Onycholysis is the medical term for the condition where the nail plate detaches from the nail bed underneath. This separation typically begins at the free edge and progresses backward toward the cuticle. It is frequently painless, though the cause may involve discomfort or inflammation. Understanding how this detachment appears is the first step in identifying the issue and determining the appropriate course of action.
Identifying Characteristics of Nail Lifting
The most obvious sign of nail lifting is a change in the nail’s color and texture in the affected area. When the nail plate lifts from the vascular nail bed, the separated portion no longer appears pink and translucent, but instead becomes opaque and white due to trapped air. This detachment usually begins at the distal edge, the part you clip, and moves inward, creating an irregular or wavy border between the healthy, attached nail and the separated section.
The texture of the nail in the area of onycholysis can feel hollow and may lift easily when gentle pressure is applied. Debris, such as keratin and dirt, accumulates in the space beneath the detached plate, which can make the nail appear thicker. While the initial color is white, secondary changes occur depending on what colonizes the new subungual space.
Specific color shifts can hint at a secondary infection. A greenish or bluish-black discoloration (chloronychia) suggests colonization by the bacterium Pseudomonas aeruginosa. Yellowish or brownish hues may indicate a fungal infection (onychomycosis), which thrives under the separated nail. The underlying nail bed may also appear tough or thickened, and the nail surface might exhibit pitting or crumbling if a skin condition is involved.
Common Triggers Leading to Nail Separation
Onycholysis is often caused by external forces that stress the nail unit. Physical trauma is a frequent culprit, ranging from a single significant injury (like stubbing a toe) to repetitive microtrauma. Aggressively cleaning under the nail or wearing shoes that are too tight can cause the nail to shear away from the bed over time.
Prolonged exposure to water or excessive moisture is another common trigger, as it weakens the integrity of the nail unit and encourages separation. This dampness makes the area susceptible to secondary infections, such as yeast or fungal growth. Occupations requiring frequent hand washing or immersion in water, such as bartending or healthcare work, carry a higher risk.
Chemical exposure from various products can also irritate the nail bed, leading to detachment. This includes harsh cleaning detergents, solvents, and ingredients found in nail cosmetics like nail polish or adhesives used for artificial nails. The reaction is often an irritant or allergic contact dermatitis, disrupting the bond that holds the nail in place.
Underlying Medical Conditions and Systemic Causes
When onycholysis is not caused by external factors, it manifests as an internal health issue. Systemic diseases affecting the body’s overall function can impact the nail matrix or bed, leading to detachment. For example, both hyperthyroidism and hypothyroidism, conditions involving the thyroid gland, are recognized causes of nail lifting.
Certain dermatological diseases specifically target the nail unit, leading to separation. Psoriasis, a chronic autoimmune condition, commonly causes onycholysis by creating an inflammatory process in the nail bed. Similarly, lichen planus, which is characterized by inflammation of the skin and mucous membranes, can also present with nail detachment.
Nutritional deficiencies or reactions to medications can also trigger this symptom. Iron deficiency anemia is sometimes associated with onycholysis, reflecting a systemic impact on tissue health. Certain drugs, including chemotherapy agents and photosensitizing antibiotics like tetracyclines, can cause the nail to lift, particularly after sun exposure (photo-onycholysis).
Home Care and When Professional Help is Needed
The detached portion of the nail plate will not reattach; the goal of home care is to protect the nail bed as a new, healthy nail grows out. Keeping the separated nail trimmed short is the most important step, preventing further trauma from catching the nail on objects. The area must be kept clean and dry to discourage secondary infections, which involves thoroughly drying the nails after washing.
Avoid irritating the underlying nail bed, meaning no aggressive cleaning or scraping underneath the lifted nail. When performing tasks involving prolonged water exposure or harsh chemicals, wearing protective gloves is recommended. Since fingernails take four to six months to fully regrow, and toenails even longer, patience is required during the healing process.
A medical professional should be consulted if the onycholysis involves multiple nails, progresses rapidly, or is accompanied by systemic symptoms like chronic fatigue or unexplained weakness. Professional help is also necessary if there are signs of a severe secondary infection (increasing pain, significant redness, or discharge). If the condition fails to improve after several weeks of consistent home care, or if a systemic cause is suspected, professional diagnosis and targeted treatment are required.