Isla Bennett
A nail growing on top of another nail is a phenomenon known as onycholysis, which is when a nail separates from the nail bed underneath it. This can occur due to various reasons such as injuries, fungal infections, or certain underlying conditions. While onycholysis is usually not painful, the cause of it might be irritating or uncomfortable. Treatment for onycholysis focuses on addressing the underlying cause and promoting new nail growth attached to the nail bed. It is important to seek medical advice and properly care for your nails to prevent further complications.
| Characteristics | Values |
|---|---|
| Medical term | Onycholysis |
| Cause | Injury, fungal infection, irritation, skin sensitivity, skin conditions, psoriasis, thyroid condition, vitamin deficiency, iron deficiency, working with fingers/toes in a wet environment |
| Treatment | Oral antifungal medication, topical antifungal medication, nail clipping, nail trimming, wearing gloves, avoiding nail products, changing medications, supplements, medication for nail infection |
| Prevention | Keep nails trimmed short, avoid nail biting, be careful when cleaning underneath nails, avoid chemicals/products that irritate nails, wear protective footwear when working with heavy objects |
| Recovery time | Fingernails: 4-6 months, Toenails: 8-18 months |
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What You'll Learn
Nail injuries and treatments
A nail injury can occur when any part of the nail becomes injured, including the nail, nail bed (skin underneath), cuticle, and the skin around the sides of the nail. This can be caused by cutting, tearing, smashing, bruising, or separating the nail from the skin. Treatment depends on the type and seriousness of the injury.
For a mild nail injury, it is recommended to treat the wound by gently cleaning it with soap and water. If the wound is bleeding, do not put a dry bandage or gauze on top, as it will stick once the bleeding stops. Instead, apply petroleum jelly to keep the wound moist, then cover it with gauze or a bandage. Change the dressing daily, and apply a small amount of antibiotic ointment to prevent the dressing from sticking. You may also take pain relievers such as ibuprofen or acetaminophen to reduce pain and swelling.
For more serious nail injuries, it is recommended to go to an urgent care center or the emergency room. They will stop the bleeding, clean the wound, and numb the area before treatment. If there is a large bruise, the provider will create a small hole in the nail to drain the blood and fluid, relieving pressure and pain. If the bone is broken or the bruise is very large, the nail may need to be removed, and the nail bed repaired with stitches or glue. If the nail cannot be reattached, a special type of material may be used to replace it. Antibiotics may be prescribed to prevent infection.
In the case of onycholysis, or nail separation, the detached part of the nail will eventually grow out. It is recommended to use nail clippers or scissors to remove the affected nail as it grows out. If the onycholysis is due to a fungus, treatment options include oral or topical antifungal medication.
It is important to note that a severe injury could cause the nail to fall off, and it usually grows back with proper medical care. However, in cases of severe nail matrix damage, some or all of the nail may not grow back.
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Nail matrix and its impact
The nail matrix is the area where fingernails and toenails start to grow. It is often referred to as the "factory" where the body manufactures new nails. The nail matrix has two parts: the germinal matrix and the sterile matrix. The germinal matrix, located under the base of the nail, produces about 90% of the cells that make up the nails, giving them their natural curvature. The remaining 10% of the cells are produced by the sterile matrix, which lies underneath the nail and is responsible for keeping the nail attached to the underlying skin.
Injuries and certain health conditions can damage the nail matrix and interfere with nail growth. Minor damage to the nail matrix can cause temporary changes in the appearance and texture of the nail. Severe injuries can cause the nail to fall off, and in cases of significant nail matrix damage, the nail may not grow back. Conditions such as severe eczema and psoriasis can affect the nail matrix, leading to changes in the nail's appearance, including white lines, pitting, and crumbling. Subungual melanoma, a type of skin cancer, can also develop in the nail matrix, causing brown or black discoloration.
Proper nail care is essential for maintaining a healthy nail matrix. Keeping nails trimmed and avoiding biting them can help prevent issues such as ingrown toenails and nail separation (onycholysis). Certain professions, such as construction work, can increase the risk of nail matrix injuries, so wearing protective footwear is crucial. Additionally, regular manicures and exposure to chemicals in nail products can irritate the nail matrix, leading to nail separation.
In the case of nail matrix damage, proper medical care can promote healthy nail regrowth. Treatment options depend on the underlying cause and may include medication, surgery, or topical treatments. With proper care, the nail matrix can heal, and healthy nail growth can resume.
While rare, severe cases of nail matrix damage may result in permanent nail loss. However, individuals can still lead full and active lives without fingernails or toenails, adapting to the absence of nails over time.
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Onycholysis and separation
Onycholysis is a common condition in which the nail separates from the nail bed. It is usually not painful, but the cause of onycholysis may be irritating or painful. The condition can last for several months or over a year and is characterised by nail lifting, which can occur with both finger and toenails. Nails may peel away from the nail bed, and the border between the pink and white areas of the nail may appear wavy. Discolouration may also occur, with nails appearing grey, green, purple, white, or yellow.
Onycholysis can be caused by a variety of factors, including injury or trauma to the nail or nail matrix, fungal infections, and skin sensitivity to products such as nail polish, nail gloss, nail hardener, nail polish remover, and fake nails. It can also be caused by certain medications, such as chemotherapy drugs and nonsteroidal anti-inflammatory drugs (NSAIDs). In some cases, onycholysis may indicate an underlying medical condition, such as thyroid disease, vitamin deficiency, or a serious yeast infection.
Treatment for onycholysis aims to address the underlying cause. If the condition is caused by a bacterial or fungal infection, a medical professional may prescribe appropriate antibacterial or antifungal treatments. If the cause is related to an underlying medical condition or medication, further evaluation and treatment of the underlying condition may be necessary.
While onycholysis cannot be cured, there are ways to manage the condition and promote healthy nail growth. Keeping nails trimmed and avoiding activities that may harm them can help. In the case of fingernail lifting, it is recommended to avoid harsh products such as artificial nails, and for toenail lifting, properly fitting shoes are advised. Applying an adhesive bandage to the affected nail can help prevent it from catching on things and worsening the condition. Additionally, keeping the nail bed dry and using diluted vinegar or tea tree oil can help prevent and treat infections.
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Skin conditions and infections
Onycholysis, or nail separation, is a common condition where the nail detaches from the nail bed. It is usually not painful, but the cause of onycholysis may be irritating or painful. Onycholysis can be caused by injuries to the nail or nail matrix, such as bumping or hitting the nails, wearing ill-fitting shoes, or keeping nails submerged in water for too long. Manicures can also cause onycholysis due to the force applied during trimming, buffing, and polishing. Additionally, chemicals in nail products like nail polish, nail gloss, and nail hardener can lead to onycholysis.
Fungal infections are another cause of onycholysis. Fungi can enter through cracks or cuts in the finger or toe, leading to nail bed separation. Treatment for fungal onycholysis may include oral or topical antifungal medications. Keeping nails short and avoiding nail biting can help prevent onycholysis.
Paronychia is a bacterial skin infection that occurs around the nails, specifically at the nail fold and cuticle where the skin and nail meet. It is caused by bacteria entering broken skin near the cuticle. Symptoms include pain, swelling, and tenderness around the nail, along with redness and warmth of the affected area. Pus may also accumulate under the skin, forming a white to yellow abscess. Treatment for paronychia includes antibiotics and drainage of the abscess. Soaking the infected nail in warm water can help reduce swelling and pain.
Mycotic nails are fungal infections of the toenails or fingernails caused by various organisms, including dermatophytes, nondermatophyte molds, yeast, and specific microbial species. These infections can lead to thickened, discoloured, and fragile nails with visible cracks. A weakened immune system, athlete's foot, blood circulation problems, nail injuries, and nail surgeries are risk factors for mycotic nails.
Underlying skin conditions, such as eczema and psoriasis, can also affect the nails. Severe eczema can interfere with nail growth, resulting in Beau's lines, pitting, and texture or colour changes. Nail psoriasis may cause white lines, pitting, and crumbling of the nails. Subungual melanoma, a type of skin cancer affecting the nail matrix, can manifest as brown or black discolouration on the nail.
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Nail growth and recovery
Onycholysis, or nail separation, can occur due to various reasons, including injuries, fungal infections, and skin conditions. It is characterised by the separation of the nail from the nail bed, the skin underneath it. While onycholysis is typically not painful, the condition that caused it might be. Treatment options vary depending on the underlying cause and can include oral or topical antifungal medications, vitamin supplements, or corticosteroids.
In the case of a bruise under the nail, a procedure called nail trephination can be performed to drain the trapped blood and provide pain relief. This procedure must be done within 48 hours of the injury, before the blood clots.
If you have separated or damaged nails, it is important to take steps to prevent further injury. Keep your nails trimmed short to prevent them from catching on objects and causing further separation or damage. Be cautious when cleaning underneath your nails, as tools like cuticle sticks and nail brushes can break the skin and cause infection.
Nail recovery and growth can take several weeks to months, depending on the severity of the damage. Fingernails typically take 4 to 6 months to grow to full size, while toenails can take up to 12 to 18 months. During this time, it is essential to maintain nail health and address any underlying causes to ensure proper recovery.
While rare, severe damage to the nail matrix, the area responsible for nail growth, can result in permanent nail loss. However, with proper medical care, healthy nail growth can often be restored.
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Frequently asked questions
This phenomenon is called onycholysis, which is the medical term for when a nail separates from the nail bed underneath it. This can occur due to an injury, infection, fungal infection, or certain skin conditions.
Treatment for onycholysis will vary depending on the underlying cause. General measures one can perform at home to support nail health include keeping the nail short, avoiding nail irritants or nail products, and treating any fungal infections.
Fingernails typically take about 4 to 6 months to grow to full size, while toenails may take twice as long. During this time, it is important to keep the nail bed protected and promote new nail growth.
