Are Your Nails Peeling Off Your Skin? Here Is What You Need to Know About Onycholysis

Have you ever noticed that a fingernail or toenail is lifting away from the skin underneath it for no obvious reason? You might even see that the color of your nail has changed. This can feel quite stressful and worrying when you first spot it.

Try not to worry too much, as this is a common condition that affects many people. Today, we will talk about onycholysis in a simple, clear way that is easy for you to understand.

What Is Onycholysis?

Simply put, onycholysis is when your fingernail or toenail (which doctors call the nail plate) separates from the underlying skin (which doctors call the nail bed). It feels and looks like the nail is lifting up from underneath.

Most of the time, this happens to just one nail. Sometimes it can affect a few nails at the same time, but that is less common.

Who Is Most Likely to Get It?

Actually, anyone can experience onycholysis. However, certain people have a higher chance of developing this condition.

• Women: This condition is somewhat more common in women than in men.
• Older adults: The risk tends to increase as people get older.
• People with certain skin conditions: Conditions like psoriasis, lichen planus, nail fungus, or benign growths under the nails can make onycholysis more likely.

How Common Is It, and How Long Does It Last?

Onycholysis is not rare at all; it is a very common condition. Once it starts, it can last for several months, and in some cases, even more than a year. Remember that anything affecting the health of the skin under your nail can eventually lead to onycholysis.

What Are the Symptoms?

If you have onycholysis, you might notice several distinct signs and symptoms:

• Nail lifting away from the skin: This is the main and most noticeable sign.
• Thickening of the skin under the nail: The nail bed may feel firmer or thicker to the touch.
• An unusual border: You might see an irregular boundary between the pink part of your nail and the white tip. This edge can sometimes look wavy. The white part may be thick in some spots and thin in others.
• Color changes: Your nails and the skin underneath can turn gray, green, purple, white, or yellow.
• Small dents: You may notice tiny cup-like depressions on the surface of your nail.
• Brittle nails: The nails can break or crumble very easily.
• Under-nail bleeding: Tiny spots of bleeding or small hemorrhages can appear beneath the nail.

Usually, onycholysis does not cause any pain. However, if the cause is a sudden injury or a fungal infection, you might feel some pain, tenderness, or burning.

Why Does Onycholysis Happen? What Are the Causes?

There are several different reasons why this condition can occur. Let us look at the main causes in detail.

• Physical Trauma:.
• Injuries to the nail or to the area where the nail grows (the nail matrix) can cause the nail to lift. For example, stubbing your toe, wearing tight shoes, or keeping your hands in water for too long can trigger it.
• Many people visit nail salons often for manicures. The pressure applied during nail trimming, cleaning, polishing, or filing can sometimes cause onycholysis.
• Even tapping your nails against a hard surface like a desk for a long time can act as a contributing cause.

• Reaction to Chemical Products:.
• The chemicals found in nail polishes, nail glosses, nail hardeners, nail polish removers, and artificial fake nails can irritate the nail bed and cause this condition.

• Fungal Infections:.
• If a fungus enters through a tiny crack or cut on your finger or toe, it can infect the space between the nail and the nail bed. Fungal infections often make nails thicker and yellowish, and you might see white spots or streaks.

• Certain medicines:.
• Chemotherapy treatments for cancer, as well as drugs that cause sensitivity to light, can lead to onycholysis. Examples include tetracycline antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), psoralens, and oral retinoids derived from vitamin A.

• Nail Psoriasis:.
• Nail psoriasis causes changes in the structure and strength of your nails, which often leads to onycholysis.

Rare Causes Affecting All Nails.

Usually, onycholysis affects only one or two nails. However, in very rare instances, it can affect all the fingernails and toenails on both hands and feet. Possible causes for this include:

• Iron Deficiency: Not getting enough iron in your diet can cause this. Iron deficiency may also lead to anemia.
• Hyperthyroidism: This happens when your thyroid gland produces more hormones than your body needs. It can cause a fast heartbeat, unexplained weight loss, increased appetite, and anxiety.

Is This Always a Fungal Infection?

No. Onycholysis is not always a fungal infection. However, as we discussed earlier, fungal infections can sometimes cause onycholysis to develop.

Is It Contagious?

Whether onycholysis is contagious depends entirely on what caused it in the first place.

• If your onycholysis was caused by an injury, psoriasis, a drug reaction, or a chemical irritation, it is not contagious.
• However, if a fungus caused your onycholysis, it can be contagious.
• This type of fungus can spread through direct skin-to-skin contact with an infected person.
• It can also spread by touching contaminated surfaces—such as walking barefoot around public swimming pools and locker rooms—or by sharing towels and nail clippers.

How Is It Diagnosed?

Onycholysis is usually easy to recognize visually. If you already know the exact cause, you do not always need to see a doctor just to confirm that it is onycholysis.

However, if you cannot figure out why it happened, seeing a doctor is the best choice. Your doctor can examine your affected nails carefully and assess your symptoms.

What Tests Are Done?

Your doctor may perform a few tests to confirm onycholysis and find the underlying cause:

• Biopsy: The doctor gently scrapes a small sample of cells from your nail using a small blade or scalpel. This sample is sent to a laboratory and checked under a microscope.
• Fungal Test: A small clipping of your nail is tested using a potassium hydroxide (KOH) preparation or a fungal culture to see if a fungus is responsible. If those tests are inconclusive, a periodic acid-Schiff (PAS) stain test may be performed.

• Blood Test: A small blood sample is drawn from a vein in your arm to check for underlying systemic health conditions that can cause onycholysis.

Are There Treatments? Can It Be Cured?

To be honest, the part of the nail that has already separated cannot be glued back down. It cannot be instantly cured in that sense. However, treatments can help ensure that the new nail growing in stays firmly attached to the skin underneath.

What Treatments Are Used?

• If caused by an injury: The separated portion of the nail will slowly grow out. You can carefully trim away the loose part using clean nail clippers.
• If caused by a fungus: You may have a few treatment choices:.
• Oral antifungal medicines: Your doctor may prescribe liquid medicine or pills such as terbinafine, itraconazole, or fluconazole.
• Topical antifungal medicines: These come as creams, ointments, or gels that you apply directly onto the nail.

Nail fungus can be stubborn and hard to cure completely. Therefore, it is very important to use your medicine for the full course prescribed by your doctor. If you stop too early, the fungus can return and become even harder to treat.

How Should You Care for Your Nails During This Time?

If you have onycholysis, these steps will help you take good care of your nails:

• Follow your doctor's instructions for using medicines precisely.
• Keep your affected nails trimmed short. Carefully cut away any loose nail portions.
• Protect your nails from having further damage.
• Wash your hands thoroughly and often to prevent infections. Use a clean cloth to gently clean underneath the nails.
• Soak your nails in an antimicrobial or antifungal liquid to prevent infections. You can use lemon juice, vinegar, hydrogen peroxide, or essential oils such as tea tree oil, orange oil, or lemongrass oil.
• Remember that while essential oils are safe for many people, it is wise to talk to your doctor before using them because you might have an allergic reaction.

How Can You Prevent This From Happening?

Following these simple guidelines can help you prevent onycholysis:

• Keep your nails trimmed short. This stops them from catching on objects and pulling away from the nail bed.
• Avoid the habit of nail biting.
• Be very careful when cleaning under your nails. Tools like cuticle sticks or stiff nail brushes can damage the delicate skin under your nails and cause infections.
• Avoid using harsh chemicals or products that irritate your nails and surrounding skin. This includes strong nail polishes, glosses, hardeners, removers, and artificial nails.
• Wear protective gloves when doing activities that could harm your nails, such as washing dishes, playing sports, or doing yard work.
• Wear clean socks and comfortable, well-fitting shoes.
• Take care and be cautious when handling heavy objects near your feet.

How Long Will This Condition Last? Will It Get Better?

If you and your doctor can successfully identify and treat the cause of onycholysis, your nails will slowly, but surely, grow back normal. However, fingernails grow very slowly, and toenails grow even slower.

A completely new fingernail can take 6 to 9 months to grow out fully. A toenail can take 12 to 18 months. Therefore, you will need to be patient.

When Should You See a Doctor?

You should make an appointment to see a doctor if you experience:

• Oycholysis accompanied by other serious symptoms, such as extreme fatigue, feeling cold all the time, dizziness, weakness, headaches, tongue sores, or a fast heartbeat.
• Symptoms that do not improve even after trying treatment.
• Signs that the skin around your nail is infected, such as redness, a purple, gray, or white color change, burning, or swelling.

Questions to Ask Your Doctor.

When you visit your doctor, you might find it helpful to ask these questions:

• Doctor, how can you tell for sure that I have onycholysis?
• If I do not have onycholysis, what other condition might this be?
• What specific reason caused this to happen to me?
• If this was caused by a fungus, how can I prevent it from spreading to other parts of my body?
• How can I prevent spreading the fungus to other people?
• What kind of medicine do you recommend?
• Are there any side effects from these medicines?
• Are there any home remedies I can safely try?
• Do those home remedies have any side effects?
• What else should I do to help my nails heal faster?
• Should I see a dermatologist or another medical specialist?

A Note from Dr. Priya Sammani.

Final Thoughts to Remember.

Onycholysis is a condition where your nail separates from the skin underneath. It usually does not hurt, but if it is caused by a fungus, it can be contagious.

Paying attention to your nail health is very important. If you notice your nail lifting without any clear injury, visiting a doctor promptly is the smart thing to do. Sometimes it might be a simple fungus, but it could also be a sign of a more serious health condition. Paying close attention to your body is always your best option.

Sources & References:

• Cleveland Clinic. Onycholysis: Causes, Symptoms & Treatment.
• Mayo Clinic. Nail abnormalities and injuries Overview.
• National Health Service (NHS UK). Nail problems and fungal nail infections guide.
• Centers for Disease Control and Prevention (CDC). Fungal Nail Infections Information.
• National Institutes of Health (NIH / PubMed Central). Clinical evaluation and management of common nail disorders (Onycholysis review).