What is The Proximal Nail Fold?

Contrary to popular belief, nail health includes more than just the hard nail plate. It also includes the skin around the nail.

One part of this skin is called the proximal nail fold, which is located on the bottom of the nail. It frames the nail, along with the lateral nail folds, which are on the left and right sides.

Though it might seem like an insignificant structure, the proximal nail fold is important. It plays an essential role in overall nail health.

To learn more about the proximal nail fold, read on. We’ll explain its function and best care practices, along with medical issues that can affect it.

What is the proximal nail fold?

The proximal nail fold is a wedge of thickened skin at the base of the nail. It’s found on both your fingernails and toenails.

The skin folds over the nail matrix and the base of the nail. The nail matrix produces the hard nail. It’s located deep inside the proximal nail fold.

The top of the proximal nail fold has normal skin, while the skin along the underside is thinner.

The proximal nail fold is different from the cuticle. The cuticle is the skin that extends from the proximal nail fold. It’s thin, clear, and attached to the nail.

What’s the function of the proximal nail fold?

In addition to securing the nail, the proximal nail fold protects the nail as it grows.

The proximal nail fold and cuticle also create a seal between the matrix and nail. This protects the area from:

  • allergens
  • irritants
  • toxins
  • infection-causing microbes, like bacteria and fungi

What’s the best way to care for the proximal nail fold?

Here’s how to care for the proximal nail fold:

Avoid cutting or trimming

Remember, the proximal nail fold protects the space between your nail and skin from harmful germs. Cutting or trimming it will make it easier for germs to get in.

The proximal nail fold is also attached to the cuticle, which shouldn’t be cut, according to the American Academy of Dermatology (AAD). If you cut the proximal nail fold, you’ll also cut the cuticle.

Avoid pushing it back

The AAD also advises against pushing back the cuticles. However, if you do so anyway, be sure to stop at the proximal nail fold.

Pushing back the nail fold will expose the space between your skin and nail, increasing the risk of infection.

Moisturize

As with all skin around your nails, it’s important to moisturize the proximal nail fold. This will keep the skin hydrated and healthy.

If you use a cuticle oil or cream, applying it will hydrate the proximal nail fold at the same time. You can also use a moisturizing hand cream or coconut oil.

What problems can occur with the proximal nail fold?

Like other parts of the nail, the proximal nail fold can develop medical issues. These include:

Physical trauma

Physical trauma to the proximal nail fold can lead to paronychia, or inflammation of the skin around the nail. This includes trauma like cuts or breaks in the skin.

If physical trauma separates the nail from the nail bed, retronychia can occur. Retronychia is when a new nail grows beneath the old nail, pushing the latter upward. This causes inflammation in the proximal nail fold.

Examples of physical trauma that can cause proximal nail fold inflammation include:

  • picking at the nail
  • biting the nail
  • getting manicures or pedicures
  • applying fake fingernails
  • developing ingrown toenails
  • wearing poorly fitted shoes (for toenails)
  • engaging in sports activities
  • applying physical pressure
  • removing the cuticle

If the proximal nail fold is cut or broken, it should be treated like any other wound. You can also soak the affected finger or toe in warm water to soothe inflammation.

For retronychia, you’ll need to get the old nail removed by a medical professional.

Reaction to irritants and allergens

If the proximal nail fold is repeatedly exposed to irritants and allergens, it can become inflamed. This includes substances like cleaning products or food.

People who are prone to this type of irritation of the proximal nail fold include:

  • house cleaners
  • laundry workers
  • cooks
  • dishwashers
  • swimmers

Treatment includes limiting exposure to the offending substances. This may include wearing gloves or using different products. Topical steroid creams can also provide relief.

Connective tissue diseases

Some connective tissue diseases can affect various parts of the nail, including the proximal nail fold. Examples of these diseases include:

  • systemic sclerosis
  • lupus erythematosus
  • dermatomyositis

These conditions may cause changes in the proximal nail fold like:

  • discoloration
  • redness
  • visible blood vessels (dermatomyositis)

Treatment should focus on managing the underlying cause.

Skin conditions

Skin diseases can affect the nail around the skin, including the proximal nail fold. This includes conditions like:

  • psoriasis
  • eczema
  • dermatitis

These conditions may cause changes to the proximal nail fold, including:

  • swelling
  • thickening
  • inflammation
Infection

Bacterial and fungal infections can affect the proximal nail fold.

Usually, bacterial infections in the fold develop after an injury. The injury allows harmful bacteria to enter the fold, resulting in infection. Symptoms include:

  • redness
  • swelling
  • tenderness
    • painpus

Meanwhile, fungal infections often affect the entire nail. But one type, called proximal subungal onychomycosis, starts at the proximal nail fold and spreads up the nail. This fungal infection typically affects people with compromised immune systems.

Bacterial infections are treated with topical antibiotics, while fungal infections are treated with topical antifungal medications.

When to see a doctor

If you notice any nail abnormalities or changes in the skin around your nails, make an appointment with a doctor. This includes:

  • unusual dryness
  • redness or discoloration
    • pain
  • swelling
  • abnormal growth
  • tenderness
  • thickened skin
  • strange odor
    • pus

Takeaway

The proximal nail fold is the skin that borders the bottom of your nail. It keeps the nail in place and protects it as it grows. The fold is connected to the cuticle, which is attached to your nail. Together, the fold and cuticle stop germs from entering your skin.

It’s recommended that you avoid cutting or trimming the proximal nail fold. Doing so can increase the risk for infection or inflammation. Some skin and connective tissue disorders can also affect the proximal nail fold, so it’s important to treat them accordingly.

Visit your doctor if the skin around your nails becomes swollen, discolored, or painful. They can determine what’s causing your symptoms and help you find relief.

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