One of the most common conditions that affects the nail is onycholysis, which is the separation of the nail plate from the nail bed. Onycholysis occurs as a result of or along with a great variety of nail traumas and disorders. Probably the most common cause of onycholysis is a fungal infection of the nail. In this situation, the separation begins at the far edge of the nail and proceeds down toward the cuticle. This is referred to as distal onycholysis. If you suspect a client has this condition, refer her to a dermatologist who will take samples of the nail to determine whether she has a fungal infection. If she tests positive for fungus, it should clear up after treatment. If the separation starts in the cuticle area and continues up the nail, it is referred to a proximal onycholysis.
Nail psoriasis can also cause onycholysis. There are many instances where nail psoriasis and fungal infections of the nail appear very similar, making it difficult for the dermatologist to tell which of the two conditions is present. In some cases, it may be necessary to perform a nail biopsy in order to establish the correct diagnosis. The usual treatment for onycholysis of the nails caused by psoriasis is some form of cortisone applied topically to the nail, but on occasion an internal treatment may be necessary. Both of these options are administered by a dermatologist.
Other infections besides fungal also bring on onycholysis. One of the more common ones is pseudomonas, a bacterial infection of the nail, which causes a blue-green or black discoloration on the nail plate. This is seen most often in people who frequently have their hands in water, such as waitresses, bartenders, nurses, and housewives. When the pseudomonas bacteria attacks the nail it causes the nail plate to lift and separate from the nail bed. This is usually treated by trimming away the separated nail, cleaning the nail bed, and applying a topical antibiotic. Sometimes, if the infection is severe enough, an internal antibiotic may be required.
Trauma or injury to a long nail is another common cause of onycholysis. In this case, the onycholysis usually occurs only in one nail. Unless the injury has been unusually severe, it will heal spontaneously over time. Also, over-vigorous cleaning under the nails can result in the nail plate separating from the nail bed.
Some ingredients used in nail products, such as formaldehyde, may also cause onycholysis if the products are misused. Formaldehyde, found in trace amounts in some nail polishes and hardeners, can cause onycholysis in two ways: as a solvent dissolving the connection between the nail plate and the nail bed or as an allergen causing an allergic reaction. While only a trace amount of formaldehyde can cause onycholysis if a person is allergic to it, the situation is very uncommon.
There is also a condition known a photo-onycholysis. This occurs when a person who is taking certain antibiotics, such as tetracycline, is exposed to significant sunlight. The combination of the sun plus the antibiotic results in lifting of the nail plate. Other medications, besides antibiotics, can cause onycholysis of the fingers and toes without exposure to sunlight. Chemotherapy drugs, for example, usually cause lifting nail plates rather than nail loss.
On occasion, onycholysis can be a sign of an internal medical disorder. For example, people with elevated or decreased thyroid activity can develop onycholysis. This may be a clue to the doctor to test the patient’s thyroid gland. Also, people who have poor circulation in their fingers and toes can develop onycholysis. This may occur in people who have Raynaud’s Phenomenon, where fingers are unusually sensitive to cold and may turn red, white, or blue in low temperatures. Onycholysis may also be seen in people with a connective tissue disorder, such as lupus.
If onycholysis has been present for a prolonged time, such as six months or more, a change in the structure of the nail bed occurs. Under normal circumstances, the nail bed does not contain a granular layer (special cells with “grain-like” particles). However, in long-standing onycholysis, the nail bed does form a granular layer and contains these abnormal cells in the nail bed itself. The problem here is that the nail plate will no longer attach to this type of nail bed and the client could have permanent onycholysis. Likewise, any type of surgical procedure performed in the nail bed, such as removal of a wart or other growth, can result in permanent onycholysis because of the formation of permanent scar tissue. There is very little that can be done in this situation other than camouflaging the nail with polish. Do keep the client’s nails short, though, so that they don’t catch on things and tear off.
Do not apply a tip or artificial product to the problem nail, and if the condition does not clear up within a few weeks, you should refer your client to a dermatologist. Once the cause of the onycholysis has been determined and treated, in most cases it should disappear.