Dr. Crutchfield, my nails seem to be separating and peeling away from my fingers. What is this and what can I do to fix it?
The condition is called onycholysis. Onycholysis is the separation of a nail from the nailbed (the skin the nail attaches to). The separation may seem to appear suddenly, but it usually occurs gradually over time.
Trauma is the most common cause of onycholysis. Sometimes the trauma can be so minor you’re not even aware of it. The trauma can be from the nervous tapping of your fingernails on a desktop or the repeated striking of the nails on a computer keyboard or musical instrument.
Mild and repetitive trauma is the most common cause of onycholysis. Even the repeated trauma of manicure tools can cause onycholysis. The problem is that something is preventing the nail from attaching smoothly to the nailbed.
Other cause of onycholysis may include:
• Fungal infections of the nails
• Pregnancy
• Psoriasis
• Repeated exposure to
water
• Medications including some antibiotics
• Thyroid disease
Diagnosis
On examination, your physician will be able to diagnose onycholysis from the skin under and around the nail. Your doctor may also check for signs of psoriasis, nail infection or thyroid disease. Your doctor may also discuss with you your medications or different hand habits that may lead to repetitive trauma or prolonged water exposure.
If your doctor suspects that a fungal infection is the cause of nail changes, he or she might scrape a sample of tissue from beneath the nail plate. This sample can be tested in a laboratory to check for fungus.
Duration
Fingernails take about six months to grow out and toenails about 9-12 months. Nails are slow to grow and take time to repair themselves. The part of the nail that has separated from the skin below it will not reattach.
The only treatment for onycholysis is for the new nail to attach itself to the nail bed and grow out to replace the affected area. Sometimes onycholysis can be extremely difficult to cure and may last a long time.
Preventive measures
• Keep nails trimmed close to prevent repetitive tapping trauma.
• Wear rubber gloves to avoid repetitive water exposure. This can also help to minimize nail infections.
• Avoid frequent exposure to harsh chemicals.
Treatment
Treatment for onycholysis depends what is causing it. If you have a medical condition such as psoriasis or thyroid disease or a nail infection, after some successful treatment the condition may improve. In troublesome cases I have had patients apply a drop of super glue under the nail and hold until dry. This will keep the nail in place for a few days and prevent it from getting caught, snagged or pulled off during daily activities.
If you have a concern about your nail health, consult your dermatologist. Fortunately, many nail changes, including onycholysis, are not permanent. Even after treatment, they can take many months to go away.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.
