is that you can make them appear longer. Read on to learn more.
While you can’t change the size of your nail beds, there are things you can do to make them appear longer. Try these three tips:
First step is to let your nails grow out. As your nails become longer, you’ll have a longer white tip, which helps elongate your nail bed. If you have difficulty growing your own nails, artificial nails can protect your real nails from cracks and breaks.
How Your Fingernails Can Show Signs Of Disease
You can also make your nail beds appear longer by cleaning underneath your nails with a nail brush instead of metal nail tools. Using a sharp object to clean underneath nails can cause slight damage and separation of the nail plate from the nail bed.
You can also push back your cuticles
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