Sophia Delgado
Fingernails can fall off due to a variety of reasons, including injury, fungal infections, and underlying health conditions. The medical term for nail separation is onycholysis, which occurs when the nail detaches from the nail bed. This can be caused by trauma to the nail, such as smashing a finger in a door or cutting it with a sharp object, resulting in a subungual hematoma or bleeding under the nail. In some cases, the nail may turn black and seem barely attached. Additionally, fungal infections, certain medications, skin conditions, and repetitive trauma can contribute to nail separation. Once the fingernail falls off, it is essential to protect the underlying nail bed to ensure proper regrowth.
Characteristics and contributing factors of fingernail falling off
| Characteristics | Values |
|---|---|
| Medical term | Onycholysis |
| Description | A condition where the nail plate separates from the nail bed |
| Causes | Injury, fungal infection, skin conditions, certain medications, an overactive thyroid, iron deficiency, working with fingers in a wet environment, nail biting, nail cleaning tools, nail products, chemicals, severe illnesses, diabetes, peripheral arterial disease, immune system problems |
| Symptoms | Nail bruising, bleeding under the nail (subungual hematoma), nail turning black, pain, persistent pain, red streaks on hand or forearm, feverish or nauseous feeling, fatigue, feeling cold, dizziness, weakness, headaches, sore tongue, fast heartbeat |
| Treatment | Trimming the nail, wearing gloves, avoiding nail products and irritants, changing medications, supplements, medication for nail infection, antibiotics, draining accumulated blood, bandaging, keeping the nail bed dry and clean, petroleum jelly, special shoes or splint, removing the nail |
| Prevention | Keeping nails short, avoiding nail biting, careful nail cleaning, wearing gloves, wearing protective shoes, being careful when putting down heavy objects |
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What You'll Learn
Fingernail injuries
Another common fingernail injury is onycholysis, which is when the nail separates from the nail bed. This can be caused by various factors, including injury, fungal infections, certain medications, skin conditions, or underlying medical conditions such as hyperthyroidism or iron deficiency. Onycholysis typically lasts for several months or over a year, and treatment focuses on promoting new nail growth and preventing further detachment.
In the case of a torn or detached nail, it is important to leave the nail alone and allow the new nail to grow underneath. Trimming the detached portion of the nail can help prevent it from catching and tearing. Soaking the injured finger or toe in warm water and applying petroleum jelly can help keep the area clean and moisturized. It is also important to protect the nail bed by covering it with a bandage or adhesive tape until the nail has grown out enough to protect the finger or toe.
More serious nail injuries may require a visit to an urgent care center or emergency room. These injuries may include severe bleeding, broken bones, or damage to the nail bed or surrounding tissues. In some cases, a doctor may need to remove the nail through a procedure called nail evulsion, where the finger is numbed, and special tools are used to lift and peel the nail away from the nail bed.
To prevent fingernail injuries, it is recommended to keep nails short and avoid biting them. When cleaning underneath nails, be careful not to break the skin, as this can lead to infection. Avoiding irritants and products that can damage nails, such as nail polish, nail gloss, or fake nails, is also recommended. Wearing gloves during activities that may damage nails, such as washing dishes or playing sports, can provide additional protection.
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Onycholysis (detached nails)
Onycholysis is a common nail disorder that typically affects a single nail but can affect multiple nails. It is characterised by the separation of the nail plate from the nail bed, resulting in a well-defined area of opaque white nail. However, the colour of the affected nail may vary depending on the underlying cause, changing to yellow, greenish, purple, or grey. Onycholysis is usually a painless condition, but it can be painful in cases of acute inflammation.
The condition has several potential causes, including trauma or injury to the nail, fungal infections, certain medications, and skin conditions such as psoriasis. It is also associated with underlying health conditions such as iron deficiency, hyperthyroidism, and type 1 diabetes. Onycholysis can be primary, with no known cause, or secondary to one of these underlying factors.
The treatment of onycholysis focuses on promoting new nail growth and preventing further detachment. General measures include keeping nails short and trimmed, avoiding activities that can cause nail trauma, and minimising exposure to irritants such as nail products and chemicals. Specific treatments depend on identifying and addressing the underlying cause. For example, if a fungal infection is the cause, proper nail care is essential to prevent the spread of the fungus. In some cases, medication or supplements may be prescribed to address vitamin deficiencies or underlying health conditions.
The recovery time for onycholysis varies and depends on the nail growth rate, which is typically slow. Fingernails can take around 4 to 6 months to regrow fully, while toenails may take twice as long. It is important to note that the detached portion of the nail will not reattach, and onycholysis can lead to permanent damage to the nail bed if left untreated. Therefore, early identification and treatment of the underlying cause are crucial for optimal recovery.
While onycholysis itself may not be a medical emergency, it can be a visible sign of a more serious underlying condition. If left untreated, it can lead to complications such as nail bed scarring and nail plate deformation. Therefore, it is advisable to consult a healthcare professional if onycholysis is observed, especially if accompanied by other symptoms or if there is no apparent cause.
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Bruised fingernail
A bruised fingernail, or subungual hematoma, is usually the result of an accident or injury. This could be stubbing your toe, getting your finger slammed in a door, or hammering your thumb. The injury causes blood to collect under the nail, which puts pressure on the nerves in your finger or toe, resulting in intense pain. This nerve pain can take weeks or even months to get better without medical attention.
If you have a bruised nail, it's important to seek medical care within two days. A healthcare provider can perform a simple, painless procedure called trephination to drain the blood and relieve the pressure and pain. If the blood is not drained within 48 hours, it will clot, causing a bulk under the nail that could lead to prolonged pain.
In some cases, a bruised nail may also indicate a broken bone in your finger or toe. X-rays are important to diagnose any potential fractures, as untreated breaks can heal incorrectly and cause long-term pain and interference with the natural function of your finger or toe.
Additionally, a fingernail may fall off as a result of damage to the matrix, the spot at the bottom of your nail responsible for its growth. When your finger experiences a shock, like getting stuck in a car door, the matrix temporarily pauses the growth of the nail. This pause causes the new part of the nail that starts growing to become disconnected from the old part, resulting in the fingernail falling off.
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Subungual hematoma (blood under the nail)
Subungual hematoma, or bleeding under the nail, is usually caused by a crush injury to the distal phalanx, such as getting a finger pinched in a doorway. It can also be caused by a direct blow to the nail. As blood enters the space between the nail and the nail bed, it applies painful pressure to the nail bed. Symptoms include severe throbbing pain and discolouration of the nail.
If you have a small subungual hematoma, you may not need medical treatment. You can ice and elevate the area to reduce swelling, and take over-the-counter anti-inflammatories like aspirin, Advil, or Motrin for minor pain. However, if the blood under the nail covers a large area, the pressure can become extremely painful, and the nail may fall off on its own after several weeks. In this case, it is important to see a doctor, who may perform a procedure called decompression or trephination to relieve the pressure and pain. This involves drilling or burning a small hole in the nail to drain the blood.
If you have not had an injury but notice a darkened area under your nail, you should see your doctor to rule out other possible causes, such as a tumour or melanoma. If you notice signs of infection, such as red streaks on your hand or forearm, or feverish or nauseous symptoms, you should seek medical attention immediately, as this could be a sign of sepsis.
After a nail injury, it is important to leave the nail alone and let the new nail grow underneath. Trimming the nail is preferable to pulling it off. Once the nail falls off, it is a good idea to protect the sensitive skin of the nail bed with a band-aid to prevent dryness and cracking.
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Treatments for a torn or detached nail
Fingernails and toenails are made of protein and fat and are not live tissue. Nails grow more than one-tenth of an inch per month and require 3 to 6 months to completely regrow. Toenails grow more slowly than fingernails and can take up to 18 months to grow back. Nails are produced by the nail matrix cells that reside in the moon-shaped whitish area (lunula) at the base of the nail. If the nail matrix is not damaged, the nail is typically capable of regrowth.
If a nail has been torn or detached, there is little that can be done to replace or repair it. The major concern is damage to adjacent structures. If there seems to be significant damage to areas around the nail, then a visit to a physician may be necessary. If there are any signs of infection, swelling, increasing pain, or pus that develop a few days after the injury, then a physician should be consulted.
If the entire nail is detached from the finger or toe, there is nothing that can be done to repair, reattach, or replace it. If there is any damage to adjacent tissues, the nail bed, the nail matrix, or the proximal nail fold that could result in scarring, this should be assessed by a physician and repaired if appropriate. If a portion of the nail is still adherent to the nail bed, it can be left intact. The non-adhering portion of the nail should be removed. The usual local precautions to prevent infection should be taken. The damaged skin should be covered with an appropriate dressing. If the nail bed and nail matrix are not damaged, the nail should regrow normally.
Home treatment can help relieve pain, promote healing, and prevent infection. Trimming the nail, wearing gloves, avoiding nail irritants or nail products, changing medications, using supplements, or taking medications to treat a nail infection are all possible options. Keeping your nails short will prevent them from catching on objects and pulling further off your nail beds.
If there is a large subungual hematoma, doctors will often drain accumulated blood by drilling a small hole in the nail plate. If the nail is infected, a doctor might have to remove the nail by force. This procedure is called a nail evulsion.
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Frequently asked questions
Onycholysis is when a nail on your fingers or toes separates from the skin on which it rests (the nail bed). It is usually caused by injury or an underlying condition.
The symptoms of onycholysis include tough, thick nail beds, an abnormal border between the pink area of your nail and the white edge of your nail, and the white areas being thicker in some parts and thinner in others.
Treatment for onycholysis depends on the underlying cause. General measures include keeping your nails short, avoiding activities that can result in nail injury, and avoiding irritants such as nail products.
It typically takes 4 to 6 months for a fingernail to grow back completely, and 12 to 18 months for a toenail to grow back.
If you have a large subungual hematoma, it is recommended to see a doctor to drain the accumulated blood. If left untreated, damage to the nail matrix could cause your nail to grow out strangely.
