Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentOutlook
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Outlook
Onycholysishappens when the nail plate separates from the nail bed. A fungal nail infection, nail injury, reaction to chemicals (like nail polish), and nail psoriasis are some possible causes.Onycholysis treatment often relies on medication, trimming away the separated nail, and cleaning the nail bed.
Dermatologists (skin specialists) often see two instances of onycholysis:
This article describes the common causes of onycholysis and the treatment options.
This photo contains content that some people may find graphic or disturbing.See PhotoDermNet /CC BY-NC-ND
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
DermNet /CC BY-NC-ND
Onycholysis Symptoms
Onycholysis typically doesn’t cause any pain but inflammation at the site can become painful. So can any trauma injury that led to symptoms. In most people, onycholysis symptoms include:
It’s recommended that a dermatologist evaluate any symptoms that involve the nail lifting up from the nail bed.
Causes of Onycholysis
Onycholysis can be a sign of many differentnail traumasor conditions.
Fungal Infection
An untreated fungal infection can lead to pain, discomfort, and even permanent disfigurement of the finger. However, the prescription medication required to treat fungal infections is expensive and can have side effects, so be sure to discuss the pros and cons of treatment with your specialist.
Some people may want to treat onycholysis with tea tree oil and other remedies. More research is needed, however, to determine if these integrative medicine options are effective.
Nail Psoriasis
Other Infections
Generally, if the infection under the nail appears to be green, a bacterial infection is to blame.One of the more common bacterial infections ispseudomonas, which is most often seen in people who frequently have their hands in water, such as waitresses, bartenders, or nurses.
Pseudomonas causes a blue-green or black discoloration on the nail plate and causes the nail plate to lift and separate from the nail bed. Treatment includes trimming away the separated nail, cleaning the nail bed, and applying a topical antibiotic.If the infection is severe, an oral antibiotic may be prescribed.
Trauma or Injury
Onycholysis usually occurs only in one nail when there is trauma or injury to a specific area and should heal on its own over time. There are a few different ways that the nails can sustain trauma or injury, such as:
Certain Medications
Chemotherapy drugs can sometimes cause lifting of the nail plates. Also, individuals taking certain antibiotics (such a tetracycline) may be prone to a condition called photo-onycholysis if exposed to significant sunlight.The combination of the sun’s UV rays and the antibiotic results in damage.
Oral retinoid use, such as Soriatane (acitretin), and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause onycholysis of the fingers and toes with exposure to sunlight. Some medications can lead to changes without sun exposure.
Iron Deficiency or Thyroid Over-Activity
In rare cases where all the nails are affected, onycholysis can be a sign ofiron deficiencyor thyroid over-activity. Increasing iron levels or treating hyperthyroidism may permit the nails to grow back normally.
Hereditary Distal Onycholysis
How Onycholysis is Diagnosed
In some cases, your healthcare provider will be able to diagnose onycholysis on the basis of your symptoms, the history of how and when they began, and an examination. A dermatologist may use a dermascope to magnify the nail, which can be especially helpful in diagnosing onycholysis.
They also may take nail clippings or scrapings to send to a lab to check for infection.Blood tests can be used to diagnose some underlying causes, such as thyroid disorder.
Is Onycholysis a Sign of Cancer?It is not common for onycholysis to be a sign of cancer, although it can be a symptom of melanoma (skin cancer) or squamous cell carcinoma.Your healthcare provider may want a nailbiopsy, a tissue sample sent to a lab, to evaluate the possibility of cancer.
Is Onycholysis a Sign of Cancer?
It is not common for onycholysis to be a sign of cancer, although it can be a symptom of melanoma (skin cancer) or squamous cell carcinoma.Your healthcare provider may want a nailbiopsy, a tissue sample sent to a lab, to evaluate the possibility of cancer.
Getting a Biopsy: How to Prepare
Onycholysis Treatment
An underlying illness that leads to the nail changes will require treatment. Having diabetes increases the risk of yeast and fungal nail infections, which can lead to brittle nails and onycholysis. Diabetes can also cause nerve damage and reduced blood supply to the nail, which impair nail growth and overall nail health, so it’s important to manage diabetes well.
In other cases, a drug-induced photosensitivity may mean you need to stop taking oral retinoids. Be sure to talk with your healthcare provider before making any changes in your medications or dosages, though. They will explain the treatment options for your specific diagnosis.
Onycholysis and Nail Psoriasis TreatmentNail psoriasis is a common cause of onycholysis, and prevention (like avoiding injury) is an important part of its management.Topical steroidsandvitamin Dproducts are used as first-line treatments, but you also may need systemic treatments for psoriasis, like biologics.
Onycholysis and Nail Psoriasis Treatment
Nail psoriasis is a common cause of onycholysis, and prevention (like avoiding injury) is an important part of its management.Topical steroidsandvitamin Dproducts are used as first-line treatments, but you also may need systemic treatments for psoriasis, like biologics.
What Is Psoriasis?
Outlook for Onycholysis
Most cases of onycholysis can be treated and do not lead to serious complications, especially when it occurs in one nail due to trauma. An isolated injury may heal on its own but treatment typically is needed for other causes.
Once the underlying cause of onycholysis is resolved, a new nail will need to regrow and replace the affected nail before the onycholysis fully heals. It can take six months or longer, depending on your body, for a new nail to fully regrow.
Keep in mind that in prolonged cases of onycholysis, it’s possible for permanent change of the structure of the nail bed to occur.Surgical procedures performed in the nail bed (such as removal of awart) can also result in permanent scar tissue. There is very little that can be done in this situation other than camouflaging the nail with polish.
How Do I Prevent Onycholysis?Keeping your nails clean and trimmed, and avoiding injury, may limit onycholysis risk. Keeping nails dry helps to avoid fungal infections. Wear gloves when around water and dry your hands and feet thoroughly whenever they get wet.Avoid nail polish remover and harsh chemicals.Biotin (vitamin B7) may be helpful for improving nail health, with potential benefits from vitamins C, E, and B6, too.
How Do I Prevent Onycholysis?
Keeping your nails clean and trimmed, and avoiding injury, may limit onycholysis risk. Keeping nails dry helps to avoid fungal infections. Wear gloves when around water and dry your hands and feet thoroughly whenever they get wet.Avoid nail polish remover and harsh chemicals.Biotin (vitamin B7) may be helpful for improving nail health, with potential benefits from vitamins C, E, and B6, too.
Keeping your nails clean and trimmed, and avoiding injury, may limit onycholysis risk. Keeping nails dry helps to avoid fungal infections. Wear gloves when around water and dry your hands and feet thoroughly whenever they get wet.
Avoid nail polish remover and harsh chemicals.Biotin (vitamin B7) may be helpful for improving nail health, with potential benefits from vitamins C, E, and B6, too.
Summary
Onycholysis is a nail condition that occurs when the nail plate separates from the nail bed. This can occur due to a number of causes, including injury, underlying illness, medications, and genetics.
Diagnosis will mean ruling out other possible causes. Your healthcare provider may order tests along with an examination to confirm a diagnosis. They’ll discuss treatment options with you, including both short-term approaches (a fungal infection, for example) as well as treatment for any chronic conditions like psoriasis.
Prevention, including nail hygiene, is an important part of home care. Make sure to confirm your diagnosis with a healthcare provider and ask them before you try any alternative remedies like tea tree oil or coconut oil.
16 Sources
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