Are your nails peeling off your skin? Let's talk about this (Onycholysis)!

Have you ever noticed that a nail on your hand or foot just lifts up from the skin underneath and seems to come off? Maybe the color of the nail has changed. This can be a bit worrying, right? Don't worry, this happens to many people. Today, we'll talk about this condition called ``Onycholysis'' in a simple way that you can understand.

What is this so-called onycholysis?

Simply put, onycholysis is when your fingernail or toenail (doctors call it the nail plate) separates from the skin it's attached to (called the nail bed). It feels like the nail is just peeling off. Most of the time, this happens to just one nail. Sometimes, it can happen to multiple nails, but it's rare.

Who can grow this much?

In fact, this condition called ``Onycholysis'' can develop in anyone. However, some people are more likely to develop it.

• For women: This is slightly more common among women than men.
• For adults: This risk may increase with age.
• People with certain skin conditions: For example, people with skin conditions like psoriasis, lichen planus, nail fungus, or tumors under the nails can also see this.

How common is this? How long does it last?

Onycholysis is actually not as rare as you might think, it is a very common condition. It can last for months, sometimes even more than a year. Remember, anything that affects the skin under your nails can eventually lead to this condition.

What are the symptoms of this?

If you have Onycholysis, you may experience symptoms like:

• Peeling away from the skin under the nail: This is the main symptom.
• Thickening of the skin under the nails, feeling of tightness.
• An unusual border appears between the pink part of the nail and the white edge at the tip of the nail: This border may be wavy. The white part may be thicker in some places and thinner in others.
• Changes in the color of the nails and the skin under the nails: may be gray, green, purple, white, or yellow.
• The formation of small cup-like depressions in the nails.
• Nails become brittle and break easily.
• Seeing small hemorrhages (hemorrhages) under the nails.

Onycholysis is usually painless. However, if it is caused by an injury or fungal infection, then you may feel pain or inflammation.

Why does onycholysis occur? What are the causes?

There could be several reasons for this. Let's look at the main ones.

• Injury (`(Trauma)`):
• This can happen due to injury to the nail or to the area where the nail begins to grow (the ``nail matrix``). For example, this can happen if your nail gets hit somewhere, when you wear tight shoes, or when you constantly keep your nails in water.
• Many people regularly go to nail salons for manicures. The force used to cut, clean, and polish the nails can sometimes cause onycholysis.
• Just think, if you've been tapping your nails on something for a long time (e.g. a table), that could also be a reason.

• Reaction to chemicals:
• This condition can also be caused by the chemicals in the nail polishes, nail glosses, nail hardeners, nail polish removers, and fake nails that we use to be beautiful.

• Fungal Infections (`(Fungal Infections)`):
• This infection usually occurs when a fungus enters the nail and the skin under the nail through a small crack or cut on a finger or toe. Fungal infections can cause the nail to become thick and yellow. You may also see white spots or streaks.

• Some medications (`(Medications)`):
• Onycholysis can also be caused by chemotherapy for cancer, as well as certain medications that cause sensitivity to light. Examples include the antibiotic tetracycline, some nonsteroidal anti-inflammatory drugs (NSAIDs), psoralens, and oral retinoids.

• Psoriasis (bark) condition of the nails:
• Nail psoriasis causes changes in the structure of the nails. This is also one of the causes of onycholysis.

Rare causes that affect all nails

Onycholysis usually affects one or two nails. However, very rarely, it can affect all of your fingernails and toenails. Possible causes include:

• Iron deficiency: This can happen if you don't get enough iron from your diet. Iron deficiency can also cause a condition called anemia.
• Hyperthyroidism: This is when the thyroid gland in your neck produces more hormones than your body needs. This can cause symptoms such as a fast heartbeat, unexplained weight loss, increased appetite, and anxiety disorders.

Is this a fungal infection?

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

Is this contagious?

Whether this is contagious or not depends on the cause of the onycholysis.

• If Onycholysis is caused by an injury, psoriasis, or a reaction to a medication or chemical, it is not contagious.
• However, if Onycholysis is caused by a fungus, it can be contagious.
• This fungus can be spread from one infected person to another through skin-to-skin contact.
• Also, fungal infections can be spread by touching an infected surface (e.g., walking barefoot around public swimming pools, bathrooms) or by sharing items such as towels and nail clippers.

How do you recognize this?

Onycholysis is a condition that is easily recognized. Therefore, if you know what is causing it, you don't necessarily need to see a doctor to confirm whether it is Onycholysis.

However, if you can't figure out why this is happening, it's best to see a doctor. He/she will carefully examine your affected nails and assess your symptoms.

What tests are being done?

The doctor may perform several tests to confirm Onycholysis and find the cause:

• Biopsy: This is where the doctor takes a small sample of cells from your fingernail, either with a razor or a scalpel. These cells are sent to a lab and examined under a microscope.
• Fungal test: A small piece of your nail is scraped off and either a Potassium Hydroxide (KOH) preparation or a Fungal culture is done to see if it is caused by a fungus. If those tests are not clear, a Periodic Acid-Schiff (PAS) stain can also be done.
• Blood test: Here, a small sample of blood is taken from a vein in your arm to check for any other systemic disease that could be causing Onycholysis.

Is there a treatment for this? Can it be cured?

To be honest, it's impossible to reattach a part of the nail that has fallen off. It can't be cured. However, treatment can help the newly growing part of the nail adhere well to the skin underneath the nail.

What is the treatment?

• If you have onycholysis due to an injury: The detached nail will gradually loosen and fall off. Carefully cut off the part with nail clippers or nail scissors.
• If you have Onycholysis due to a fungus: You may have these treatment options:
• Oral antifungal medication: Your doctor may give you a liquid medicine, a pill, or a tablet. Examples include Terbinafine (Lamisil®), Itraconazole (Sporanox®), and Fluconazole (Diflucan®).
• Topical antifungal medications: These come in the form of creams, ointments, or gels. They are applied directly to the nails.

Nail fungus can be difficult to treat. Therefore, it is very important to use the medication exactly for the full course prescribed by your doctor. If you stop taking it too soon, the fungus may come back and be even harder to treat.

How do you take care of your nails during this time?

If you have Onycholysis, these things can help you take care of your nails:

• Use the medicine exactly as the doctor tells you.
• Always keep affected nails trimmed short. Carefully trim and remove any loose nails.
• Protect your nails from further damage.
• Wash your hands thoroughly to prevent infections. Use something like a clean cloth to clean under your nails.
• Soak your nails in an antifungal or antimicrobial solution to help prevent infection. You can use lemon juice, vinegar, hydrogen peroxide, and essential oils like tea tree oil, orange oil, or clove oil.
• But remember, although these essential oils are safe for most people, it's best to consult a doctor before using them. You may have an allergic reaction.

How can this be prevented from happening?

Following these tips will help prevent the development of ``Onycholysis``:

• Keep your nails trimmed short. This will reduce the chance of your nails getting tangled and peeling off the skin under your nails.
• If you have the habit of biting your nails, quit it.
• Be very careful when cleaning under your nails. Some tools (e.g. cuticle sticks, nail brushes) can damage the skin under your nails and cause infection.
• Avoid using chemicals or products that are harmful to your nails or the surrounding skin. This can include nail polish, nail gloss, nail strengtheners, nail polish removers, and artificial nails.
• Wear gloves when doing tasks that can damage your nails, such as washing dishes, playing sports, or gardening.
• Wear clean socks and comfortable, safe shoes.
• Be careful when carrying heavy objects near your feet.

How long will this situation last? Will it get better?

If you and your doctor can find the cause of your onycholysis, your nails will grow back, but they will definitely grow back. However, fingernails grow back very slowly, and toenails even more slowly. It can take about 6 to 9 months for a fingernail to completely grow back. It can take about 12 to 18 months for a toenail to grow back. So you have to be patient.

When should you see a doctor?

See a doctor in the following cases:

• If you have other serious symptoms (e.g., extreme fatigue, chills, dizziness or weakness, headache, tongue sores, rapid heartbeat) along with onycholysis.
• If symptoms do not improve despite treatment.
• If the skin around the nail looks infected (red, purple, gray or white; inflamed and swollen).

Questions to ask your doctor

When you go to see the doctor, you can ask questions like these:

• Doctor, how exactly do you tell if I have `(Onycholysis)`?
• If I don't have Onycholysis, what other condition could it be?
• Why did this happen to me?
• If this is caused by a fungus, how can I prevent it from spreading to other parts of my body?
• If this is caused by a fungus, how can I prevent it from spreading to others?
• What kind of medicine does the doctor recommend?
• Are there any side effects from those medications?
• Are there any treatments that can be done at home?
• Are there any side effects from those home treatments?
• What else should I do to help my nails heal faster?
• Should I see a dermatologist or another specialist?

Finally, things to remember

Onycholysis is when your nail comes away from the skin underneath it. It is usually painless, but can be contagious if it is caused by a fungus.

It's important to take care of your nails. If you notice a nail peeling off like this without any injury or anything, it's wise to see a doctor right away. It could be a fungus, or it could be a symptom of a more serious condition. So, it's best to pay attention to your body.

` Onycholysis, nail separation, nail diseases, nail separation, nail bed, fungal infection, nail fungus, skin diseases