Nail lifting, medically known as Onycholysis, is a common condition defined by the painless separation of the nail plate from the nail bed underneath. This detachment typically begins at the distal edge of the nail and progresses inward toward the cuticle. While often benign, the separated area creates a space susceptible to moisture and debris, which can lead to secondary issues.
The Visual Characteristics of Nail Lifting
The most distinguishing feature of nail lifting is the change in color of the affected area. A healthy nail plate appears pink because it is transparent, allowing the color of the underlying vascular nail bed to show through. When the nail separates, air gets trapped in the space, causing the lifted portion to appear opaque, white, or yellowish-white. This clearly demarcates the detached section from the pink, attached portion of the nail.
The separation usually starts at the free edge, but in some cases, it can begin at the sides or as a central “oil spot,” often associated with conditions like psoriasis. The texture of the lifted nail plate may remain smooth, but the space underneath the separation can accumulate a chalky or crumbly material, known as subungual hyperkeratosis. This debris consists of thickened skin cells from the nail bed.
Secondary discoloration can develop if the open space becomes a breeding ground for microorganisms. A greenish or black discoloration, known as chloronychia, suggests an infection by the bacterium Pseudomonas aeruginosa. Fungal infections may contribute to yellowing and thickening of the nail plate. Less common colors like brown or purple can also appear, often indicating a different underlying cause or subungual hemorrhage from trauma.
Common Triggers and Underlying Causes
Nail lifting can be triggered by a wide variety of factors, broadly categorized into external forces, infections, and underlying health conditions. The most common causes are mechanical or traumatic, involving repetitive minor impacts. This includes actions like aggressively cleaning underneath the nail with tools, wearing shoes that are too tight, or the repeated tapping of long fingernails.
Chemical exposure is another frequent external cause, particularly for those whose hands are often immersed in water or exposed to harsh cleaning agents. Strong solvents, detergents, and ingredients in nail cosmetics, such as adhesives for artificial nails, can weaken the bond. Wet work, like frequent dishwashing without gloves, softens the nail unit and makes it more vulnerable to separation.
Infections play a significant role, with fungal infections (onychomycosis) being a major culprit. The fungus invades the nail unit, causing thickening and often a yellowish discoloration that can lead to detachment.
Beyond external factors, nail lifting can be a manifestation of systemic diseases or dermatologic conditions. Disorders like psoriasis, eczema, and lichen planus are known to affect the nail unit and cause onycholysis. Systemic issues such as thyroid dysfunction (both hypo- and hyperthyroidism) and iron deficiency anemia can also lead to nail separation.
Next Steps: Managing Onycholysis at Home and Professionally
The initial step in managing nail lifting is to eliminate the potential causes that are within your control. Keep the affected nail trimmed short, cutting it back to where the separation ends to prevent the lifted portion from catching on objects and causing further trauma. Keep the area dry and avoid using tools to clean underneath the separated nail, as this can worsen detachment and introduce bacteria.
For many cases of trauma-induced or chemical-induced lifting, protecting the nail and avoiding the irritant allows the nail to grow out and reattach naturally. Since a fingernail can take four to six months to fully regrow, patience is required. Wearing gloves while doing wet work or handling chemicals is an effective protective measure.
If the cause of the nail lifting is not obvious, or if you notice significant discoloration, swelling, or pain, a consultation with a healthcare professional, such as a dermatologist or podiatrist, is necessary. Professional treatment depends entirely on the underlying cause identified. For instance, a fungal cause requires prescription oral or topical antifungal medication. If the cause is a systemic condition, treating the underlying health issue is the primary method for resolving the nail separation.