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Onycholysis: Separation of the nail from the nail bed

What is onycholysis?

Onycholysis refers to the condition of separation of nail plate from the nail bed. It is a common generally painless problem.  Many times, it is reported in women with long fingernails.  This painless condition is often a sign of infection resulting from an injury.

Onycholysis: Separation of the nail from the nail bed

What are the causes of onycholysis?

Onycholysis can result from

  • Trauma: It is the most common cause. Daily activities like fingernails hitting the computer keyboard or tapping on a hard surface repetitively can lead to the separation of the nails.
  • Manicuring: During manicuring, the cleaning below the nails and smoothening can result in onycholysis.
  • Infections: Fungi (Trichophyton rubrum and mentagrophytes), bacteria, yeast and viral infections.
  • Medications: Certain medications like tetracycline, oxsoralen, minocycline, naproxen make individuals unusually sensitive to light. Sunburns occurring under these sensitised nails can cause onycholysis.
  • Hyperthyroidism and iron deficiency
  • Skin diseases like psoriasis and dermatitis

What are the symptoms of onycholysis?

The symptoms include:

  • An irregular border between the white outer edge of the nail and the pink part of the nail occurs when the nail lifts from the nail bed.
  • The large part of the nail, the opaque region can whiten, turn yellow or green.
  • Secondary infection can lead to discoloration underneath the nail.
  • The nail surface can get deformed with the thickening of skin beneath the nail plate’s edge.
  • Pain

How is onycholysis diagnosed?

Your doctor can easily diagnose it by clinically examining the fingernails. Your doctor will also look for the signs of rashes and other problems.

A sample of the nail bed tissue could be scrapped to test for the presence of fungus if fungal infection is suspected.

What is the treatment for onycholysis?

The treatment for onycholysis includes:

  • Addressing the cause (such as hyperthyroidism or iron deficiency) can help the nails regrow normally.
  • Nail infections are treated with antimicrobials.

The separated nail plate will not reattach, and you need to wait for the nail to regrow (4-6 months for fingernails and double the duration for toenails).

Prevention

  • Avoid deep mechanical cleaning of undersurfaces of the nails.
  • Clip nails to appropriate length to prevent damage from tapping routinely on a keyboard.
  • Use rubber gloves during washing dishes and cleaning.

Complications

The complications of onycholysis include

  • Discomfort
  • Functional impairment

Next Steps

Visit your doctor if you notice any unusual changes in your nails.

Consult a top Dermatologist

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References

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  • Zaias N, Escovar SX, Zaiac MN.. Finger and toenail onycholysis. J Eur Acad Dermatol Venereol. 2015 May;29(5):848-53.
  • American Osteopathic College of Dermatology. http://www.aocd.org/?page=Onycholysis. Accessed 16 Aug. 16.
  • DermNetNZ. http://www.dermnetnz.org/topics/onycholysis/. Accessed 16 Aug. 16.

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