Caleb Foster
Fingernails and toenails can become loose for a variety of reasons, including nail trauma, fungal infections, and skin conditions such as psoriasis. This condition is known as onycholysis, which is the medical term for when a nail separates from the nail bed or the skin beneath it. It is characterized by nails that are thick, yellow, and may show white spots and streaks. Onycholysis can also be an indication of a more serious underlying health condition, such as thyroid disease, iron deficiency, or even lung disorders. Treatment for loose nails will depend on the underlying cause and can include medications, keeping nails trimmed, and avoiding nail irritants.
| Characteristics | Values |
|---|---|
| Medical term | Onycholysis |
| Cause | Nail injury, fungus, or psoriasis |
| Symptoms | Fatigue, feeling cold, dizziness or weakness, headaches, a sore tongue, and a fast heartbeat |
| Treatment | Anti-fungal medications, antibiotics, clipping the affected portion of the nail, and keeping the nail short with regular trimming |
| Prevention | Avoid or minimize activities that can result in nail injury, wear rubber gloves if your hands are often in water or you regularly use cleaning products |
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Nail trauma
Types of Nail Trauma
There are many ways in which nail trauma can occur. A common cause is a blow to the nail, or trapping the finger or toe in a door or drawer. This often results in blood under the nail, known as a subungual hematoma. Nails can also be torn, split, or lifted away from the nail bed. Repeated trauma to toenails, such as from ill-fitting shoes, can lead to deformities and may even resemble a fungal infection.
Nail-biting is a common cause of nail trauma, which can lead to dystrophy and horizontal ridging. It can also cause acute paronychia, a bacterial infection where bacteria get underneath the tissue at the side of the nail, causing swelling and irritation.
Treatment
Treatment depends on the type and severity of the injury. For minor injuries, you can treat them at home by stopping any bleeding and ensuring the nail is still attached to the nail bed. For more serious injuries, you should seek medical attention. They will stop the bleeding, clean the wound, and numb the area before treatment. If there is a large bruise, a small hole may be created in the nail to drain blood and fluid and relieve pressure and pain. In some cases, the nail may need to be removed, and the nail bed repaired. Antibiotics may be prescribed to prevent infection.
Prevention
To prevent nail trauma, it is important to wear properly sized shoes and keep your nails trimmed. It is also recommended to wear rubber gloves if your hands are often in water or if you are using cleaning products.
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Nail fungal infections
Fingernail problems are not usually caused by anything serious. Common nail problems include brittle, loose nails that may change colour or shape. Nails that are loose may be a sign of a fungal nail infection.
Fungal nail infections, also known as onychomycosis, comprise over 50% of all nail disease, with an estimated prevalence of 5.5%. They can affect the toenails, fingernails, or both. Fungal nail infections are caused when a fungus gets between your nail and nail bed, usually through cracks or cuts in your finger or toe. They can cause your nails to become thick, yellow, and crumbly, and may show white spots and streaks. The nail may become loose and
Fungal nail infections are often regarded as a trivial cosmetic problem. However, they can cause significant pain and affect full mobility and activities, as well as cause social stigma. The infection often spreads to the whole nail, making it thicker and turning it white or yellow.
Fungal nail infections are usually treated with antifungal tablets, although these may not be suitable for those with liver or kidney disease, or those who are pregnant or breastfeeding. In some cases, badly infected nails may need to be removed.
To prevent fungal nail infections, it is recommended to wear shoes that do not squeeze the toes together, and to avoid wearing trainers for long periods of time, as this can cause your feet to become hot and sweaty.
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Psoriasis
Nail problems are usually not caused by anything serious. Common nail problems include brittle, loose nails that may change colour or shape. Loose nails can be caused by onycholysis, a condition where the nail separates from the skin on which it rests (the nail bed). This condition can be caused by fungal infections, injuries, certain medications, and chemotherapy.
One specific condition that can cause loose nails is nail psoriasis, an autoimmune condition that affects the fingernails and toenails. It causes discoloration, pitting, and changes in nail structure. While there is no cure for nail psoriasis, treatments can help alleviate symptoms. Prescription medications and over-the-counter creams can be applied directly to the nails to reduce symptoms. Corticosteroids, calcipotriol (derived from vitamin D), and tazarotene (derived from vitamin A) are commonly used to treat nail psoriasis. Phototherapy, or ultraviolet light treatment, can also be used.
Nail psoriasis is a common condition, affecting over 50% of people with psoriasis and around 86% of people with psoriatic arthritis. It typically appears alongside a psoriatic rash on other parts of the body. The skin underneath the nails may change colour, with colours ranging from yellow to red, pink, brown, or purple. Pitting, or small dents in the nails, is a common symptom. Nails may also thicken, develop pinprick holes, change shape, or separate from the nail bed.
If you are experiencing loose nails, it is important to consult a healthcare professional for a proper diagnosis and treatment plan. They will examine your nails, ask about your symptoms and family history, and may use the nail psoriasis severity index (NAPSI) to grade the severity of the condition. Treatment for nail psoriasis can take time due to the slow growth rate of nails, and multiple treatments may be necessary.
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Hyperthyroidism
Fingernail abnormalities can be indicative of a person's overall health. Changes in the appearance of your nails could indicate a medical condition, including thyroid dysfunction. Hyperthyroidism, for instance, is a condition where the thyroid gland in the neck produces and releases more hormones than the body needs. While hyperthyroidism is not directly associated with onycholysis (a condition where the nail plate pulls away from the skin of the nail bed), it can cause "spoon-shaped" nails or clubbing, a condition where fingernails curve over rounded fingertips.
Clubbing of the nails can be a sign of many serious, long-term conditions. It is often associated with lung disorders and lymphedema, especially of the ankles. Clubbed nails may also be over-curved both transversely and longitudinally, and lunulae and cuticles may be lost. In addition, hyperthyroidism can cause nail thickening and yellow-to-yellow-green discolouration of all nails.
Nail psoriasis, which causes changes to the structure of the nail and may include onycholysis, can also be caused by hyperthyroidism. Nails affected by psoriasis may exhibit small dents or pits (cupuliform depressions), thick and yellow discolouration, white spots and streaks, crumbling, and abnormal borders between the pink and white areas of the nail.
Other symptoms of hyperthyroidism include:
- Thinning (or missing) eyebrows on the outer edge
- Coarse, dull, dry, and brittle hair that breaks easily
- Soft and fine hair with lots of shedding
- Thinning hair or balding patches
- Dry, itchy scalp and dandruff
- Less hair on your legs, arms, and other areas
- Dry, pale, and cool skin
- Moist, velvety, and warm skin
- Deep, noticeable lines on your palms and soles
- Yellowish-orange colour on your palms and soles
- Doughy and swollen face, especially on your eyelids, lips, and tongue
- Widening nose
- Slow-healing wounds
- Goiter (swelling in the neck)
- Protruding eyes
- Flushing on your face and red palms
- Darker skin in the creases of your palms, on your gums, or elsewhere in your mouth
- Rashes, especially in the creases of your skin
- Painless lumps and patches of scaly, discoloured skin, and the affected skin feels hard and waxy
- Reddish spots on the skin that come and go
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Iron deficiency
Fingernail abnormalities can be caused by several factors, including iron deficiency. Iron deficiency occurs when the body does not have enough iron to carry out its tasks, such as producing haemoglobin, a protein in red blood cells that carries oxygen from the lungs to all parts of the body.
One of the tell-tale signs of iron deficiency is the appearance of brittle or spoon-shaped nails, known as koilonychia. Koilonychia is an abnormal shape of the fingernail where the nail is thin and curved inward with raised ridges. Initially, nails may become brittle and chip or crack easily. In later stages of iron deficiency, untreated over a long period, the nails can become spoon-shaped, with the middle of the nail dipping and the edges raising to give a rounded, spoon-like appearance. This condition is relatively rare and usually only occurs in severe cases of iron deficiency.
Another nail abnormality associated with iron deficiency is onycholysis, or nail separation, where the nail loosens and may even detach from the nail bed. This condition can be caused by various factors, including fungal infections, certain medications, and nail psoriasis. While onycholysis can be painless, it can also be accompanied by pain and irritation, especially if it is due to injuries or infections.
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Frequently asked questions
There are several reasons why your fingernails may feel loose. One common reason is onycholysis, which is when the nail separates from the nail bed. This can be caused by a variety of factors such as injury or trauma, fungal infection, certain medications, or skin conditions such as psoriasis.
Symptoms of onycholysis include discoloration of the nail, which may include white, yellow, or green hues, an irregular border between the pink portion of the nail and the white outside edge, and a pitted, indented, or crumbly nail surface.
Treatment for onycholysis depends on the underlying cause. General measures include keeping nails short and trimmed, avoiding activities that may cause nail injury, and minimizing exposure to irritants such as nail products. Specific treatments may include antifungal medications, antibiotics, or procedures based on the underlying cause.
If you experience nail trauma, especially with bleeding, it is recommended to consult a doctor. Additionally, if you notice other symptoms such as fatigue, dizziness, headaches, or a sore tongue, it may be advisable to seek medical advice as loose nails can sometimes indicate a more serious underlying condition.
