Sophia Delgado
If your fingernails are lifting from the nail bed, you may be experiencing onycholysis, the medical term for nail separation. Onycholysis can be caused by injury, fungal infection, or an underlying condition such as hyperthyroidism, psoriasis, or eczema. It is important to determine the underlying cause of onycholysis to treat it effectively. Treatment may involve cutting away the separated nail, medication, or simply keeping the nail bed dry.
| Characteristics | Values |
|---|---|
| Medical Term | Onycholysis |
| Description | The separation of the nail from the nail bed |
| Symptoms | Nails turning white, yellow, or green; nails becoming thick; nails developing white spots or streaks; irregular border between the pink and white portions of the nail; nail bed disappearance; nail plate becoming shorter or narrower; scarring of the nail bed |
| Causes | Injury to the nail; fungal infections; certain medications; an overactive thyroid; iron deficiency; working with the fingers or toes in a wet environment; yeast infection; certain skin conditions such as psoriasis, eczema, lichen planus, and dermatitis; hyperthyroidism; type 1 diabetes; graft-versus-host disease (GVHD); genetic disorder; nail products; nail length; local irritation; allergic reactions; exposure to sunlight |
| Treatment | Clipping away the separated nail; keeping the nail short; avoiding activities that can result in nail injury; avoiding irritants such as nail products and chemicals; medication; using antibacterial soaks; wearing gloves; keeping nails clean and dry |
| Recovery Time | Fingernails typically take 4 to 6 months to regrow completely, while toenails can take 8 to 18 months |
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Onychomycosis
The condition is more common in older adults, affecting 10% of the general population, 20% of those over 60, and 50% of those over 70. Several factors contribute to the higher prevalence in older individuals, including peripheral vascular disease, immunologic disorders, and diabetes mellitus. People with diabetes have a 1.9 to 2.8 times higher risk of developing onychomycosis compared to the general population. Additionally, it is more prevalent in those with human immunodeficiency virus (HIV) infection, affecting 15% to 40% of this population.
Toenails are more commonly affected than fingernails due to their slower growth rate, reduced blood supply, and frequent confinement in dark, moist environments. Other risk factors for onychomycosis include distorted nails, a history of nail trauma, genetic predisposition, hyperhidrosis, concurrent fungal infections, and nail psoriasis. Smoking and the use of occlusive footwear and shared bathing facilities are also associated with an increased risk.
Accurate diagnosis of onychomycosis is crucial for successful treatment. It involves physical and microscopic examination, culture, and histologic evaluation using techniques like periodic acid-Schiff staining. Treatment aims to eradicate the causative organism and restore the nail's normal appearance. Systemic antifungals are the most effective treatment option, with meta-analyses showing high cure rates for medications like terbinafine. Topical therapies, such as ciclopirox, have lower efficacy, with failure rates exceeding 60%. Laser and photodynamic therapies show promise, but more clinical studies are needed.
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Injury
Onycholysis, or nail lifting, is a condition in which the nail separates from the skin beneath it, or the nail bed. It is often caused by injury or trauma to the nail or the area where the nails start to grow (the nail matrix). This can include bumping or hitting your nails, wearing ill-fitting shoes, keeping your nails in water for too long, or even just tapping your nails on a hard surface over a long period. Manicures can also cause onycholysis, as can the daily tapping of long fingernails on a keyboard or counter.
It may take up to six to nine months for fingernails to grow out completely, and 12 to 18 months for toenails. During this time, it is important to keep nails short and trimmed to avoid further injury and to allow new, healthy nail growth.
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Fungal infections
Onycholysis, or nail lifting, is the separation of the fingernail or toenail from the nail bed. It is often caused by an injury to the nail, but it can also be caused by fungal infections. Fungi can get between your nail and nail bed through cracks or cuts in your fingers or toes.
Fungal nail infections are common, with many people developing one at some point in their lives. Toenails are more frequently affected than fingernails. The medical name for a fungal nail infection is onychomycosis. The infection causes the nail to become thickened, distorted, and discoloured, with white spots and streaks. Nails become yellow, thick, and brittle, and pieces may break off and come away completely. The infection develops slowly, and mild cases may not need treatment. However, antifungal medication may be recommended for more severe or troublesome infections. This medication comes in the form of tablets or a special paint applied directly to the nail. Terbinafine and itraconazole are the two medicines most commonly prescribed for fungal nail infections.
If you haven't experienced any injury or trauma to your nails, it's a good idea to contact your healthcare provider as soon as you notice onycholysis. They may advise you to cut away the separated nail as it grows out. Keeping your nails short will prevent them from catching on objects and pulling further off the nail bed. It's important to keep the nail bed dry and to wear gloves when doing activities that may damage your nails, such as washing dishes.
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Skin conditions
Onycholysis, or nail lifting, is the separation of the fingernail or toenail from the nail bed. It is a common condition that can affect people of any age and tends to be more frequent in women. Onycholysis can occur due to various skin conditions and underlying causes, which can be both internal and external.
Several skin conditions can contribute to onycholysis. These include:
- Psoriasis: This autoimmune condition can cause changes to the structure of nails, including pitting, nail bed separation, and discoloration.
- Eczema: People with eczema may experience nail lifting, particularly in cases of hand dermatitis.
- Lichen planus: This skin condition can affect the nails and lead to onycholysis.
External Causes
External factors, such as injury or trauma to the nails, are a common cause of onycholysis. This can include stubbing a toe, repetitive actions like tapping or filing, or using tools to clean underneath the nails, which can break the skin and lead to infection. Additionally, working with the fingers or toes in a wet environment can contribute to onycholysis.
Internal Causes
Internal factors, such as certain medications, vitamin deficiencies, and medical conditions, can also play a role in onycholysis. For example:
- Medications: Chemotherapy drugs, tetracycline, non-steroidal anti-inflammatory drugs (NSAIDs), and oral retinoids can cause onycholysis, especially when combined with sun exposure.
- Vitamin Deficiencies: Iron deficiency and low levels of niacin (vitamin B3) have been linked to onycholysis.
- Medical Conditions: Thyroid disease, fungal infections, and yeast infections are associated with onycholysis.
Grafted versus host disease (GVHD), which can develop after a stem cell transplant, is another potential cause.
It is important to note that identifying the underlying cause of onycholysis can be challenging, and a dermatologist should be consulted, especially if multiple nails are affected. Treatment options will depend on the specific cause and typically focus on promoting new nail growth while managing the underlying condition.
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Chemotherapy drugs
The main drugs that cause nail changes are:
- Taxanes (e.g. Taxotere, Taxol, and Abraxane)
- Anthracyclines (e.g. Doxorubicin and Epirubicin)
Taxotere, a chemotherapy drug, can cause nails to lift from the nail bed or come off completely. This can be painful and may increase the risk of infection under the nail. Chemotherapy can weaken your immune system, making it harder for your body to fight off bacteria and other invaders.
If you are taking a taxane, consider applying cold packs to your nails for 15 minutes before and after the infusion. This may help prevent nail lifting. You can also soak your fingers or toes in a mixture of equal amounts of white vinegar and water for 15 minutes every night to help alleviate nail fold inflammation.
It is important to tell your healthcare team about any nail changes you experience during chemotherapy. They can give you tips and medications to help manage the symptoms.
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Frequently asked questions
Your fingernails may be lifting from the nail bed due to a condition called onycholysis. This is when the nail separates from the skin underneath it, often after an injury to the nail. It can also be caused by fungal infections, certain medications, skin conditions such as psoriasis, an overactive thyroid, or iron deficiency.
Treatment for fingernail lifting depends on the underlying cause. In general, it is recommended to keep your nails short and trim them regularly. You should also avoid activities that may harm your nails, such as biting them or cleaning underneath them with sharp tools. If the cause is a fungal infection, you may need to take antifungal medications.
Fingernails typically take 4 to 6 months to fully regrow, but this may take longer depending on the severity of the case. Toenails usually take 8 to 12 months, or even up to 18 months in some cases.
