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Onycholysis: Causes, Symptoms, Diagnosis, Prevention And Treatment

Onycholysis is a condition in which a person's nail or nails detach from the skin underneath. It is not serious in nature, however, can be a symptom of any other serious illnesses. The condition develops when your nail separates from the nail bed or the skin located right under the nail and can last for several months. Onycholysis usually gets cured with time, that is when the nail completely grows out [1] .

The recovery time for onycholysis varies from one person to the other, as it is dependent on an individual's level of nail growth. In most cases, fingernails take about 4 to 6 months and toenails take up to 8 months.

Causes Of Onycholysis

The reason behind the condition can vary from one person to the other. One of the most common causes of onycholysis is any underlying medical conditions. In some people, it can develop due to any injury or repetitive trauma such as, slamming your finger between gates/doors, or stubbing your toe [2] .

Onycholysis can also develop from repeatedly tapping your nails for a long time, causing your nails to get separated from the skin or the nail bed[3] .

Apart from the aforementioned, the following are some of the most common causes of onycholysis [4] :

  • Reaction to medication
  • Allergies caused by chemicals, such as nail polish, nail polish remover, or household cleaners
  • Fungal infections in the feet
  • Psoriasis

Some of the health problems that can cause onycholysis are as follows [5] :

  • A severe yeast infection
  • Vitamin and mineral deficiencies
  • Thyroid disease

Symptoms Of Onycholysis

When an individual develops the condition, the nail will start to pull away from the nail bed beneath. The nail will begin to peel upward and is not usually painful. The symptoms of onycholysis are as follows [6] [7] :

  • A change in the nail colour (such as white, grey, yellow, green and purple)
  • Mild pain caused by underlying health conditions
  • A larger portion of the nail becomes opaque, can be whitened or discoloured to yellow or green

Diagnosis Of Onycholysis

Usually, your doctor will be able to diagnose your onycholysis just by looking at your nail. However, your doctor may want to take a sample of the skin beneath the nail to check for certain fungal infections or psoriasis [8] .

If your doctor suspects that the condition is caused by your thyroid, the doctor may administer certain tests to check for a thyroid disorder.

Treatment For Onycholysis

Determining the cause of your onycholysis is the most important step. Once the cause is found, treating the underlying issue will help the nail lifting resolve. Treating the correct condition will allow the nail to heal and reattach to the skin as it grows out again. The cause of the nail separation will need to be addressed before the symptoms stop occurring. It is important that you go meet a doctor, especially in the case of a recurring onycholysis [9] .

It is not uncommon to have onycholysis as a symptom of psoriasis. At least 50 per cent of people with psoriasis experience problems with their nails. Therefore, for these individuals, the treatment for psoriasis is recommended. Doctors may prescribe topical vitamin D or corticosteroids to treat nail psoriasis [10] .

A blood test may reveal that you have a thyroid condition or vitamin deficiency which is causing the onycholysis and the treatment prescribed will be comprised of medication or oral supplements.

Home Remedies For Onycholysis

Home remedies that may help onycholysis include a range of essential oils.

  • Tea tree oil can be used to help treat the infections, which when combined with carrier oil has natural antifungal properties [11] .
  • Do not clean underneath the nail, as that could sweep bacteria deeper underneath the nail.

Prevention Of Onycholysis

It is not always possible to prevent onycholysis. However, the following steps can be useful [12] .

  • Wear gloves and appropriate footwear when exercising.
  • Manage your thyroid conditions.
  • Consume a balanced diet and supplementing with vitamin D and iron.
  • Avoid wearing warm, wet shoes for prolonged periods.
  • Manage your psoriasis with therapies and medications.
View Article References
  1. [1] Zaias, N., Escovar, S. X., & Zaiac, M. N. (2015). Finger and toenail onycholysis. Journal of the European Academy of Dermatology and Venereology, 29(5), 848-853.
  2. [2] Tern, P. J. W., & Gass, J. (2018). Case report: photo‐onycholysis after PUVA treatment for hypopigmented mycosis fungoides with response to topical steroid. Clinical case reports, 6(2), 267-268.
  3. [3] Al-Kathiri, L., & Al-Asmaili, A. (2016). Diclofenac-induced photo-onycholysis. Oman medical journal, 31(1), 65.
  4. [4] Malan, M., Dai, Z., Jianbo, W., & Quan, S. J. (2019). Onycholysis an early indicator of thyroid disease. The Pan African Medical Journal, 32.
  5. [5] Bétrian, S., Gomez-Roca, C., Vigarios, E., Delord, J. P., & Sibaud, V. (2017). Severe onycholysis and eyelash trichomegaly following use of new selective pan-FGFR inhibitors. JAMA dermatology, 153(7), 723-725.
  6. [6] Iorizzo, M. (2015). Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatologic clinics, 33(2), 175-183.
  7. [7] Aghazadeh, N., Sotoudeh, S., Ghanadan, A., Tajalli, M., & Norton, S. A. (2019). Onycholysis and subungual purpura of nails. International journal of dermatology, 58(4), 425-427.
  8. [8] Yorulmaz, A., & Yalcin, B. (2018). A novel dermoscopic feature in traumatic onycholysis. Our Dermatology Online/Nasza Dermatologia Online, 9(3).
  9. [9] Van Loon, J., Van Glabbeek, L., Smedts, S., Serneels, S., Herweyers, L., & De Bruyne, G. (2018). Prevention of Onycholysis During Cancer Treatment Using an Active Local Cooling Device: Comparison of Three Different Cooling Strategies. In Proceedings of the 20th Congress of the International Ergonomics Association (IEA 2018).: Healthcare ergonomics (Vol. 818, p. 214). Springer.
  10. [10] Dow, E. N., Piccolo, J., Segal, E. M., & Charlson, J. A. (2015). Drug induced periarticular thenar erythema with onycholysis related to nano-albumin bound paclitaxel therapy. Cancer Treatment Communications, 4, 161-164.
  11. [11] Pawar, M., & Singh, M. (2018). Sparfloxacin-induced photo-onycholysis and photosensitivity characteristically sparing lepromatous skin lesions: an interesting observation. Acta dermatovenerologica Alpina, Pannonica, et Adriatica, 27(3), 149-151.
  12. [12] Thomas, R., Williams, M., Cauchi, M., Berkovitz, S., & Smith, S. A. (2018). A double-blind, randomised trial of a polyphenolic-rich nail bed balm for chemotherapy-induced onycholysis: the UK polybalm study. Breast cancer research and treatment, 171(1), 103-110.
    Read more about: onycholysis
    Story first published: Tuesday, December 17, 2019, 18:30 [IST]
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