Taking care of fingernails is probably not the most top priority in life, let alone toenail which we may take for granted. Healthy nails are characterised by smooth surfaces, free from ridges or bumps and no dents. Healthy nails are free from spot or discolouration and uniform in colour which is often strong pink nail beds. There are nail diseases that cause nails to look different and some may even cause symptoms. In this DoctorOnCall’s article, we will learn about onycholysis being one of the nail disorders.

Onycholysis is separation of the fingernail or toenail from the nail bed. It is a common condition. This condition occurs slowly and typically painless. Onycholysis can be caused by many reasons such as from trauma to the nails, infections, skin conditions such as allergic or psoriasis and associated medical conditions such as iron deficiency or overactive thyroid gland. Certain medications may cause photo-oncolysis due to photosensitizers properties that cause the lifted nail as its reaction. Fingers or toes in a wet environment can increase the chances for onycholysis. It may also be caused without any specific reason. It is said that it is possible for nail separation to occur when there is excessive filing or chemicals used in manicure. Wearing ill-fitted footwear, stubbing toes and sports may cause toenail onycholysis.

Onycholysis can occur to anyone of any age and any gender with different races. It may seem that onycholysis seems to be frequent in adult women to the tendencies of women to keep long nails for aesthetic purposes or receiving beauty treatment on their nails. Do you know that even daily tapping of long fingernails on keyboard or counter can easily cause onycholysis even if it is a small trauma? Thus, at times it may be difficult to pinpoint what is the exact cause of onycholysis when there are many causes that could be leading to this condition.

Symptoms of onycholysis can affect one or more nails at a time. It is common that the end part of the nail is lifted with a free edge. Even though nail detachment may occur on the side (laterally) or the nail close to the skin (proximally). Irregular bur sharp border between the pink part of the nail and the white edge from the detached nail can be seen. If there are oil spot signs, onycholysis is said to be under the nail. Detached nails are often seen as white and opaque which is in contrast with the normal nail that is transparent with pink hue. Green or yellow nails are often signs of ongoing infection. Bleeding may be visible under the nail. Nail bed itself may be seen with ridges or dips.  In most cases, onycholysis is painless but may be painful at the beginning of the disease or when it is inflamed such as from infection.

You may wonder what you can do to fix onycholysis. The basic principle of fixing this issue is to ensure there is new nail growth that is attached to the nail bed. It is worth noting that the detached nail will never reattach. Hence, what you can do is to ensure that the nail is able to grow normally. Thus, you can clip the affected nail and keep the nail short. Always keep the nail clipped back to the point where attachment can occur as this can guarantee a continued progress. Onycholysis can only go away when the new nail takes the place of the affected area. Fingernails take 4 to 6 months to regrow and toenails take twice longer than fingernails before they are able to regrow. This is why it is important to ensure a continuous progress of nail growth.

Beside keeping the nail short and trimmed, you should minimise activities that can cause trauma to the nail. Avoiding potential irritants such as solvents, nail enamel and detergents can reduce the likelihood of onycholysis. Remember to wear gloves when in contact with wet work. If you are unsure of what you can do for onycholysis, you can always talk to a doctor and they can help you trim the nail. It is very important to treat onycholysis because persistent onycholysis may cause less chances for the new nail growth to attach. This is resulted from the permanent damage of the underlying nail bed which makes it not optimal to stick on the new nail.

While in most cases of onycholysis can be solved with simple trimming, some cases such as infection may need antifungal to resolve. If medication is suspected to be the cause for onycholysis, patients might want to discuss the matter with their doctor who prescribed the specific medication. Underlying medical conditions such as iron deficiency or psoriasis, when treated, can improve the outcome for onycholysis.

It is unusual for onycholysis to affect one nail and long standing even after treatment. If this condition occurs, this may sign of an underlying possible malignancy or cancer. This may be suspected more if bleeding or oozing occur. Biopsy, a procedure of obtaining tissue samples, is usually performed to evaluate the possibility for a malignancy.