How to Treat Onycholysis (Nail Separation)

Onycholysis is a condition where the nails, either on the hands or feet, gradually detach from the nail bed. Trauma is the most common cause, but other factors may also lead to onycholysis. It’s important to consult a doctor to determine the cause. If there is an underlying condition causing the issue, the doctor can treat it to help the nails heal. If the cause is trauma or prolonged exposure to moisture or chemicals, onycholysis can usually be resolved with appropriate treatment and preventive measures.

Visit a doctor if you experience symptoms of onycholysis. The doctor can diagnose the cause of onycholysis by examining the nails. They may also take a sample of tissue beneath the nail to test for fungi or other infections. Seek medical attention if you notice any of the following symptoms:

• One or more nails lifting off the nail bed beneath
• The edge between the nail bed and the white nail portion appears irregular
• The wider part of the nail becomes cloudy or discolored
• The nail plate becomes deformed due to dents or curved ridges

Inform your doctor about all the medications you are currently taking. Some medications can cause the nails to react to sunlight, leading to nail separation. Notable examples include psoralens, tetracycline, and fluoroquinolones. Be sure to tell your doctor about any prescription or over-the-counter medications you're using so they can rule out this cause.

Notify your doctor if you have a history of psoriasis or other skin conditions. Let your doctor know if you have been diagnosed with psoriasis, as this condition can lead to onycholysis. If you haven’t been diagnosed, share any recent skin issues with your doctor. Symptoms of psoriasis may include:

• Dry, cracked, or bleeding skin
• Red patches on the skin
• Silver scaly patches on the skin
• Itchy, burning, or painful skin

Tell your doctor about any recent injuries to your hands and feet. Injuries to the nail bed can gradually cause painless onycholysis. Inform your doctor if you've had any injuries that affected your nails, such as impacts or punctures that caused the nails to tear or rip.

• Injuries can range from minor incidents like stubbing your toe to more serious accidents, such as pinning your finger in a car door.

Consider environmental factors. Exposure to environmental triggers can damage the nails, gradually causing onycholysis. Review your usual activities, such as cleaning, manicuring, and other habits, to identify possible causes. Environmental and occupational factors that harm the nails include:

• Prolonged water immersion (such as frequent swimming or dishwashing)
• Frequent nail painting, using fake nails, or nail polish removers
• Regular exposure to chemicals, such as cleaning products
• Wearing tight shoes that put uneven pressure on flat feet

Trim your nails to prevent further damage. Nails that have detached from the nail bed are highly vulnerable. Ask your doctor if they can assist with removing the detached part at the clinic. If you do this at home, there's a risk of pain, infection, or further injury to the nail.

• If an infection is present under the nail, removing the nail allows for direct application of treatment to the infected area.

Use antifungal medications if onycholysis is caused by a fungal infection. Nails can only grow back once the fungus and bacteria beneath the nail have been eliminated. After diagnosing a fungal infection, your doctor will prescribe either oral or topical antifungal treatments to aid in recovery. Follow the prescribed dosage until new healthy nails begin to grow.

• Oral medications may need to be taken for 6-24 weeks, depending on the severity and nature of the condition.
• Topical creams or ointments should be applied daily around the nail bed and generally show slower results.
• Oral medications are generally more effective than topical treatments but carry potential risks, such as liver damage.
• Follow up with your doctor after 6-12 weeks of treatment.

Consult your doctor about treatment options for onycholysis caused by psoriasis. Psoriasis is a common cause of onycholysis. Discuss treatment plans with your doctor to choose the most effective method. Available options include:

• Oral medications like methotrexate, cyclosporine, and retinoids
• Topical treatments like corticosteroids, synthetic vitamin D, anthralin, calcineurin inhibitors, salicylic acid, and topical retinoids
• Light therapies such as UVB, narrow-band UVB, and excimer laser
• Natural remedies like aloe vera, fish oil, and topical creams made from Oregon grape extract

Ask your doctor about supplements if you're deficient in vitamins and minerals. Vitamin and mineral deficiencies can weaken the nails, making it difficult for them to regrow. Inquire with your doctor about taking supplements to strengthen your nails, especially iron, which can help improve nail strength.

• Biotin, a type of B vitamin, can also improve nail condition.
• Taking a daily multivitamin will help you meet your body's overall health needs.
• Your doctor may recommend dietary changes to increase the intake of necessary vitamins and minerals.

Apply a drying solution prescribed by your doctor. To protect your nails from moisture during recovery, use a drying solution after your hands or feet get wet. Ask your doctor if they can prescribe a drying solution like Thymol 3% in alcohol. This solution can be applied directly to the nail using a dropper or small brush.

• Apply the drying solution for 2-3 months during the recovery phase of the nail.

Keep your nails clean and dry. Prevent bacteria and fungi from growing under your nails by washing your hands frequently throughout the day. Lather a gentle hand soap to create foam and wash thoroughly. Be sure to dry your nails well after they get wet.

Choose the right size shoes. Shoes that are too small can squeeze your toes and cause injury. Continuous pressure on the nails can lead to onycholysis.

Avoid wearing wet shoes for long periods. Wet feet can cause nail infections and lead to onycholysis. Wear waterproof shoes or boots if you need to walk or exercise in damp conditions. Remove shoes and sweaty socks immediately after exercising to prevent bacterial growth.

• Allow shoes to fully dry if they become wet.
• If you exercise regularly, consider buying multiple pairs of sneakers to avoid wearing wet shoes.

Wear gloves when cleaning. Prolonged exposure to chemicals and frequent immersion in water can cause onycholysis. Protect your hands by wearing rubber gloves when cleaning, doing dishes, or performing similar tasks. Gloves also protect long nails from injury while doing household chores.

Trim and keep nails clean. Moisture and bacteria tend to accumulate under long nails, increasing the risk of onycholysis. To prevent this, it is recommended to regularly trim your nails short and neat. Use clean nail clippers when cutting your nails and remember to smooth the edges with a nail file.

• Short nails also have a lower risk of injury.