50 year old woman presents and states that her nail is separating from her finger. She reports that it seemed to happen “overnight”. She washes her dishes, twice daily, by hand. She also plays the piano on a regular basis (3-5 times per week) and works with a computer keyboard updating her music blog daily. She is otherwise healthy and taking no medications other than a daily multivitamin with iron.
What’s your diagnosis?
Onycholysis is the separation of a nail from the nailbed (the skin the nail attaches to). The separation may seem to appear suddenly, but it usually occurs gradually over time.
Trauma is the most common cause of onycholysis. Sometimes the trauma can be so minor you're not even aware of it. The trauma can be from the nervous tapping of fingernails on a desktop or the repeated striking of the nails on a computer keyboard or musical instrument.
Mild and repetitive trauma is the most common cause of onycholysis. Even the repeated trauma of manicure tools can cause onycholysis. The problem is that something is preventing the nail from attaching smoothly to the nailbed.
Other cause of onycholysis may include:
- Fungal infections of the nails
- Repeated exposure to water
- Medications including some antibiotics
- Thyroid disease
The only treatment for onycholysis is for the.
- Keep nails trimmed close to prevent repetitive tapping trauma.
- Wear rubber gloves to avoid repetitive water exposure. This can also help to minimize nail infections.
- Avoid frequent exposure to harsh chemicals.
Treatment for onycholysis depends identifying the etiology. Review for trauma issues. Evaluate for psoriasis or thyroid disease or a nail infection. In troublesome cases I have had patients apply a drop of super glue under the nail and hold until dry. This will keep the nail in place for a few days and prevent it from getting caught, snagged or pulled off during daily activities.
The goal is for the new nail to attach itself to the nail bed and grow out to replace the affected area. Fortunately, many nail changes, including onycholysis, are not permanent. Even after treatment, onycholysis can take many months to resolve. Sometimes onycholysis can be extremely difficult to treat and may remain refractory to all treatments.
For additional information please see:
Article on nail conditions