Isla Bennett
Toenails growing away from the nail bed is a condition known as onycholysis, which is the medical term for nail separation. This condition can affect both the fingernails and toenails and may be caused by a variety of factors, including nail trauma, injury, fungal infections, or even an allergic reaction. Onycholysis usually resolves on its own as new nail growth replaces the old, detached nail. However, proper treatment and care are necessary to prevent complications and ensure the new nail growth attaches securely to the nail bed.
| Characteristics | Values |
|---|---|
| Medical term | Onycholysis |
| Cause | Nail trauma or injury, fungal infection, psoriasis, eczema, thyroid disease, bacterial infection, allergic reaction |
| Symptoms | Nails peeling away from nail beds, thick nail beds, abnormal border between pink and white areas of the nail, discoloration, dents, crumbling nails, haemorrhages underneath nails |
| Treatment | Antifungal medication, avoiding harsh nail products, keeping nails short, wearing well-fitting shoes, covering the nail with an adhesive bandage |
| Prevention | Keeping nails dry, avoiding harsh products, wearing gloves when handling chemicals |
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What You'll Learn
Trauma or injury to the nail
If a toenail is injured, it may fall off completely (a condition called avulsion), tear or split (lacerations), or become ingrown. In some cases, a splinter may get under the nail. Toenail injuries often result in blood under the nail, a condition called subungual haematoma, which appears dark red and can be painful. If blood occupies more than half of the area under the nail, it is important to seek medical attention to drain the blood and relieve pressure.
If the nail lifts completely off the nail bed, it can be replaced and held in place with a bandage, but it will not reattach to the nail bed. However, in most cases, a new nail will slowly regrow. This process can take 12 to 18 months for toenails, and during this time, it is important to protect the toe while wearing shoes to prevent further irritation. Keeping toenails trimmed can help reduce the risk of injury by preventing rubbing or pressure.
To prevent toenail trauma and injuries, it is recommended to buy properly fitting shoes and to wear closed-toed shoes, especially around the house. Silicone or gel toe caps can also help protect the toes and prevent toenail loss. Controlling moisture with an antiperspirant spray can be beneficial for those with sweaty feet. Additionally, keeping toenails trimmed can reduce the risk of catching or pulling the nail, which can cause injury.
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Fungal infections
Onycholysis is the medical term for nail separation, when the nail detaches from the nail bed. While onycholysis usually occurs due to nail trauma, it can also be caused by fungal infections.
Toenail fungus is a widespread fungal infection caused by fungi getting between the toenail and the nail bed. This typically occurs through a crack or cut in the toe. Fungi thrive in warm, moist, and dark environments, and toenail fungus often occurs in older adults, especially those over 60.
Toenail fungus can cause the nail to become thick, discoloured, and brittle. The nail may appear white, yellow, grey, green, purple, or blue. In some cases, the whole nail can break off, leading to pain and swelling in the surrounding skin.
Fungal nail infections are often treated with antifungal medications. Topical antifungal treatments are applied directly to the nail, while oral antifungal medications come in the form of liquid, pills, or tablets. It is important to complete the full course of antifungal medication to effectively treat the infection.
To prevent toenail fungus, it is recommended to keep toenails trimmed short and avoid walking barefoot in communal areas like swimming pools, gyms, and showers.
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Psoriasis
Onycholysis, or nail separation, can be caused by several factors, including nail trauma, allergic reactions, and fungal infections. While psoriasis is a potential cause of onycholysis, it is primarily characterised by its symptoms rather than being a direct cause of toenails growing away from the nail bed.
Symptoms of Nail Psoriasis
Nail psoriasis is an autoimmune disease where the immune system overreacts, causing new skin cells to grow too quickly. It can lead to various symptoms, including:
- Discolouration: The nail bed, or the skin underneath the nails, may change colours, appearing yellow, red, pink, or brown.
- Pitting: Small dents or pits can form on the nail surface, ranging from pin-tip to crayon-tip sizes.
- Changes in nail structure: Horizontal grooves, known as Beau's lines, may develop across the nails. Nails may also become thin and crumble, leading to separation from the nail bed.
- Nail thickening: Nails may thicken, and the thick layer of skin underneath the nail may peel and separate from the nail bed.
- Subungual hyperkeratosis: A chalky substance accumulates under the nail, causing it to raise and become tender when pressed.
Treatment Options for Nail Psoriasis
There is currently no cure for nail psoriasis, but various treatment options can help alleviate symptoms:
- Corticosteroids: Prescribed as a cream, ointment, or nail polish, corticosteroids must reach the nail bed and the area where the nail starts to grow. They may need to be applied up to twice a day for at least four to six months before noticeable improvements.
- Medicine injections: In more severe cases, medicine is injected into the skin around the nails using a thin needle.
- Topical treatments: Aloe vera gel, with its anti-inflammatory properties, can be applied to the nails and surrounding skin. Capsaicin creams or ointments may also be used but avoid touching or rubbing the eyes after application.
- Soaking in Dead Sea salt: Adding Dead Sea salt to warm water and soaking nails in it for at least 10 minutes several times a week can provide relief.
- Vitamin D analogue treatments: Vitamin D analogue creams or ointments are massaged into the cuticle twice a day for about five minutes each time.
- Tazarotene: Derived from vitamin A, tazarotene can treat pitting, nail separation, and discolouration. However, it may irritate the surrounding skin.
- Laser treatments: While lasers have been studied, more research is needed before becoming a recommended treatment option.
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Harsh nail products
Onycholysis, or nail separation, can be caused by a variety of factors, including nail trauma, fungal infections, and psoriasis. While injury to the nail or nail matrix is a common cause of onycholysis, certain products and chemicals can also irritate the nails and surrounding skin, potentially leading to nail separation.
Nail polish remover, for example, often contains acetone or other strong solvents that can dry out and weaken the nails, making them more prone to separation. Artificial nails, on the other hand, can cause lifting by creating a tight seal over the natural nail, not allowing moisture to escape, and trapping bacteria or fungi underneath. Additionally, the glue used to apply artificial nails can irritate the nail bed and surrounding skin, further increasing the risk of onycholysis.
To prevent nail separation caused by harsh nail products, it is recommended to avoid or minimise the use of such products. This may involve opting for natural nail care routines, such as using gentle soap and water to clean the nails, trimming them regularly, and avoiding aggressive clipping or biting. Gloves can also be worn when performing tasks that involve harsh chemicals, such as cleaning or dishwashing, to protect the nails and prevent exposure to irritants.
It is important to note that nail lifting can be a sign of other underlying medical conditions, such as thyroid disease or eczema. Therefore, if nail separation occurs despite taking the necessary precautions, it is advisable to consult a healthcare professional for further evaluation and guidance.
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Thyroid disease
The thyroid is a butterfly-shaped gland in the neck that produces hormones to regulate various bodily functions, including nail growth. Thyroid hormones help supply blood to the nail bed, providing the nail cells with nutrients and oxygen.
Nail abnormalities can be indicative of underlying diseases or conditions. Changes in the appearance of your nails could indicate thyroid dysfunction, and it is recommended that you consult a healthcare provider if you notice any nail changes. Onycholysis, or Plummer's nail, is a condition where the nail plate pulls away from the skin of the nail bed, and it is more commonly associated with hypothyroidism than hyperthyroidism. Onycholysis is considered an early indicator of thyroid disease. Other nail changes associated with hypothyroidism include slow nail growth, thickening, and nail brittleness. In the case of hyperthyroidism, onycholysis is also observed, along with nail brittleness and koilonychia.
If your nail issues are due to thyroid dysfunction, the first course of action is thyroid hormone replacement treatment to help manage your thyroid hormone levels. Nail health should improve over time after treatment.
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Frequently asked questions
Onycholysis is the medical term for when your nail separates from the skin underneath it, or the nail bed.
Onycholysis can be caused by a number of factors, including nail trauma, injury, or an allergic reaction. It can also be caused by a fungal infection, which can be treated with oral or topical antifungal medication.
Treatment for onycholysis involves cutting away the separated nail as it grows out. It is important to keep the nail bed dry and avoid harsh nail products that may be causing the nail lifting.
Toenails grow slowly, so it may take 8 to 18 months for the nail to grow out completely. During this time, it is important to keep your nails trimmed short to prevent them from catching on objects and pulling further off the nail bed.
Yes, onycholysis can be prevented by keeping your nails short and avoiding activities that may harm them. Wearing gloves while working with substances that could hurt your nails can also help prevent onycholysis.
