Isla Bennett
There are many reasons why fingernails can separate from the nail bed, known as onycholysis. This condition can be caused by nail trauma, fungal infections, certain medications, an overactive thyroid, iron deficiency, and working with the fingers in a wet environment. Nails can also split horizontally or vertically due to damage, weakness, or brittleness. Horizontal splits are usually a sign of damage to the proteins that connect the nail layers, while vertical splits can indicate damage to the nail matrix, the part of the finger that creates the nail.
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What You'll Learn
Nail trauma or injury
Nail injuries can range from bruises under the nail to the separation of the nail from the nail bed. They can be complex wounds to repair, and permanent deformities can result even after proper repair. The nail is a complex structure involving three different layers. The nail bed is responsible for nail growth and support, and the nail plate is the hard substance on the back of the finger or toe. The eponychium (cuticle) and lateral nail folds (raised skin on the sides of the nail) are also part of the nail unit.
There are five categories of nail injury: crushing forces, slicing or cutting, tearing or ripping, nail avulsion, and fingertip amputation. Crushing forces can include injuries from hammers, doors slamming on fingers, human bites, or machinery. Slicing or cutting can be caused by knives, box cutters, or machinery. Tearing or ripping can occur from stubbing a toe or catching a fingernail on an object. Nail avulsion occurs when a portion of the nail is lifted off the nail bed or sticks out of the skin at the base of the nail. Finally, fingertip amputation involves the removal of a portion of the fingertip, including part or all of the nail, from the rest of the finger.
If you experience a nail injury, it is important to make sure your tetanus vaccination is up to date. Depending on the severity of the injury, you may need to seek medical attention. For minor injuries, you can trim or file down jagged edges and let your nail grow back naturally. However, for more serious injuries, you may need to go to an urgent care center or the emergency room for treatment.
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Fungal infections
Onychomycosis is a common fungal nail infection that can affect both the fingernails and toenails. It is caused by various fungi, including dermatophytes and candida, which thrive in dark, warm, and moist environments. Toenails are more susceptible to infection than fingernails due to reduced blood flow and the ideal conditions created by shoes.
Fungal nail infections can cause the nail to thicken, discolour, and crumble. Nails may turn white, yellow, green, or black, and can become difficult to trim. In some cases, the nail may loosen, curl, or detach from the nail bed. These infections usually start mildly and worsen over time.
Fungal spores can enter the nail bed through tiny cuts or small separations between the nail and the nail bed. Walking barefoot in places like gym showers, swimming pools, and locker rooms increases the risk of contracting a fungal infection, as these are environments where fungi thrive and spread easily.
Fungal nail infections are typically treated with oral antifungal medications or topical treatments. In severe cases, the infected nail may need to be surgically removed to prevent the infection from spreading and allow a healthy nail to grow in its place. Laser or photodynamic therapy is also being explored as a potential treatment option.
To prevent fungal nail infections, it is important to keep your nails short, clean, and free from chemical irritants. Washing your hands and feet regularly with soap and ensuring you clean between your fingers and toes can also help reduce the risk of infection.
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Allergic reactions
Fingernail separation, or onycholysis, can be caused by allergic reactions to nail cosmetics. These cosmetics include nail enamels (varnish/polish), nail enamel removers, cuticle removers, and artificial nails. An allergic reaction to nail cosmetics can cause redness and swelling of the fingertips, as well as intense swelling and redness of the affected area within a few hours. A rash may also appear a day or two after exposure. The skin may be red, swollen, and blistered or dry and bumpy.
The chemical most responsible for allergic reactions to nail enamel is tosylamide formaldehyde resin, also known as toluenesulfonamide formaldehyde resin. This chemical was found to be the seventh most common ingredient causing allergic contact dermatitis in patients with cosmetic allergies. While free formaldehyde may be found in tosylamide formaldehyde resin, most people who react to this resin do not have a formaldehyde allergy. An allergic reaction is usually due to wet nail enamel, although some people may also react to dried enamel. Other reported causes of dermatitis to nail enamels include an allergy to the solvent butyl acetate and discolouration of the nail surface caused by colourants.
Nail varnish used as a barrier against nickel allergy can also cause sensitisation. The strong solvents used in nail enamel removers, such as acetone, alcohol, and various acetates, can also lead to nail splitting and brittleness. Nail polish and removers can weaken nails over time, leading to split nails.
Artificial nails are custom-made to fit the nails perfectly and are usually applied by a manicurist. The artificial nail is made from a blend of chemicals, including liquid methacrylate acid esters, powdered polymethyl methacrylate polymer, benzoyl peroxide accelerator, and hydroquinone. Liquid methacrylate acid esters are strong sensitisers and can cause irritant and allergic contact dermatitis reactions. Benzoyl peroxide and hydroquinone are found to be occasional allergens. Acrylates, which are used in both preformed and sculpted nails, can cause two rare but very serious reactions: paraesthesias (tingling and prickling) and nail loss.
Gel nail products can also cause allergic reactions, as seen in many TikTok videos. These reactions develop in response to specific chemicals present in numerous nail products.
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Iron deficiency
Fingernail separation, or onycholysis, is usually caused by fungal infections, injuries, and reactions to chemicals in nail products like nail polish and remover. However, iron deficiency can also be a cause of nail abnormalities, such as spoon nails (koilonychia) and brittle nails (onychoschizia).
Spoon Nails
Spoon nails get their name from their indented, concave shape that resembles a spoon. This condition is often a sign of iron deficiency, especially in the case of iron deficiency anemia. Spoon nails can also be caused by vitamin B or B12 deficiencies, malnutrition, lupus, and inflammatory skin diseases like psoriasis. In babies, spoon nails are usually not a cause for concern as they tend to flatten as the child grows. However, in adults, spoon nails can indicate an underlying medical condition.
Brittle Nails
Brittle nails are a common nail problem, often caused by repeated wetting and drying of the fingernails. This can be due to frequent exposure to water or chemicals like detergents and nail treatments. In some cases, brittle nails can also indicate an underlying health issue, such as hypothyroidism or iron deficiency.
If you suspect that your fingernail separation is due to iron deficiency, it is important to consult a healthcare professional. They can help determine the underlying cause and recommend appropriate treatment, which may include dietary changes or supplements to correct the deficiency.
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Thyroid problems
Nail changes can be an early indicator of thyroid disease, and a medical review in 2022 found that people with thyroid dysfunction often experience brittle nails. Additionally, those with autoimmune thyroid disorders have higher frequencies of nail brittleness than those with non-autoimmune thyroid conditions. This suggests a strong connection between hormone health and nail problems. Thyroid hormones play a crucial role in regulating bodily growth and development, including nail growth, so any dysfunction can significantly alter the appearance and health of nails.
Hashimoto's thyroiditis, a common thyroid disorder that can lead to hypothyroidism, has been associated with adverse effects on the skin, hair, and nails, including conditions that predispose nails to splitting. Additionally, people with hypothyroidism may experience other nail-related conditions such as leukonychia (white nails), striped nails, and pitting (small indents creating an uneven nail surface).
It is important to note that nail separation or onycholysis can also be caused by other factors, such as fungal infections, reactions to chemicals, medications, nail psoriasis, and iron deficiency. However, if you notice persistent nail changes and are concerned about potential thyroid issues, it is recommended to consult a healthcare professional, such as a dermatologist, who can help determine the underlying cause and provide appropriate treatment.
To maintain nail health, it is generally advised to keep your nails clean and dry, trim them regularly, and avoid biting, picking, or tearing at them. Additionally, wearing gloves during activities that may damage your nails, such as washing dishes or playing sports, can help protect them from potential harm.
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Frequently asked questions
Onycholysis is the medical term for when your nail separates from the skin underneath it, also known as the nail bed.
Onycholysis can be caused by several factors, including nail trauma, iron deficiency, thyroid problems, fungal infections, and allergic reactions to chemicals in nail products such as nail polish, nail gloss, nail hardeners, and fake nails.
Treatment for onycholysis depends on the underlying cause. General measures include trimming the nail, wearing gloves, avoiding nail irritants, and using antibacterial soaks. Managing underlying conditions, such as fungal infections or skin conditions like psoriasis, can help prevent the problem.
