Nail Matrix

What is a nail matrix?

Your nail matrix is where your fingernails and toenails form. Your nail matrix has two parts: the germinal matrix and the sterile matrix.

What does my nail matrix do?

Your nail matrix creates new cells that become your fingernails or toenails. About 90% of your nail growth comes from your germinal matrix. Your sterile matrix is responsible for the remaining 10% of cells that make up your fingernails and toenails, but is more important in keeping your nail attached to the underlying skin.

What happens if my nail matrix is damaged?

Injuries and certain health conditions can damage your nail matrix and interfere with nail growth. Minor damage to your nail matrix can temporarily change your nail’s appearance. You might notice:

• A bruise.
• Ridges.
• Dents.
• A change in how your nail feels to the touch.

A severe injury could cause your nail to fall off. Once your nail matrix heals, your nail will usually start to grow again. It may take several weeks before you see your new nail appear. In cases of severe nail matrix damage, some or all of your nail may not grow back.

Where is my nail matrix located?

Your nail’s germinal matrix is under the base of your nail, and the sterile matrix lies underneath your nail. You can’t see most of your nail matrix. The lunula (white crescent shape at the base of your nail) is the only visible part of your nail matrix. But some people don’t have visible lunulas, and that’s normal, too.

The nail matrix and lunula are part of your nail’s overall structure, which also includes your:

• Cuticle (white or transparent skin at the base of your nail).
• Lateral nail fold (skin that’s on either side of your nail).
• Nail plate (your nail itself).
• Nail bed (area under your nail plate).
• Proximal nail fold (skin at the base of your nail below your cuticle).

What is my nail matrix made of?

Your nail matrix is made of special cells whose main job is to make new fingernails or toenails. Each nail matrix produces 196 layers of cells that combine to make each of your fingernails and toenails. Each nail matrix is constantly making new nail cells, unlike your hair follicles, which go through periods of rest.

What health conditions can affect my nail matrix?

Some health conditions and other factors can affect your nail matrix, including:

• Fungal infection: Certain types of fungus (mold) can infect your nails, usually your toenails. Toenail fungus may appear as thick, yellow, cracked or cloudy nails.
• Illnesses: A serious health event like a heart attack or an illness like COVID-19 or pneumonia can interrupt new nail growth and cause Beau’s lines (horizontal ridges in your nails).
• Injuries: Pinching or crushing your finger or dropping something heavy on your toe can injure your nail matrix. After a nail matrix injury, you may have bruising, ridges or discoloration. Your nail may fall off. Some injuries to your fingernails or toenails can cause a nail infection.
• Medications: Chemotherapy and other medications can temporarily affect your nail matrix, causing Beau’s lines or slow nail growth. Medications may also cause Mees’ lines (white bands across your nails) and nail color changes. Usually, these changes go away after you finish the medication.
• Peripheral artery disease (PAD): Peripheral artery disease causes less blood flow to your legs and feet. This reduced blood flow affects your nail matrix and can make nail growth slower.

Additionally, certain skin conditions and diseases can affect your nail matrix, such as:

• Eczema: Severe eczema can affect your nail matrix and temporarily interfere with nail growth. You might see Beau’s lines, pitting (small, pinhole-like dots) and texture or color changes.
• Psoriasis: Up to 80% of people with psoriasis develop nail psoriasis. Nail psoriasis can cause changes to your nails, including white lines, pitting and crumbling.
• Subungual melanoma: Nail matrix melanoma, also called subungual melanoma, is a type of skin cancer that affects your nail matrix. Brown or black discoloration on your nail is the most common sign. Seek medical care if you see any color changes in a single nail.

What are common signs of nail matrix problems?

Any change to the appearance or texture of one or more of your nails could be a sign of a nail matrix problem. If you have nail matrix damage or a condition affecting your nail matrix, your nails may have:

• Dents (large or small).
• Horizontal ridges or lines.
• Pain or soreness.
• Splits or cracks.
• Spots or streaks of color.
• Texture changes, such as becoming thicker or crumbly.

It can be difficult to tell the difference between a harmless nail change and one that requires treatment. If you notice any change to your fingernails or toenails, see a healthcare provider. They can determine the cause and recommend treatment, if needed.

How do I know if my nail matrix is damaged?

Not all nail changes mean your nail matrix is damaged. Some nail problems affect the nail bed, nail plate or nail folds, and not your nail matrix.

Your healthcare provider can tell you whether it’s a nail matrix problem or some other issue. Let your provider know if you notice any nail changes, from a small spot of color to lines or ridges.

How are nail matrix problems treated?

Treatment for a nail matrix condition depends on the cause. For example, your provider may recommend:

• Medication: Prescription antifungal pills are the typical treatment for nail fungus. If you have nail psoriasis, certain medications can help you manage the condition. These may include pills, injections or topical treatments, depending on your needs.
• Relieving nail injuries: If you have a bruise under your nail, you may benefit from a procedure that drains the trapped blood. This procedure, called nail trephination, provides pain relief and helps your new nail grow in correctly. Providers must perform this procedure within 48 hours of the injury, before your blood clots.
• Surgery: Subungual melanoma needs to be removed with surgery. Your provider may take a biopsy (sample of tissue) to get a diagnosis. If the biopsy shows melanoma, your provider will remove the affected area in your nail matrix and under your nail. If the cancer has spread, you may need other treatments, such as chemotherapy or radiation.

How should I care for my nail matrix?

Accidents happen, so you can’t always prevent a nail matrix injury. But you can help prevent problems with your nail matrix if you:

• Cut your nails properly: Trim toenails straight across to help prevent ingrown toenails. Trim fingernails with a slight curve at the edges, and don’t cut them too short. Avoid manipulation of the cuticle, either at home or at a nail salon.
• Manage health conditions: If you have a condition that could affect your nails, such as psoriasis, see your provider regularly to manage the condition.
• Minimize foot fungus risk: Don’t go barefoot in public bathrooms or locker rooms, where foot fungi commonly thrive. Change out of wet shoes and socks as soon as you can.
• Protect your hands: If you work with tools or machinery, be familiar with “pinch points” that could injure your fingers or hands. Wear gloves if your employer advises it and if you work with chemicals.
• Seek treatment for nail changes or injuries: If your nail has color changes, pitting, ridges, lines or texture changes, see a provider.
• Wear proper footwear: If you play sports, wear the correct shoes for your sport and ensure they’re the right size. Replace shoes when they become worn or hurt your feet. Avoid wearing shoes that are too tight. If you work with heavy objects or in construction, wear steel-toe boots to protect your toes.

A note from Cleveland Clinic

Your nail matrix is the “factory” where your body makes new fingernails and toenails. Certain injuries and illnesses can damage your nail matrix and affect how your nails look or grow. But with the right treatment, you can often see healthy nails grow again. Even if your nail falls off, it usually grows back with proper medical care.

It’s rare for your nail matrix to be permanently damaged, preventing your nail from growing back. But if this happens, ask your provider if you should protect your finger or toe during physical activity. Over time, you’ll likely get used to your nail being gone. Remember that you can still live a full, active life without a fingernail or toenail.