Onycholysis: When your nail lifts from the nail bed

Onycholysis is when a fingernail or toenail starts to lift away from the nail bed, creating a gap underneath. This condition can be caused by injuries, infections or even reactions to certain nail products, according to the NIH. While it’s usually not painful at first, it can lead to discomfort or further damage if left untreated.

Treatment depends on the cause and may include medications, keeping the nails clean and dry or avoiding harsh nail polishes and removers. Read on to understand what triggers onycholysis and how to care for your nails, which can help prevent the problem from getting worse.

What is onycholysis?

Onycholysis is a condition where a fingernail or toenail separates from the skin underneath, creating a noticeable gap. The NIH explains that this can happen for many reasons, including injury, infections, allergic reactions or even long-term exposure to moisture. While the nail itself may look normal at first, the space underneath can trap dirt and bacteria, sometimes leading to further problems.

Anyone can develop onycholysis, but certain people are more at risk. Those who frequently use nail products like gel polish or acrylics, work with their hands a lot or have health conditions like psoriasis or thyroid disorders may be more likely to experience it. Onycholysis is fairly common and can affect people of all ages. While it’s usually not serious, treating it early can help prevent complications and keep nails healthy.

Onycholysis causes

There are many reasons why a nail might start to lift from the nail bed. Sometimes, it’s due to something as simple as an injury or constant pressure on the nail. Other times, it can be a sign of an underlying health issue or a reaction to nail products. Knowing the cause of onycholysis can help prevent it from getting worse and guide the best treatment options.

Here are some common causes of onycholysis:

• Injury to the nail – A sudden hit or repeated pressure on the nail can cause it to lift.
• Wearing tight shoes – Too much pressure on the toenails from snug footwear can lead to separation.
• Allergy to nail products – Some polishes, adhesives and removers can irritate the nail and cause detachment.
• Nail fungus – A fungal infection can weaken the nail, making it lift from the nail bed.
• Psoriasis – This skin condition can affect the nails, causing them to thicken, discolor or separate.
• Frequent exposure to water or chemicals – Too much moisture or contact with harsh chemicals can weaken the nail structure.

Symptoms of onycholysis

Onycholysis often starts with a small change in the nail, but over time, it can become more noticeable and uncomfortable, according to the NIH.. The nail may lift at the tip, change color or even develop an odd texture. While onycholysis itself isn’t usually painful, it can lead to infections or further nail damage if left untreated. Paying attention to these symptoms can help catch the condition early and prevent it from getting worse.

Some common signs of onycholysis include:

• Nails that peel – Layers of the nail may start to separate or flake off.
• Tough, thick nail beds – The skin underneath the nail may harden or become rough.
• Discoloration in your nails – The nail may turn white, yellow, brown or even green.
• Dents or pits in your nails – Small depressions or uneven surfaces can appear on the nail.
• Crumbling nails – The nails may become weak and start to break apart.
• Hemorrhages underneath your nails – Small red or black spots from bleeding under the nail may develop.
• Foul odor – If an infection is present, the nail may give off a bad smell.
• Pain or tenderness – While onycholysis isn’t always painful, irritation or infections can cause discomfort.

What tests are performed to diagnose onycholysis?

If your nail starts to lift or change in appearance, the NIH explains that your healthcare provider may run a few tests to figure out what’s causing it. Since onycholysis can result from infections, allergies or underlying health conditions, testing helps determine the best treatment. Your provider will examine your nails, ask about your medical history and perform specific tests to check for infections or other issues.

Some standard tests used to diagnose onycholysis include the following:

• Biopsy – A small piece of nail or skin is taken and examined under a microscope to check for conditions like psoriasis or other skin disorders.
• Fungal test – Your provider may scrape some debris from under the nail and send it to a lab to see if a fungal infection is present.
• Blood test – Since onycholysis can be linked to thyroid issues or other health conditions, a blood test can help rule out underlying medical causes.
• Patch test – If an allergic reaction is suspected, your provider may do a skin patch test to see if nail products or other chemicals are triggering the problem.

Onycholysis treatment

The right treatment for onycholysis depends on what’s causing it. In many cases, making small changes to your nail care routine can help the nail heal over time. If an infection or medical condition is to blame, your healthcare provider may recommend medications to treat the underlying issue. No matter the cause, keeping the nail clean and protected is key to preventing further damage and helping it grow back healthy, according to the NIH. They list the following as possible treatments for onycholysis:

Self-care

Simple at-home care can make a big difference. Keeping nails trimmed, avoiding harsh nail products and wearing gloves when using chemicals or working with water can help prevent worsening damage. If tight shoes are the issue, switching to a better-fitting pair can ease pressure on the toenails.

Oral medication

If a fungal infection or another health condition is causing onycholysis, your doctor may prescribe oral medications. Antifungal pills can treat nail fungus from the inside out, while other medications may be needed if thyroid issues or psoriasis are contributing factors.

Topical medication

For mild cases, topical treatments like antifungal creams or medicated nail lacquers can be applied directly to the affected nail. If a bacterial infection is present, an antibiotic ointment may also be recommended to prevent further complications.

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