Isla Bennett
There are many reasons why fingernails fall off, and it is a common problem. The medical term for a detached nail is onycholysis, which is when the nail separates from the nail bed. This can be caused by a number of factors, including nail injury, fungal infection, or skin conditions such as psoriasis. In some cases, fingernails falling off can indicate a more serious underlying health condition.
| Characteristics | Values |
|---|---|
| General Causes | Trauma to the nail, fungal infection, psoriasis, hyperthyroidism, allergic reaction, chemotherapy treatment, poor-fitting shoes, nail injury, nail products, ageing, iron deficiency |
| Clinical Features | Irregular border between pink and white portions of the nail, discolouration, pitted, indented or crumbly nail surface, subungual haemorrhage, thickening of the skin under the nail |
| Treatment | Trimming the nail, wearing gloves, avoiding nail irritants, changing medications, supplements, medication for nail infection, antibiotics, anti-fungal medication |
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What You'll Learn
Fingernail injuries
Onycholysis typically presents with clinical features such as an irregular border between the pink portion of the nail and the white edge of the lifted detached nail. The detached nail is generally white and opaque compared to the normal transparent nail, which appears pink. In some cases, lateral or proximal onycholysis may exhibit a yellow-pink colour. The nail surface may be normal or show signs of pitting, indentations, or crumbling. Additionally, thickened skin may accumulate beneath the detached nail. While onycholysis itself is usually painless, it can be painful if acute or inflammatory.
The treatment for onycholysis depends on the underlying cause. General measures to support nail health include keeping the nails trimmed short, avoiding activities that can lead to nail injuries, and steering clear of irritants like nail products. If the detached nail is only partially attached, it is advisable to use scissors to remove it carefully. Soaking the affected finger or toe in cold water after trimming the nail can help soothe the area. Applying a thin layer of petroleum jelly and covering the area with a bandage can promote healing and protect the nail bed.
In some cases, onycholysis may indicate a more serious condition. For instance, it could be a sign of skin cancer, melanoma, or other underlying health issues. Therefore, if you notice any unusual symptoms or have related health concerns, it is recommended to consult a doctor for a thorough examination and appropriate treatment.
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Skin conditions, e.g. psoriasis
Skin conditions such as psoriasis can cause fingernail changes, including pitting, nail bed separation, and discolouration. Psoriasis is an inflammatory autoimmune disease that causes the body to produce too many skin cells, resulting in thick, itchy, scaly patches on the skin. It can also affect the joints and nails, with fingernails being more commonly affected than toenails.
Nail psoriasis can cause the nail plate to lose cells, resulting in small pits on the nail surface, which can vary in number and depth. Additionally, the nails can become thicker due to a fungal infection called onychomycosis, which is common in people with psoriasis. The nail may also separate from the nail bed (onycholysis), causing a gap to form under the nail. When onycholysis is present, a calcipotriol scalp solution can be dripped under the nail and massaged in as treatment.
Other symptoms of nail psoriasis include nail discolouration, with nails turning white, yellow, or brown, and the presence of small red or white spots underneath. Ridges or grooves may also appear on the nails, and chalky white material may gather under the nail, causing it to lift away from the skin, a process known as subungual hyperkeratosis. Nails affected by psoriasis may also crumble, become thicker, and develop pinprick holes, changing in colour and shape. These changes can cause pain and tenderness, impacting the use of the hands and feet.
Treatment options for nail psoriasis include corticosteroid injections under the nail, oral medications, and topical treatments such as vitamin D analogue creams and ointments massaged into the cuticle. Keeping nails trimmed short, moisturising the nails and surrounding skin, and wearing gloves during activities that may damage or dry out the nails are also recommended.
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Nail infections, e.g. fungal
Fingernails and toenails can detach from the nail bed and fall off due to a fungal nail infection, known as onycholysis. This occurs when fungi invade a fingernail or toenail and the skin underneath the nail. Toenails are more commonly affected than fingernails, and symptoms include cracked, yellow, discoloured, streaked, thickened, or spotted nails.
Fungal infections are not the only cause of onycholysis. Other causes include certain skin conditions, such as psoriasis, and medications, including chemotherapy and antibiotics. Additionally, working with your fingers or toes in a wet environment can increase the risk of developing onycholysis. Untreated nail injuries can also lead to nail infections and other serious problems.
Onycholysis itself is usually not painful, but the underlying cause may be. Treatment for onycholysis will vary depending on the underlying cause. General measures to support nail health include keeping the nail short and avoiding activities that can result in nail injury. Specific treatments will depend on identifying and addressing the root cause of the condition. For example, if the onycholysis is caused by a bacterial infection, antibiotics may be prescribed.
If you are experiencing nail detachment or other nail health issues, it is important to consult a healthcare professional for proper diagnosis and treatment. They can help determine the underlying cause and recommend appropriate treatments or lifestyle changes to promote nail health and prevent further complications.
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Chemotherapy or other medications
Chemotherapy targets fast-growing cells, helping to slow or prevent the growth of cancer cells. However, chemotherapy drugs may also target fast-growing body cells, such as cells that control nail growth. This can result in several side effects affecting the nails.
Chemotherapy can cause nails to become dry, brittle, thin, and fragile. Nails may also discolour, developing grooves or ridges, and in some cases, they may fall off. These changes may make nails more prone to breakage. The time it takes for a person to experience nail changes varies, but research from 2020 found that the time from the start of chemotherapy to when a person starts to develop nail changes was 3–6 weeks.
Certain types of chemotherapy are more likely to affect your nails, including drugs that contain taxanes such as Docefrez, Taxol, Onxal, Oraxol, and Taxotere. If you are receiving Taxol treatments, your doctor may recommend using a hydrating nail solution to prevent some nail-related chemotherapy side effects.
Nail changes during chemotherapy can increase the risk of infection because nails and cuticles serve as protective barriers against foreign bodies. Chemotherapy can also weaken the immune system, making it less able to fight off bacteria and other invaders. To reduce the risk of infection, keep your nails clean and short, and wear protective gloves when doing activities such as cleaning or gardening. You should also avoid biting or picking at your cuticles or nails.
After chemotherapy, it can take about six months for fingernails to grow back and up to a year or longer for toenails. In some cases, nails may never return to how they were before chemotherapy.
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Ageing and thyroid function
There are many reasons why fingernails may fall off, including injury, fungal infection, and skin conditions. One potential cause is onycholysis, which is the detachment of the nail plate from the underlying nail bed. Onycholysis can be caused by an overactive thyroid, among other things.
The thyroid plays a crucial role in health and well-being, and normal thyroid function is defined by the standard 95% confidence interval of the disease-free population. However, thyroid function does vary with age, and current reference intervals may not be appropriate for all age groups. For example, thyroid stimulating hormone (TSH) concentrations are higher at the extremes of life and show a U-shaped longitudinal trend in iodine-sufficient Caucasian populations.
The prevalence of thyroid disorders increases with age, and the clinical course of thyroid diseases in elderly individuals differs from that of younger people. Symptoms in older people may be more subtle and often attributed to normal aging. Subclinical hypothyroidism, characterised by normal free thyroxine (FT4) and increased TSH levels, becomes more common with age, affecting 3-16% of people aged 60 and over. Interestingly, decreased thyroid function and increased TSH levels have been associated with extended longevity in some studies.
The endocrine system, including the thyroid, undergoes important functional changes during aging. These changes can result in morphological and physiological alterations to the thyroid gland. Subclinical hypo- and hyperthyroidism, as well as thyroid neoplasms, require special attention in elderly individuals. While decreased thyroid function may contribute to increased lifespan, it is important to note that thyroid hormones play a key role in maintaining normal metabolic processes throughout life.
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Frequently asked questions
There could be several reasons for fingernails to fall off. One common reason is onycholysis, a condition in which the nail separates from the skin beneath it. This can be caused by a nail injury, fungus, or skin conditions such as psoriasis. Other causes of fingernails falling off include aging, fungal infections, certain medications, an overactive thyroid, iron deficiency, and working with your hands in a wet environment.
Fingernails typically take 4 to 6 months to grow back fully after falling off. During this time, it is important to take care of your nails and avoid any activities that could harm them.
To prevent fingernails from falling off, it is important to maintain proper nail health. This includes keeping your nails short and trimmed, avoiding nail biting or picking, wearing gloves when working with your hands in a wet environment, and using emollient creams to keep the skin and nails moisturized.
