Onycholysis
Symptoms
Onycholysis refers to the painless separation of the nail from the nail bed. It usually starts at the tip and progresses toward the cuticle. The affected portion of the nail may appear white, yellow, or green depending on secondary infection. The nail may become brittle or distorted. While typically not painful, it can become tender if debris collects under the nail. Fingernails are more often affected than toenails. Patients may feel embarrassed about nail appearance. The detachment may occur gradually or suddenly.
Cause
Causes include trauma (nail injury or aggressive manicures), fungal infections, psoriasis, thyroid disease, or certain medications (e.g., tetracyclines). Prolonged water exposure and chemical irritants can also weaken the nail. It may also occur in systemic diseases or as a side effect of chemotherapy. Psoriasis and lichen planus are common dermatologic causes. It is not usually infectious unless accompanied by secondary fungal or bacterial growth. Identifying the underlying cause is key to treatment.
Treatment
Treatment depends on the cause—removing triggers such as trauma, moisture, or irritants is the first step. Fungal causes require topical or oral antifungals. Psoriasis-related onycholysis may be treated with corticosteroids or systemic immunosuppressants. Keeping the nails trimmed, dry, and protected is essential to promote reattachment. Avoiding aggressive nail care and chemical exposure helps prevent recurrence. In some cases, full resolution may take months. Wearing gloves during wet work can be protective. A dermatologist can evaluate for systemic causes if onycholysis is persistent or recurrent.
Dr. Beth Schulz-Butulis
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