About Onycholysis (Nail Separation)

Overview

Onycholysis, also known as nail separation, is a condition where the fingernail or toenail detaches from the skin underneath it, called the nail bed. This separation occurs gradually and is typically painless. Onycholysis can be caused by various factors, including trauma to the nail, repetitive tapping of long nails, use of manicure tools that push beneath the nail, excessive moisture, certain medical conditions that affect the shape or contour of the nail bed, fungal infections of the nails, allergic reactions, psoriasis, and exposure to certain medications. The separated nail may appear lifted or detached from the nail bed. Onycholysis usually resolves on its own as a new nail grows out, which can take several months for fingernails and up to eight months for toenails.

Causes and Risk Factors

Onycholysis, or nail separation, may be associated with factors that increase the chances of nail separation.

Risk factors for onycholysis include:

Medical conditions: Underlying medical conditions like an overactive thyroid gland and iron deficiency are associated with onycholysis. Skin conditions like psoriasis and lichen planus increase the risk of onycholysis.
Infections: Fungal infections of the nails and severe yeast infections can cause the tissue underneath the nail plate to thicken, leading to the separation of the nail.
Medications: Certain medications, such as those from certain types of antibiotics, can cause onycholysis as a reaction to sun exposure.
Trauma: Repetitive trauma, such as tapping fingernails on a keyboard or counter, can cause onycholysis. Injuries like slamming a finger in a car door or stubbing a toe can also lead to nail separation. Taking precautions to avoid repetitive trauma or injuries to the nails can reduce the risk of onycholysis.
Chemical exposure: Allergic reactions to chemicals found in nail polish, nail polish remover, or household cleaners can contribute to onycholysis. Minimizing exposure to chemicals that may trigger allergic reactions can help prevent onycholysis.

It's important to note that these risk factors may vary from person to person. If you are experiencing nail separation, it is recommended to consult with your healthcare professional for an accurate diagnosis and appropriate management.

Symptoms

The main symptom of onycholysis is separation of the nail from the nail bed. The nail typically gradually separates from its pink nail bed.

Other symptoms that may occur include:

Discoloration of the nail: The nail may turn green, yellow, or opaque due to the separation from the nail bed.
Thickening of the nail
Small depressions or pits may appear on the surface of the nail
Crumbling or brittle nails
Extra skin tissue may form beneath the detached part of the nail
Curled nails
Pain

If you experience any symptoms of onycholysis or have concerns about your nails, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

Diagnosis

To diagnose onycholysis, the following examinations, tests, and procedures may be performed:

Clinical assessment: A healthcare professional will visually examine the affected nails to assess the extent of separation and any associated symptoms.
Onycoscopy: This non-invasive method allows for detailed visualization of the nails. It can reveal findings such as onycholysis, irregular vascularity, areas of hemorrhage, and a rough warty surface. However, these findings are not specific to onycholysis and may require further differential diagnosis.
Biopsy: If the nail lesion does not respond to medical management, a biopsy may be performed to confirm the diagnosis. It involves taking a small sample of the affected nail for examination under a microscope. In rare cases, if no other cause is found, skin cancer should be ruled out.

It's important to note that these examinations, tests, and procedures should be carried out by qualified healthcare professionals. They play a crucial role in accurately diagnosing onycholysis and determining its stage or severity.

Treatment Options

The goals of treatment for onycholysis are to address the underlying cause of the condition and promote nail regrowth. Here are the recommended treatments and how they work to achieve these goals:

Trim the nail: Trimming the nail close to the point where it separates from the nail bed can prevent catching and further damage.
Treat underlying conditions: Identifying and treating the underlying cause of onycholysis is crucial. For example, hyperthyroidism, iron deficiency, or psoriasis may require specific treatments to improve nail health.
Topical medications: Topical antifungal medications like amorolfine and ciclopirox may be prescribed to treat fungal nail infections. These medications are applied directly to the nails and work by inhibiting the growth of fungi.
Oral prescription medicines: In severe cases of fungal nail infections, oral prescription medicines may be necessary. These medications have potential side effects and should be prescribed by a healthcare professional. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.

It is important to note that specific treatments may vary depending on individual circumstances. It is best to consult with a healthcare professional for personalized advice.