Onycholysis is the separation of a fingernail or toenail from its pink nail bed. The separation occurs gradually and is painless.
Separation of the nail from the nail bed
The most common cause of onycholysis is trauma. Even slight trauma can cause onycholysis when it happens repetitively — for example, the daily tapping of long fingernails on a keyboard or counter. Onycholysis also can be caused by manicure tools that are pushed beneath the nail to clear dirt or smooth the nail. Too much moisture also can cause the problem.
Some medical conditions can cause onycholysis, generally by changing the nail’s shape or the contour of the soft tissue bed beneath it. In these situations, the nail cannot attach smoothly to the nail bed.
• Fungal infections of the nails thicken the tissue immediately underneath the nail plate and cause edge of the nail to lift.
• The skin condition psoriasis is a common cause of onycholysis.
• After exposure to some medicines (notably medicines from the psoralen, tetracycline or fluoroquinolone groups) the nail can react to sun exposure by lifting away from its bed.
• An overactive thyroid gland can cause onycholysis.
Treatment for onycholysis varies and depends on its cause. Eliminating the predisposing cause of the onycholysis is the best treatment. Onycholysis related to psoriasis or eczema may respond to a midstrength topical corticosteroid. Pulsed dye laser treatment was reported as effective for psoriasis-induced onycholysis in one small series but caution is advised until more data are available regarding this intervention. Psoralen plus ultraviolet A (PUVA) treatment has also been reported as an effective therapy for psoriatic onycholysis. Note the following:
• Avoid trauma to the affected nail, and keep the nail bed dry.
• Avoid exposure to contact irritants and moisture (important).
• Clip the affected portion of the nail, and keep the nails short
• Wear light cotton gloves under vinyl gloves for wet work.