Sophia Delgado
Have you ever noticed a hollow space underneath your fingernail or toenail? This condition is known as onycholysis, and it occurs when the nail separates from the nail bed, creating a gap that can trap dirt and debris. While onycholysis is usually painless, it can indicate a more serious underlying issue, such as a fungal or bacterial infection, or even a yeast infection, thyroid disease, or iron deficiency. In this paragraph, we will delve into the causes, symptoms, and treatments for onycholysis, providing you with the knowledge to address this nail-related concern.
| Characteristics | Values |
|---|---|
| Medical Term | Onycholysis |
| Description | Separation of the nail from the nail bed |
| Symptoms | Nails that peel away from their nail beds, thick nail beds, an abnormal border between the pink area of the nail and the white edge of the nail, discoloration, dents or pits, crumbling nails, hemorrhages underneath the nails |
| Causes | Nail injury, fungal infection, psoriasis, manicure tools, moisture, certain medications, iron deficiency, hyperthyroidism, eczema, thyroid disease, bacterial infection, cancer |
| Treatment | Clip away the detached nail, wash the nail and surrounding skin with soap and water, keep the nail bed dry, avoid harsh products, wear well-fitting shoes, cover the nail with an adhesive bandage |
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What You'll Learn
Onycholysis, or nail lifting
Causes
Onycholysis can be caused by trauma or injury to the nail or nail matrix (the area where nail growth starts). Even slight repetitive trauma, such as daily tapping on a keyboard, can cause nail lifting. Other causes include:
- Fungal infections, which can cause the tissue under the nail to thicken and the nail edge to lift
- Certain medications, such as chemotherapy drugs, tetracycline, nonsteroidal anti-inflammatory drugs (NSAIDs), psoralens, and oral retinoids
- Skin conditions, including allergic reactions, eczema, lichen planus, and psoriasis
- Thyroid conditions, such as hyperthyroidism, which can be caused by an overactive thyroid gland
- Vitamin and mineral deficiencies, particularly iron deficiency
- Graft-versus-host disease (GVHD), which can develop after a stem cell transplant
Treatment
The treatment for onycholysis depends on identifying and addressing the underlying cause. In the case of fungal infections, for example, a medical professional may prescribe antibacterial or antifungal medication. For vitamin or mineral deficiencies, supplements or medication may be recommended.
While waiting for the underlying cause to be treated, it is important to keep the affected nail(s) short and trimmed to prevent catching or further damage. The nail should be gently washed daily with mild soap and water, and the area should be kept dry to prevent further infection. Rubber gloves can be useful for keeping nails dry during activities such as dishwashing. Bandages or adhesive coverings can also be applied to protect the nail.
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Symptoms of onycholysis
Onycholysis, or nail lifting, is a common nail disorder in which the nail plate separates from the nail bed. It typically only affects one nail and is usually painless. However, it can be contagious if caused by a fungal infection. Onycholysis can result from various factors, including injuries, fungal infections, certain medications, and underlying medical conditions. While it may not cause any pain, it can lead to secondary infections and other symptoms. Here are some detailed symptoms of onycholysis:
Visible Separation and Discoloration: The most noticeable symptom of onycholysis is the visible separation of the nail from the nail bed. This separation creates a well-defined area of opaque whiteness under the nail. The border between the pink portion of the nail and the white edge of the lifted nail may appear irregular and wavy. In some cases, the nail may also exhibit yellow, green, purple, or grey discolouration.
Deformities and Indentations: Nails affected by onycholysis may develop deformities, such as pits, indentations, or a bent nail edge. The nail surface may become crumbly or brittle, and the nail plate may thicken or deform. These changes in texture and appearance are signs of onycholysis and can be unsightly, especially for those who work with their hands.
Subungual Haemorrhage: In some cases of acute-onset onycholysis, individuals may experience subungual haemorrhage, or bleeding underneath the nails. This condition can cause discolouration and further separate the nail from the nail bed.
Underlying Medical Conditions: Onycholysis can be a symptom of various underlying medical conditions, including thyroid disease, vitamin and mineral deficiencies (such as iron deficiency), eczema, psoriasis, lichen planus, and, in rare cases, certain forms of cancer. It can also be associated with graft-versus-host disease (GVHD), which can develop after a stem cell transplant.
Infection and Contagion: The space created by the nail lifting can gather dirt, debris, and moisture, providing an ideal environment for bacteria and yeast to thrive. This can lead to secondary infections, commonly caused by Candida albicans and Pseudomonas aeruginosa, resulting in further discolouration and potential contagion if the cause is fungal.
It is important to note that onycholysis may occur alongside other symptoms, including fatigue, feeling cold, dizziness, weakness, headaches, a sore tongue, and a fast heartbeat. If you notice any of these symptoms or signs of infection, it is recommended to consult a healthcare professional.
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Causes of onycholysis
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 fungus. Nails that have lifted from their nail beds may have an irregular border between the pink portion of the nail and the white outside edge. The portion of the nail that has lifted may also have collected thickened skin underneath, and the nail plate may have a deformed shape with pits or indentations in the nail surface, a bent nail edge, or coarse thickening of the nail.
There are several causes of onycholysis. Firstly, injuries or trauma to the nail or the area where the nails start to grow (the nail matrix) can cause onycholysis. This can include bumping or hitting your nails, wearing ill-fitting shoes, keeping your nails in water for too long, or even getting manicures, as manicurists use a lot of force to trim, buff, and polish nails. Even slight trauma, such as the daily tapping of long fingernails on a keyboard or counter, can cause onycholysis when it happens repetitively.
Fungal infections are another common cause of onycholysis. These infections occur when a fungus gets between the nail and the nail bed, usually through cracks or cuts in the finger or toe. They cause the nails to become thick and yellow, and they may show white spots and streaks. In addition to fungi, bacterial infections can also cause onycholysis.
Certain medications can also cause onycholysis, including chemotherapy, tetracycline, nonsteroidal anti-inflammatory drugs (NSAIDs), psoralens, and oral retinoids (vitamin A derivatives).
Onycholysis can also be caused by certain medical conditions, such as an overactive thyroid gland, iron deficiency, hyperthyroidism, nail psoriasis, eczema, lichen planus, thyroid disease, and some forms of infection and, rarely, some forms of cancer. Pellagra, a condition associated with low levels of niacin (vitamin B3), can also cause onycholysis.
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Treatment for onycholysis
Onycholysis is a common nail disorder that is characterised by the separation of the nail plate from the nail bed. It is not a medical emergency, but it may be a sign of a more serious underlying condition. Therefore, it is important to determine the cause of onycholysis to effectively treat it.
Treatment Options:
- Trimming the nail: Keep the nails short and trimmed to avoid repeated trauma from tapping. However, aggressive clipping is not recommended. As the new nail grows out, the lifted nail can be clipped off.
- Protecting the nail: Wear gloves, especially when working with substances that could irritate the nails. Rubber gloves are recommended to avoid repeated immersion in water. Light cotton gloves under vinyl gloves are suggested for wet work.
- Avoiding irritants: Minimise exposure to contact irritants, moisture, and harsh chemicals. Avoid nail products like nail polish, nail enamel, and enamel remover.
- Antibacterial and antimicrobial soaks: Use diluted vinegar or antibacterial soaks to prevent secondary infections.
- Treat underlying conditions: Onycholysis can be caused by fungal infections, thyroid problems, vitamin deficiencies, skin conditions, or autoimmune conditions such as psoriasis, hyperthyroidism, and type 1 diabetes. Treating these underlying conditions can help resolve the onycholysis. For example, antifungal medication can be used for fungal infections, and oral supplements can address vitamin deficiencies.
- Topical treatments: Topical vitamin D, corticosteroids, or creams can be used to treat psoriasis-related onycholysis.
- Laser treatments: Laser treatments, such as pulse dye laser (PDL) and fractional carbon dioxide laser (FCL), have shown favourable results in treating nail psoriasis.
- Intralesional injections: In severe cases of psoriatic nail dystrophy, intralesional injections of medications like triamcinolone may be required.
It is important to note that recovery time for onycholysis depends on nail growth, which is typically slow. Fingernails can take around 4 to 6 months to regrow fully, while toenails may take twice as long.
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Conditions related to onycholysis
Onycholysis is a nail disorder characterised by the spontaneous separation of the nail plate from the nail bed. It is often the result of injury or trauma to the nail or nail matrix, which can occur through activities such as bumping or hitting nails, wearing ill-fitting shoes, or even prolonged exposure to water. Regular manicures and the application of artificial nails can also cause onycholysis.
Onycholysis is also associated with certain underlying conditions, including:
- Fungal infections: Fungi can enter through cracks or cuts in the fingers or toes, causing nails to thicken and turn yellow, with white spots or streaks.
- Iron deficiency: Lack of iron in the diet can lead to onycholysis and may also result in anaemia.
- Hyperthyroidism: This condition causes the overproduction of hormones by the thyroid gland in the neck.
- Psoriasis: A skin condition that affects nail structure and can lead to onycholysis.
- Graft-versus-host disease (GVHD): A condition that can develop after a stem cell transplant, causing nail separation.
- Autoimmune conditions: Such as type 1 diabetes, lichen planus, and thyroid disease.
- Cancer treatments: Certain medications and chemotherapy can induce onycholysis.
It is important to note that onycholysis can be a sign of an underlying condition, and it is always advisable to consult a doctor to determine the root cause.
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Frequently asked questions
A hollow place on a fingernail is called onycholysis, the separation of the nail from the nail bed.
Onycholysis can be caused by trauma or injury to the nail, fungal infections, or psoriasis.
Symptoms of onycholysis include discoloration (white, yellow, green, purple or grey), thickening of the nail, dents or pits in the nail, and crumbling nails.
Treatment for onycholysis involves keeping the nail short and trimmed, avoiding activities that may harm the nails, and treating any underlying conditions. In some cases, medication or medical procedures may be necessary.
Onycholysis can last for several months as a new nail grows to replace the old one. Fingernails can take 4 to 9 months to fully regrow, while toenails can take 12 to 18 months.
