Overview

Onycholysis is a common condition where your fingernail or toenail painlessly separates from the nail bed underneath. This separation often starts at the tip of the nail and can progress towards the base. It can be caused by a variety of factors including injury, infection, skin diseases like psoriasis, or even reactions to certain chemicals or medications.

While anyone can develop onycholysis, it's often seen in adults, particularly those whose hands are frequently wet or exposed to irritants. It is not usually contagious itself, but if an infection is the underlying cause, that infection could potentially be spread. Living with onycholysis can be concerning, as the appearance of your nails changes, and it can sometimes make you feel self-conscious or worried about an underlying issue.

Symptoms

You might notice several changes if you have onycholysis:

• Painless separation of the nail - from the skin beneath it, starting at the tip or sides.
• The separated part of the nail may appear opaque, white, yellowish, or even greenish - if there's a secondary infection.
• The border between the attached pink part of the nail and the separated white part may look irregular or wavy.
• Debris may collect under the nail - in the space created by the separation.
• The nail plate itself might feel normal, or it could become brittle or thickened - depending on the cause.
• There is usually no pain or itching - unless an infection or another skin condition is also present.
• The texture of the nail surface might change in some cases.
• More than one nail can be affected.

Diagnosis

A doctor, often a dermatologist, can usually diagnose onycholysis by carefully examining your nails and the skin around them. They will likely ask about your medical history, any recent injuries, your occupation, and products you use on your hands or nails.

Sometimes, to find the exact cause, your doctor might take a small sample of debris from under the nail or a nail clipping to check for fungal or bacterial infections. If a skin condition like psoriasis is suspected, they will look for other signs on your skin.

Management & Treatment

We understand that seeing your nail lift can be concerning, but the good news is that with the right care, you can encourage healthy new nail to grow. The key to treatment is identifying and addressing the underlying cause.

It's important to know that the separated part of the nail will not reattach to the nail bed. The goal of treatment is to protect the area while the new, healthy nail grows in and replaces the detached portion. Patience is essential, as this process takes time.

Home Care and Self-Management Strategies

This is the first and most important step in managing onycholysis:

• Keep the nail trimmed: Carefully trim the detached part of the nail back to where it is still attached. This prevents the nail from catching on objects, which could cause further separation.
• Keep the area dry: Moisture can encourage bacteria or fungi to grow. Dry your hands and feet thoroughly after washing. You can even use a hairdryer on a low, cool setting to gently dry under the nail.
• Avoid trauma: Protect your nails from injury. Wear gloves when doing manual work, washing dishes, or working with chemicals.
• Skip the nail cosmetics: Avoid nail polish, artificial nails, and harsh removers, as they can be irritating.
• Do not clean under the nail: Avoid using sharp tools to clean under the nail, as this can push bacteria deeper and worsen the problem. Gentle washing is all that is needed.

When Prescription Treatments May Be Needed

If home care isn't enough, or if an underlying condition is the cause, your doctor may recommend:

• Antifungal Medications: If a fungal infection is diagnosed, you may need a prescription for topical (applied to the nail) or oral (taken by mouth) antifungal medication.
• Topical Steroids: For onycholysis caused by skin conditions like psoriasis, a prescription-strength corticosteroid cream can help treat the underlying inflammation.
• Treating Systemic Conditions: If the onycholysis is a symptom of another issue, like a thyroid disorder or an iron deficiency, treating that primary condition is necessary for the nail to heal.

Expected Timeline for Improvement

Nails grow slowly. You can expect it to take 4-6 months for a fingernail to fully regrow and 8-12 months for a toenail. With proper treatment of the cause, the new nail that grows in should remain attached.

If you have tried these steps and the condition isn't improving or seems to be spreading, it is important to see a healthcare professional to get an accurate diagnosis and a tailored treatment plan.

Duration & Outlook

The time it takes for onycholysis to resolve depends on the cause and how quickly your nails grow. Fingernails generally grow out completely in about 4-6 months, while toenails can take 12-18 months. If the underlying cause is identified and addressed, the nail will typically reattach as the new, healthy nail grows out from the base.

Onycholysis can be acute (short-term) if caused by a one-time injury, or it can become chronic (long-term) if the trigger is ongoing or if it's related to a chronic condition like psoriasis. With proper care and management of any underlying cause, the outlook is generally good for the nail to return to normal. Warning signs for complications include increasing pain, redness, swelling, or pus under the nail, which could indicate an infection.

Prevention

Preventing onycholysis often involves protecting your nails from injury and irritation.

• Keep your nails trimmed short and clean.
• Avoid aggressive cleaning under the nails with sharp objects.
• Wear protective gloves when your hands will be in water for long periods or when using harsh chemicals.
• If you have a condition like psoriasis, managing it well can help prevent nail changes.
• Be gentle with your nails; avoid using them as tools to pry or scrape things.

Causes & Triggers

Onycholysis happens when the nail plate detaches from the nail bed. This can be due to:

• Trauma or injury: - This is a very common cause, such as repetitive tapping, a direct blow to the nail, or even overly aggressive manicures or cleaning under the nails.
• Prolonged exposure to water or moisture.
• Chemicals: - Irritants like nail polish removers, strong soaps, or solvents.
• Infections: - Fungal infections (onychomycosis) or bacterial infections can cause the nail to lift.
• Skin diseases: - Conditions like psoriasis or eczema can affect the nails.
• Medications: - Certain drugs, including some antibiotics or chemotherapy drugs, can cause onycholysis, sometimes triggered by sun exposure (photo-onycholysis).
• Systemic diseases: - Thyroid problems (especially an overactive thyroid) or iron deficiency can sometimes be linked.

Anyone can develop onycholysis, but it's more common in people whose hands are frequently exposed to moisture or chemicals, those with certain skin conditions, or individuals who experience nail trauma.

When to see a doctor

It's a good idea to see a doctor or dermatologist if:

• You notice your nail separating and you're not sure why.
• The separation is spreading or affecting multiple nails.
• The area is painful, red, swollen, or has pus, which are signs of infection.
• The nail changes color significantly (e.g., turns dark brown, black, or green).
• You suspect it might be related to a new medication or an underlying health condition.
• Home care and avoiding irritants haven't helped after a few weeks.

A healthcare professional can help determine the cause of your onycholysis and guide you on the best way to care for your nails. Getting an accurate diagnosis is important, especially to rule out infections or other conditions that might need specific attention.

Frequently Asked Questions (FAQs):

• Is onycholysis painful?
  Usually, the separation itself is not painful. However, if there's an underlying infection or inflammation, you might experience pain or discomfort.
• Will my nail grow back normally?
  Yes, in most cases, once the cause of onycholysis is removed or treated, the new nail that grows from the base should be healthy and reattach to the nail bed. This takes time, as nails grow slowly.
• Can I wear nail polish if I have onycholysis?
  It's generally best to avoid nail polish and harsh removers on affected nails, as they can sometimes worsen the condition or trap moisture, potentially leading to infection. Your doctor can give you the best advice for your specific situation.
• Is onycholysis a sign of a serious disease?
  While often caused by local factors like injury or irritation, onycholysis can sometimes be a sign of an underlying systemic condition, like thyroid disease or psoriasis. That's why seeing a doctor for a proper diagnosis is important.
• How can I tell if it's a fungal infection?
  Fungal infections often cause nail thickening, discoloration (yellowish or brownish), and crumbling, in addition to separation. A doctor can confirm a fungal infection with a lab test.

References

• American Academy of Dermatology Association. (n.d.). Nail Psoriasis: Diagnosis and treatment. Retrieved from https://www.aad.org/public/diseases/psoriasis/treatment/nails/nail-psoriasis
• Cleveland Clinic. (2022). Onycholysis (Nail Separation). Retrieved from https://my.clevelandclinic.org/health/diseases/22903-onycholysis
• DermNet NZ. (n.d.). Onycholysis. Retrieved from https://dermnetnz.org/topics/onycholysis
• Verywell Health. (2023). Onycholysis: Causes and Treatments. Retrieved from https://www.verywellhealth.com/onycholysis-definition-1069359