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Demystifying Nail Pterygium: Understanding Abnormal Skin Growth

Many don’t understand what nail pterygium is, but this nail professional apparently does. “Pterygium” is any abnormal growth of skin that becomes stretched. This can occur on any part of the body, on the eye, fingers, toes, elbows, etc.  When it occurs on the nail plate, it is considered an abnormal growth of skin. A true case of nail pterygium is most often a result of disease or injury  to the eponychium, as shown in the image below and occurs in three stages.

The eponychium slowly fuses to the nail plate, in three stages to create nail pterygium and prevents the cuticle from forming.

The Mechanism of Nail Pterygium Formation: Fusion of Proximal Nail Fold

Researchers who study these problems believe some types of pterygium occurs because the proximal nail fold fuses to with the nail plate, as shown.  The fusion is progressive until eventually all of the eponychium is fused to the nail plate. From this point, the proximal nail fold has become fused to the nail plate and will be stretched toward the free edge along with the nail plate in a triangular shape. Nail professionals should not try to cut, abrade, remove or reduce the pterygium, since that would be a medical treatment and outside the scope of allowed practices.

The fusion is thought to occur due to injury or disease, e.g. burns, physical trauma, lichen planus, and certain medical conditions also cause this abnormal growth. Such conditions should be referred to a doctor for examination if they have an unhealthy appearance. Pterygium should not be cut away by nail technicians, since it can bleed and become infected. It can be softened and conditioned, e.g. hot oil manicures.

Understanding Proximal Nail Fold Changes: Differentiating Pterygium from Overgrowth

Hardening and thickening of the proximal nail fold is not pterygium.  This tissue hardening, also referred to by some nail technicians as “overgrowth”, is often created by the nail service, e.g. by cutting, abrasion, or rough treatment. This is much like callous formation which occurs when the skin is repeatedly injured. If that is the case, the nail professional should eliminate the parts of the service that are causing the skin damage.

Eventually this condition may resolve itself.  The client may be able to have gentle manicures, without disrupting the pterygium, and eventually the tissue may recover from previous harsh treatment that caused its formation in the first place.  This recovery can typically take a month to several months to occur.

If the condition worsens, e.g. becomes red, swollen, tender or shows other signs of inflammation the client should be immediately referred to a medical practitioner; preferably a dermatologist (best for hands) or podiatrist (best for toes), so they can get a proper evaluation and treatment if needed.

No nail technician should take it upon themselves to “diagnose”, “treat” or prescribe treatment for this or any other medical condition. Practicing medicine without a medical license is forbidden by most countries, if not all. Find out how nail professionals can help with pterygium.

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