What happens to the nail
The nail plate normally fits tightly to the bed, and the border between the pink attached part and the white free edge is smooth. With onycholysis, this border shifts to the base, and a cavity forms under the exfoliated area. Water, soap, dirt particles and microorganisms get there, so detachment often progresses and can be complicated by secondary infection. It doesn’t hurt the plate itself, but the nail becomes fragile, clings to clothing and is easily further injured. The detached part can no longer attach back.
- Cavity between plate and bed
- White or yellowish color of the exfoliated part
- Accumulation of moisture and dirt under the nail
- Risk of secondary bacterial or fungal infection
- Reverse growth is not possible
Reasons
On the hands, mechanical and chemical influences are most often to blame: the habit of picking under the nails and cleaning them with sharp objects, prolonged work in water without gloves, aggressive manicure, hardware treatment, gel polish and extensions, especially frequent removal. On the feet, the main cause is injury and pressure from tight shoes, as well as fungus. Among skin diseases, the first place is occupied by psoriasis, which can only affect the nails. Less commonly, the cause is thyrotoxicosis, iron deficiency, pregnancy, as well as a reaction to certain drugs during sun exposure.
- Injuries and impacts
- Wet work without gloves
- Manicure, gel polish, extensions
- Tight shoes
- Fungal infection
- Nail psoriasis
- Thyrotoxicosis and iron deficiency
- Photosensitizing drugs
How to make a diagnosis
The doctor examines all nails, assesses the separation boundary, the color and condition of the surface of the plate, checks the nail folds and skin, including the elbows, knees and scalp, where signs of psoriasis are often found. Dermatoscopy helps to examine the structure and distinguish hemorrhage from pigment. A scraping or section of the nail is sent for microscopy and culture: without this, antifungal drugs cannot be prescribed. In case of multiple lesions and the absence of an obvious external cause, TSH and ferritin are checked and medications taken are specified.
- Inspection of all nails and skin
- Dermatoscopy of the nail plate
- Microscopy and culture of material
- Checking for signs of psoriasis
- TSH and ferritin in multiple lesions
- Clarification of medications taken
What to do
The first rule is to keep your nails dry and short: the exfoliated part is carefully trimmed so that it does not cling and moisture does not accumulate under it, but do not break it off. Do housework with gloves, preferably with a cotton lining, and dry your hands thoroughly after washing. During treatment, varnish, gel polish and extensions are abandoned: the coating seals the cavity and promotes the proliferation of microbes. You should not clean out the void under the nail with sharp objects - this will deepen the peeling. The doctor prescribes treatment for the underlying cause.
- Trim the loose part short
- Keep nails dry
- Gloves in contact with water and chemicals
- Refusal of varnish and extensions
- Do not clean under the nail with sharp objects
- Treatment of fungus or psoriasis as prescribed by a doctor
Timing and prevention
Even if the cause is eliminated, the nail on the hand grows completely in 4-6 months, on the foot - in 9-18 months, so the result is not immediately visible: first, an even attached area appears at the base, and improvement is judged by it. To prevent peeling from happening again, you should choose comfortable shoes, observe pauses between coats, ask the technician not to use aggressive treatment or remove the cuticle deeply, protect your hands when cleaning and treat foot fungus in a timely manner. With psoriasis and thyroid diseases, it is important to control the underlying disease.
- Regrowth on arms takes 4–6 months, on legs longer
- Control by the attached part at the base
- Comfortable shoes without putting pressure on your toes
- Pauses between nail coatings
- Gentle manicure without deep processing
- Timely treatment of foot fungus