Liam Carter
Fingernails and toenails can detach from their nail beds due to a condition called onycholysis. This condition is common and can last for several months or over a year. Onycholysis is usually not painful, but the nail may change colour to yellow, greenish, purple, white or grey. It can be caused by injury, fungal infection, certain skin conditions such as psoriasis, thyroid disease, eczema, bacterial or fungal infections, iron deficiency, hyperthyroidism, or irritation from chemicals or physical trauma. Treatment options include trimming the nail, wearing gloves, avoiding nail products and irritants, changing medications, using supplements, or taking medication to treat a nail infection.
| Characteristics | Values |
|---|---|
| Medical term | Onycholysis |
| Description | Fingernail or toenail detaches from the nail bed |
| Cause | Injury, fungal infection, skin conditions such as psoriasis, medications, overactive thyroid, iron deficiency, working with fingers or toes in a wet environment |
| Symptoms | Fatigue, feeling cold, dizziness, weakness, headaches, sore tongue, fast heartbeat, nail discolouration, nail thickening, white spots or streaks, nail fragility, nail odour |
| Treatment | Trimming the nail, wearing gloves, avoiding nail products and irritants, changing medications, using supplements, treating nail infection |
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What You'll Learn
Injury or trauma to the nail
Onycholysis, or nail lifting, is the separation of the fingernail or toenail from the nail bed. It is often caused by some sort of injury or trauma to the nail. This could be a heavy object crushing or hitting the fingers or toes, or a cut from a sharp object. In medical terms, this is known as a subungual hematoma, which looks like a bruise. It occurs when small blood vessels under the nail bed leak, and blood pools between the nail and the nail bed. This usually happens when the tips of the fingers or toes have been crushed or subjected to a heavy impact.
Nail bed injuries are common, with fingertip injuries being the most frequently seen type of hand injury. The fingertips are the most vulnerable to injury because they are the point of interaction between the body and its surroundings in most daily activities. The hand is involved in 11-14% of on-the-job injuries and 10% of all accident cases in US emergency departments. However, the exact prevalence of nail bed injuries is unknown, as many patients do not seek medical attention for what they perceive as a minor trauma.
Nail bed injuries can also occur as a result of industrial accidents, road traffic accidents, or sports injuries. For example, a ball or weight may hit the nail bed, or a machine may cause a crush injury. These accidents can result in closed or open injuries. The nail bed gets squeezed between the hard nail and the distal phalanx, resulting in simple or complex lacerations. Sharp lacerations can occur when objects land with enough force to penetrate the nail plate.
Avulsion injuries are another type of nail bed injury, where the nail and part of the nail bed pull away from the rest of the nail bed, either partially or entirely. This typically results from the nail being crushed or sustaining a high-impact injury. Avulsions can be extremely painful.
After an injury, nail growth is stunted or absent for up to 21 days. The nail then grows rapidly for approximately the next 50 days and then slows again before resuming a normal and sustained growth rate. These changes in growth rate create the characteristic lump that is often observed on nails that regrow after trauma. As a result of scar tissue being unable to produce nail material, damage to specific components of the perionychium will lead to defects during the regrowth of the post-traumatic nail. For example, a scar on the dorsal roof of the nail fold may create a dull streak on the nail surface, while a scar on the germinal matrix may cause a split or absent nail.
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Fungal infections
Onycholysis, or nail lifting, is the separation of the fingernail or toenail from the nail bed. It is usually not painful, but it can be contagious if caused by a fungal infection.
Fungal nail infections are common and are caused by fungi that live in the environment. They enter through small cracks in the nail or the nearby skin, causing infection. Toenails are more commonly affected than fingernails, as they are usually confined to shoes, creating a warm, moist environment in which fungi thrive.
Fungal nail infections can cause nails to become brittle and discoloured, with white, yellow, green, black, or purple spots or streaks. The nail may thicken and become hard to trim, and it may start to curl up or down or loosen from the nail bed.
Distal subungual infections are the most common type of fungal nail infection and can develop in both fingernails and toenails. When infected, the outer edge of the nail has a jagged appearance with white and/or yellow streaks across the nail. White superficial infections usually affect toenails, with a certain type of fungus attacking the top layers of the nail and creating well-defined white spots on the nail. Eventually, these white patches cover the entire nail, which becomes rough, soft, and prone to crumbling.
Proximal subungual infections are uncommon but can affect both fingernails and toenails. Yellow spots appear at the base of the nail as the infection spreads upward. This infection can commonly occur in people with compromised immune systems.
Onychomycosis, also called tinea unguium, is a fungal infection that affects either the fingernails or toenails. It is a lot like athlete's foot, but instead of affecting the skin on the bottom of the feet or between the toes, it invades the nails. The same fungi that cause jock itch, athlete's foot, and ringworm can cause nail infections.
Candida yeasts cause a type of infection that invades nails previously damaged by a prior infection or injury. Candida more commonly affects fingernails, especially in people who frequently soak their hands in water. The cuticle becomes swollen, red, and tender to the touch, and the nail may partially lift off the nail bed or fall off completely.
Nail fungus can be treated with oral or topical antifungal medications, or in some cases, surgery may be required to remove the nail entirely and allow a healthy one to grow back.
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Skin conditions, such as psoriasis
Onycholysis, or nail lifting, is the separation of the fingernail or toenail from the nail bed. It is typically not painful, but it can be contagious if caused by a fungal infection. The condition can last for several months, and the nail that has separated from the nail bed will not reattach itself. The goal is to allow new nail growth, which can take up to a year for toenails.
Many people with psoriasis develop nail changes, such as pitting, nail bed separation, and discolouration. Psoriasis on the hands can lead to cracked, bleeding, and painful skin, which can be embarrassing and prevent someone from using their hands comfortably. Palmoplantar psoriasis, which affects the hands and feet, is the most common type of psoriasis in people with nail changes. Pustular psoriasis, which mostly affects adult smokers, can cause painful cracks, redness, and scales on the palms and soles.
There are various treatments for psoriasis on the hands and feet, including:
- Moisturizers, mild soaps, and soap substitutes
- Coal tar products, like creams, gels, or ointments, to slow skin growth and ease itchy, inflamed, or scaly skin
- Keratolytics such as salicylic acid or urea cream, which is a peeling agent that softens or reduces thick scales
- Corticosteroid creams or ointments to reduce inflammation
- Vitamin D analogue creams, which can be used in combination with steroid creams
- Calcineurin inhibitors, such as tacrolimus and pimecrolimus, which reduce the activity of the immune system and help to reduce inflammation
- Topical retinoids, which speed up the process of skin shedding and slow the growth of skin cells
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Iron deficiency
Onycholysis, or nail separation, can be caused by several factors, one of which is iron deficiency. While onycholysis typically affects only one nail, it can sometimes occur in multiple nails. It is characterized by the nail lifting or peeling away from the nail bed, creating a space that can gather dirt and debris, and potentially leading to infection. This condition usually lasts for several months and is often accompanied by other symptoms such as fatigue, dizziness, headaches, and a sore tongue.
The treatment for onycholysis caused by iron deficiency aims to address the underlying issue. This involves increasing iron intake through dietary changes or supplements. Iron-rich foods include meat, seafood, beans, lentils, dark chocolate, fortified bread and cereals, dates, figs, prunes, raisins, and leafy greens. Additionally, keeping nails short and avoiding biting them can help manage onycholysis.
In the case of koilonychia, treating the iron deficiency can help resolve the nail abnormalities. Similar to onycholysis, dietary changes or supplements may be recommended to increase iron levels. However, it is important to consult a healthcare provider to determine the cause of koilonychia, as it can also be related to other medical conditions or genetic factors.
While nail separation is typically not painful, it can be a source of concern and may indicate a more serious underlying condition. Therefore, it is advisable to seek medical advice to identify and address the root cause of the issue.
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Thyroid disease
Onycholysis is the medical term for when your nail separates from the nail bed. It is often not painful, but the affected nail may change colour to yellow, greenish, purple, white or grey. Onycholysis can be an indicator of thyroid disease, as well as other conditions.
Some of the nail abnormalities associated with thyroid disease include:
- Alunula (absence of the lunula, the little white moons at the base of the nail bed)
- Onychorrhexis (longitudinal ridging of the nails)
- Beau's Lines (transverse grooves or depressions of the nail plate)
- Koilonychia (spoon-shaped nail plates)
- Pterygium unguis (thinning of the nail fold and spreading of the cuticle over the nail plate)
- Onychomycosis (fungal nail infection)
- Yellow Nail Syndrome
- Brittleness, slow growth and thickening
- Jagged and rough edges around the cuticles (paronychia)
- White vertical ridging in the nail beds (a sign of selenium deficiency)
- Thick, dry and brittle nails with visible ridges
- Soft, shiny nails that easily crumble
- Nails that lift up, curve and thicken, with swollen fingertips
If you notice any of these symptoms, it is important to consult a dermatologist, especially if multiple nails are affected. A blood test can also be used to check for the presence of any systemic diseases that may be causing onycholysis. Treatment can prevent complications, so it is important to catch thyroid disease early.
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Frequently asked questions
Onycholysis.
The symptoms of onycholysis include the nail lifting or peeling away from the nail bed, the nail changing colour to yellow, greenish, purple, white or grey, and an irregular border between the pink portion of the nail and the white outside edge of the nail.
Onycholysis can be caused by injury, fungal infection, certain skin conditions such as psoriasis, eczema, thyroid disease, bacterial or fungal infections, iron deficiency, hyperthyroidism, or chemotherapy and other medications.
Treatment for onycholysis will depend on the underlying cause. General measures include keeping nails short, trimming the nail, using antibacterial soaks, wearing rubber gloves when washing dishes, and avoiding activities or chemicals that may irritate the nail, such as nail polish, nail hardener, and nail polish remover.
It can take several months for onycholysis to resolve, as fingernails take 4 to 6 months to fully regrow, and toenails can take 8 to 18 months.
