Isla Bennett
A detached nail is a common condition, but it can be painful. It can occur due to several reasons, including injury, fungal infection, psoriasis, chemical exposure, certain medications, and serious illness. Once a nail falls off, it cannot reattach and one must wait for a new nail to grow back, which can take several months to a couple of years. To promote healthy healing and regrowth, it is important to keep the area clean and dry, avoid pulling or cutting the nail, and seek medical attention if any signs of infection, such as redness, swelling, or pain, are observed.
| Characteristics | Values |
|---|---|
| Cause | Injury, fungal infection, psoriasis, chemicals, certain medications, serious illness, diabetes, peripheral arterial disease, immune system problem, skin conditions, chemotherapy, antibiotics, severe illnesses, subungual hematoma, nail polish, nail gloss, nail hardener, nail polish remover, fake nails, acrylic-based gel polishes |
| Symptoms | Toenail discoloration, cracked, yellow, discolored, streaked, thickened, spotted nails |
| Treatment | Surgical removal of exostosis, oral antifungal medication, topical antifungal medication, nonsteroidal anti-inflammatory drugs (NSAIDs), soaking the finger or toe in cold water, applying petroleum jelly, soaking foot in salt dissolved in warm water, applying antibiotic ointment, using open-toed shoes or protective footwear, keeping the area clean |
| Prevention | Keep nails trimmed short, avoid biting nails, be careful when cleaning underneath nails, avoid chemicals or products that can irritate nails, keep feet clean, keep toenails smooth and short |
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What You'll Learn
Trimming the nail to prevent further tearing
Trimming your nails is an important part of your hygiene routine. It keeps your nails clean and prevents them from snagging and breaking. Here are some tips for trimming your nails to prevent further tearing:
Firstly, it is important to use the right tools. You can use nail clippers, small scissors, or a nail file/emery board. If using scissors or clippers, ensure they are disinfected with isopropyl alcohol and hot water before and after use. If you are using a file/emery board, it is best to keep your nails dry as filing wet nails may cause them to bend in unwanted ways.
Before trimming your nails, soften them by soaking them in water for a few minutes or trimming them right after a shower or bath. This will make them easier to cut and less likely to split. Dry your nails before cutting them.
When cutting your nails, cut straight across with multiple small cuts, rather than one large cut. Avoid cutting your nails into a "V" shape or rounding off the edges. Leave a sliver of "white" at the top of your nails, and ensure the corners of the nail are left intact at the sides. Be careful not to cut too much, as exposing the sensitive skin beneath the nail increases the risk of infection.
After cutting your nails, use a nail file or emery board to smooth out and shape them. Always file in the same direction, as filing back and forth can weaken your nails.
Finally, apply a moisturizer to your nails and cuticles to keep them flexible and prevent dryness and splitting.
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Soaking the nail in salt water
To prepare the salt bath, start by boiling some water in a kettle or microwave. Pour the water into a large bowl and let it cool for 15 to 20 minutes, or until the water is lukewarm. Add a teaspoon of salt to 4 cups of this warm water. You can also add several drops of cuticle oil to the water to moisturize your fingers and nails as they soak.
Once the solution is ready, soak your foot for 15 to 20 minutes. Keep your nails fully submerged for 10 to 15 minutes at a time to ensure that all your nails are loosened. You can soak your entire hand or just your fingertips. After soaking, the fake nails should be easy to remove. If the nails are still difficult to remove, continue soaking for another 10 to 15 minutes.
This method can also be used to remove acrylic nails.
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Applying a bandage
If your toenail has fallen off or is in the process of falling off, applying a bandage can help protect the nail bed from infection and support healthy healing. Here are some detailed instructions on how to apply a bandage:
Cleaning and Preparing the Nail Bed:
- Clean your toe gently with soap and water, removing any debris or dirt from the exposed nail bed.
- If there are any sharp or jagged edges remaining on the nail, use a nail file to smooth them out. This will prevent the nail from catching on socks or other items.
- Apply a thin layer of petroleum jelly, such as Vaseline, to the exposed nail bed and surrounding skin. This will help keep the area moist and promote healing.
Applying the Bandage:
- Choose a non-stick, adhesive bandage that is large enough to cover the exposed nail bed and surrounding area.
- Center the bandage over the nail bed, ensuring that it adheres securely to the surrounding skin. Smooth out any air bubbles or wrinkles in the bandage.
- Make sure the bandage is not too tight, as this can restrict blood flow and cause discomfort. The bandage should feel snug but comfortable.
- Change the bandage daily and whenever it gets wet. Gently soak the bandage under warm running water if it sticks to the skin and is difficult to remove.
- Keep the bandage on for 7 to 10 days, or until the skin of the nail bed hardens and is no longer sensitive.
It is important to note that you should not use plain gauze or a regular adhesive bandage, as these can stick to the nail bed and cause pain and difficulty when changing the dressing. Always seek medical attention if you notice any signs of infection, such as redness, swelling, or increasing pain.
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Using antifungal medication
If you have a fungal nail infection, there are several antifungal medications that can help. These include:
Antifungal nail polish
Your doctor may prescribe an antifungal nail polish that you paint onto your nails. This is usually a clear polish containing antifungal drugs like ciclopirox or amorolfine. You'll need to apply it regularly, following the instructions provided. For example, ciclopirox nail polishes are usually applied every day for the first month, at least twice a week during the second month, and once a week from the third month onwards. It's important to remove the old layer of polish before applying a new coat. While this treatment is easy to use, it may take up to a year to see results.
Antifungal creams, ointments, or gels
Topical antifungal medications come in the form of creams, ointments, or gels that you rub directly onto your nails. Over-the-counter (OTC) options include clotrimazole (Lotrimin) and terbinafine (Lamisil) cream. However, for more severe cases, you may need a prescription-strength cream or ointment containing urea or bifonazole. To use these products, you typically need to soak your nails in warm water, dry them, apply the medication, and then cover your nails with adhesive bandages. After 24 hours, you remove the bandages and soak your nails again before scraping off the softened layer of the nail and reapplying the cream. This treatment regimen is typically carried out over 14 days, followed by four weeks of treating the skin beneath the nail. While these topical treatments are convenient, they may not be strong enough for moderate to severe cases of fungal nail infections.
Oral antifungal medication
If you have a severe or persistent fungal nail infection, your healthcare provider may prescribe oral antifungal medication in the form of liquid medicines, pills, or tablets. Examples of oral antifungal drugs include terbinafine, itraconazole (Sporanox), and tavaborole. These medications are more effective than topical treatments, but they can have more side effects and require careful monitoring by your doctor. Liver function tests are often necessary before and during treatment with these medications. Additionally, itraconazole should be avoided during pregnancy as it can harm the baby, and both itraconazole and terbinafine can interact with other medications.
It's important to remember that treating a fungal nail infection can take a long time, sometimes up to 6 to 18 months. During this period, it's crucial to follow your healthcare provider's instructions and complete the full course of treatment to prevent the infection from returning.
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Preventing infection
Keep the Area Clean and Dry:
- Gently clean the exposed nail bed and surrounding area with mild soap and water. Avoid soaking the affected foot or hand unless specifically recommended by your doctor. Soaking can increase the risk of infection.
- After cleaning, pat the area dry with a clean towel or cloth. Ensure that you do not rub or apply pressure to the exposed nail bed, as this can be painful and potentially damage the sensitive underlying skin.
Apply Antibiotic Ointment:
After cleaning and drying the area, apply a thin layer of antibiotic ointment or cream to help prevent infection. This is especially important if the nail bed has been exposed due to a complete or partial detachment.
Bandage the Area:
Cover the nail and exposed nail bed with a clean bandage or adhesive tape. This will protect the area from external trauma and potential sources of infection.
Trim Sharp Edges:
If the nail is only partially detached, trim any sharp or rough edges of the nail to prevent it from catching on clothing, carpets, or other objects. Use clean nail clippers or scissors to create a straight, smooth edge.
Avoid Pulling or Cutting the Nail:
If part of the nail is still attached, resist the urge to pull or cut it off. Allow the nail to fall off naturally or seek professional advice from a podiatrist on the safest method of removal to minimise the risk of infection.
Look Out for Signs of Infection:
Monitor the area for any signs of infection, such as redness, swelling, increased pain, or pus. If you notice any of these symptoms, seek medical attention promptly to prevent the infection from worsening.
Keep Nails Short:
As a general preventative measure, keep your nails trimmed and short to reduce the risk of them catching and tearing. This is especially important if you regularly engage in activities that put your nails at risk of injury or detachment.
Remember, if you are uncomfortable treating the nail yourself or suspect a serious injury, it is always best to consult a doctor or podiatrist for professional advice and treatment.
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Frequently asked questions
There are many reasons why a nail may fall off, including injury, fungal infection, skin conditions such as psoriasis, and certain medications or illnesses.
If your nail is partially detached, do not pull or cut it off. Instead, let it fall off naturally or consult a doctor or podiatrist to determine the safest way to remove it.
To care for the exposed nail bed, gently clean the area with soap and water, apply an antibiotic ointment, and cover it with a clean, non-stick bandage. Change the bandage daily and whenever it gets wet. Keep the area clean and dry to prevent infection.
It typically takes a few months to a year for a nail to grow back, but in some cases, it may take up to two years. During this time, it is important to keep the area clean and protected to ensure healthy nail regrowth.
