Onycholysis is when a person’s nail or nails detach from the skin underneath. Onycholysis or nails falling off may be a symptom of a potentially serious illness.

It is important for a person to understand what onycholysis is and what it may mean so they can make informed medical decisions.

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Onycholysis may occur in the fingernails or toenails.
Image credit: CopperKettle, (2012, September 9)

Onycholysis can last for several months and will typically correct itself when the nail fully grows out. Until then, the nail will not reattach to the skin beneath it.

Recovery time varies for onycholysis as it is largely dependent on nail growth. It is not uncommon for fingernails to take about 4 to 6 months to grow to a full size. Toenails may take up to 8 months.

When a person has onycholysis, the nail will start to pull away from the nail bed beneath. A person may also notice the nail turns a different color. What color it changes to depends on what is causing the onycholysis.

Some of the possible colors include:

  • white
  • gray
  • yellowish
  • green
  • purple

Onycholysis itself is usually not painful. However, the underlying cause of onycholysis may cause pain.

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Onycholysis may not always have an obvious cause.
Image credit: Alborz Fallah, (2013, August 3)

The cause of a person’s onycholysis varies widely. A person may experience an injury or repetitive trauma.

Simply tapping nails repeatedly for a long time can cause the nail to separate from the skin. Injuries such as slamming a finger in a car door or stubbing a toe may also cause onycholysis.

Some other typical causes include:

  • reaction to chemicals, such as nail polish, nail polish remover, or household cleaners
  • fungal infections, common in the feet
  • psoriasis
  • reaction to medication

If a person’s nails are detaching from the nail bed, it may be because of an underlying medical condition. If onycholysis cannot be explained by one of the more usual causes listed above, it may be one of the first symptoms of something more serious going on inside the body.

Health problems that can cause onycholysis include:

  • a severe yeast infection
  • thyroid disease
  • vitamin and mineral deficiencies

The first step in treating onycholysis is to determine what is causing the nail to lift from the nail. Treating the correct condition will allow the nail to heal and reattach to the skin as it grows out again.

Injuries may not require much additional treatment. However, if the skin opened, it is important to keep the area clean and prevent infection. A person should take care not to clean under the nail, as the water may push bacteria or fungus deeper under the nail.

Fungal Infections require antifungal medication to heal the underlying infection. Typically, fungus medication is administered through medicated creams and ointment applied near or on the nail.

Psoriasis is a chronic skin condition characterized by red, scaly patches on the skin. In some cases, psoriasis flares can affect the nails.

Nails affected by psoriasis may turn an ashy color and detach from the nail bed underneath. Psoriasis is typically treated with topical creams, creams, biologics, systemics, and phototherapy.

Thyroid issues can cause onycholysis and often require medications that help the thyroid regulate hormone production.

Vitamin and mineral deficiencies are often treated with dietary changes. In some cases, a doctor may prescribe or recommend supplements. A person with brittle or detaching nails may be required to take iron supplements to help the nails regain strength.

Home remedies that may help onycholysis include a range of essential oils. There is some evidence that tea tree oil can help treat fungus infections. Often combined with a carrier oil, tea tree oil has natural antifungal properties and might mean a person does not have to seek further treatment.

No matter the cause, it is important for a person to follow a doctor’s instructions on how to treat the underlying condition. Failing to treat the underlying cause fully may result in onycholysis worsening or recurring.

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Wearing comfortable footwear for exercise or work may help to prevent onycholysis from ocurring.

It is not always possible to prevent onycholysis. However, a person can try:

  • avoiding wearing warm, wet shoes for prolonged periods
  • wearing gloves and appropriate footwear when exercising or doing manual labor
  • keeping psoriasis well controlled with therapies and medications
  • eating a balanced diet and supplementing with vitamin D and iron if needed
  • managing any thyroid conditions

Since the nail’s health is a potential visible sign of a more serious condition, it is important to take onycholysis seriously.

No matter the cause, it is possible that further treatment will be needed to fight off the infection. A person should see his or her doctor as soon as possible once the symptoms start.

When the underlying condition is treated and under control, onycholysis will usually clear up over the course of a few months.

Failing to treat the underlying cause may result in further medical complications or the nail failing to heal. It is important to follow a doctor’s recommendations to ensure the underlying condition is treated correctly.