Sophia Delgado
Toenails growing away from the nail bed is a condition known as onycholysis, which is often the result of an injury to the nail or nail matrix. It can also be caused by fungal infections, psoriasis, eczema, thyroid disease, or even cancer. Treatment for onycholysis involves cutting away the separated nail as it grows out, which can take up to 12 to 18 months for toenails. In the case of a fungal infection, oral or topical antifungal medications may be prescribed. To prevent onycholysis, it is important to keep nails trimmed short, avoid nail biting, and be cautious when cleaning underneath the nails to prevent infection.
| Characteristics | Values |
|---|---|
| Medical Term | Onycholysis |
| Causes | Nail trauma, 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 |
| Treatment | Oral antifungal medication, topical antifungal medication, cutting away separated nail, avoiding harsh nail products, wearing well-fitting shoes |
| Prevention | Keeping nails trimmed short, avoiding nail biting, being careful when cleaning under nails, avoiding harsh chemicals and nail products |
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What You'll Learn
Onycholysis, or nail separation
Onycholysis is a common condition in which the nail separates from the nail bed, or the skin underneath the nail. It usually affects only one nail and can occur with both fingernails and toenails. Onycholysis is often painless but can be painful if acute or inflammatory. It is typically caused by an injury to the nail or nail matrix, but it may also be caused by fungal infections, bacterial infections, or psoriasis.
The symptoms of onycholysis include nails that peel away from the nail bed, thick nail beds, and an abnormal border between the pink area and the white edge of the nail, which may appear wavy. The white areas may be thicker in some parts and thinner in others. Nails may also show signs of discoloration, appearing gray, green, purple, white, or yellow. Other symptoms include dents or pits in the nails, crumbling nails, and hemorrhages underneath the nails.
The treatment for onycholysis depends on the underlying cause. If it is caused by an injury, the nail will eventually grow out, and the detached part can be cut away as it grows out. If it is caused by a fungal infection, oral or topical antifungal medications may be prescribed. To prevent onycholysis, it is recommended to keep nails trimmed short, avoid nail-biting, be cautious when cleaning underneath nails, and avoid harsh nail products and chemicals that can irritate the nails or the skin around them.
The condition typically lasts for several months or over a year, as it takes time for a new nail to grow and replace the old one. Fingernails can take 4 to 6 months to fully regrow, while toenails can take 8 to 18 months. During this time, it is important to keep nails short to prevent the separated nail from catching on objects and to avoid any activities that might harm the nails.
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Toenail fungus
To prevent toenail fungus, you should keep your toenails trimmed straight across so that the nail does not extend beyond the tip of the toe. Wear shoes that fit well and are made of materials that breathe. Avoid wearing excessively tight hosiery to decrease moisture, and wear socks made of synthetic fibre that “wicks” moisture away from your feet.
If you have toenail fungus, you should disinfect instruments used to cut nails and home pedicure tools. Avoid applying nail polish to nails suspected of infection. If you have athlete's foot, this may also contribute to toenail fungus, so treat athlete's foot if present.
If you have onycholysis, you may need to take antifungal medications. Your healthcare provider may prescribe liquid medicines or pills/tablets that you swallow with water. These medications may include terbinafine (Lamisil®), itraconazole (Sporanox®), and fluconazole (Diflucan®). Topical antifungal medication comes in the form of creams, ointments, or gels that you rub directly onto your nails.
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Injury to the nail
Onycholysis, or nail lifting, is a condition in which the nail separates from the nail bed. It is often caused by injury to the nail or the nail matrix (the area where nails start to grow). Injuring the nail matrix can cause bruising, ridges, or discolouration, and the nail may fall off.
Injuries to the nail or nail matrix can occur by bumping or hitting the nails, wearing ill-fitting shoes, or keeping the nails in water for too long. Pinching or crushing the fingers or dropping something heavy on the toes can also injure the nail matrix.
If onycholysis is caused by injury, the nail will not reattach to the nail bed, but treatment can encourage new nail growth. As the nail grows out, the detached section can be cut away with nail clippers or nail scissors. Keeping the nails trimmed short can prevent them from catching on objects and pulling further off the nail bed.
It is important to determine the underlying cause of onycholysis. A medical professional may prescribe treatment for any skin conditions, medical problems, or exposures causing the nail lifting.
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Allergic reaction
Onycholysis is a condition in which the nail separates from the skin beneath it, or the nail bed. It is often caused by trauma or injury to the nail, such as bumping or hitting the nail, wearing ill-fitting shoes, or keeping the nails in water for too long. However, it can also be caused by allergic reactions or skin sensitivity to certain products.
If you are experiencing onycholysis due to an allergic reaction, it is important to identify and remove the irritant or allergen immediately. This may include nail products such as nail polish, nail gloss, nail hardener, nail polish remover, artificial nails, or glue used during manicures and pedicures. Discontinuing the use of these products and choosing allergen-free alternatives can help prevent further irritation and allow the nail to regrow.
Allergic contact dermatitis, for example, is a skin condition that may cause onycholysis and requires diagnosis by a healthcare professional. Certain medications or treatments, such as chemotherapy or immunotherapy, can also affect skin cell production, making the skin thinner and more sensitive to allergies and reactions. Additionally, exposure to certain medicines, such as those from the psoralen, tetracycline, or fluoroquinolone groups, can cause photosensitivity, making the nails react to sun exposure by lifting away from the nail bed.
In some cases, onycholysis may be caused by fungal or bacterial infections, which can be treated with oral or topical antifungal medications. It is important to finish the full course of medication to effectively treat the infection. Keeping your nails short, clean, and dry can also help prevent the spread of the infection and promote healthy nail growth.
If you suspect that your toenails are growing away from the nail bed due to an allergic reaction, it is recommended to consult a healthcare professional for proper diagnosis and treatment. They can help identify the underlying cause and provide guidance on managing and preventing further occurrences of onycholysis.
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Psoriasis
Symptoms
Nail psoriasis can cause a range of symptoms, including:
- Pitting of the nails – small pits on the surface of the nail that can vary in number and size, from pin-sized to crayon-tip-sized.
- Onycholysis – the nail becomes detached from the underlying nail bed, with a white or yellowish patch at the tip of the nail that extends down to the cuticle. Bacteria may grow under the nail, turning it green, and the nail can become infected.
- Subungual hyperkeratosis – a chalky substance accumulates under the nail, causing it to become raised and tender.
- Discoloration – the skin underneath the nails (nail bed) may change colours, appearing yellow, red, pink, brown, grey, purple, or white.
- Nail thickening and crumbling – the nails may become so thin that they start to crumble, and can also thicken due to fungal infection.
- Beau's lines – grooves that run horizontally across the nails.
Treatment
While there is no cure for nail psoriasis, various treatments can help alleviate symptoms. These include:
- Corticosteroids – prescribed as a cream, ointment, or nail polish, or as injections, corticosteroids can help treat most signs and symptoms of nail psoriasis.
- Vitamin D analogue preparations – massaging a vitamin D analogue cream or ointment into the cuticle can be an effective treatment for nail psoriasis.
- Tazarotene – derived from vitamin A, this medication can treat pitting, nail separation, and discolouration.
- Natural remedies – aloe vera gel, capsaicin creams or ointments, Dead Sea salt soaks, and turmeric can help relieve symptoms of nail psoriasis.
- Laser treatments – while more research is needed, laser treatments have been studied as a potential therapy for nail psoriasis.
It is important to note that nails grow slowly, so it may take several months or even years for treatments to be effective. Additionally, nail psoriasis may worsen without treatment, causing discomfort or pain and impacting daily activities. Therefore, early treatment is essential to prevent nail psoriasis from progressing and reduce its effects.
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Frequently asked questions
Onycholysis is the medical term for toenails (or fingernails) separating from the nail bed.
Onycholysis can be caused by a variety of factors, including nail trauma or injury, fungal infections, psoriasis, eczema, thyroid disease, and allergic reactions. It is also common in pregnant women and people on certain medications.
Treatment for onycholysis aims to promote new nail growth attached to the nail bed. Keeping nails trimmed short can help manage the condition. In cases of fungal infections, oral or topical antifungal medications may be prescribed.
Toenails grow slowly, and it may take 8 to 18 months for them to grow completely out after onycholysis.
To prevent onycholysis, avoid nail biting and keep your nails trimmed short to prevent them from catching on objects. Wear properly fitting shoes to avoid nail trauma, and be cautious when cleaning underneath your nails to prevent skin breakage and infection. Avoid harsh nail products and chemicals that can irritate the nails and nail beds.
