Q&A

I'm a hairdresser and am having trouble with lifting from a previous nail injury.

Q.

I am a hairdresser and for the last eight years, my nails have lifted off the nail bed at the tip, but stay attached at the base and sides. It is extremely painful when I hit my nail on a surface. I first noticed this after I had Lyme Disease and began taking Rocifin IV. At the time, I wore sculptured nails but have not worn them for years. I have taken medications for nail fungus, but is not a fungus. There are time when I get pain in the finger and the tip, and it gets very hot and lifts some more. Other times I will get a discoloration of the underside of the nail. That is when it starts to reattach, but not for long. I have seen two dermatologists, a general practitioner, and an internist – no luck so far. Could you please tell me what to do?

A.

I am a hairdresser and for the last eight years, my nails have lifted off the nail bed at the tip, but stay attached at the base and sides. It is extremely painful when I hit my nail on a surface. I first noticed this after I had Lyme Disease and began taking Rocifin IV. At the time, I wore sculptured nails but have not worn them for years. I have taken medications for nail fungus, but is not a fungus. There are time when I get pain in the finger and the tip, and it gets very hot and lifts some more. Other times I will get a discoloration of the underside of the nail. That is when it starts to reattach, but not for long. I have seen two dermatologists, a general practitioner, and an internist – no luck so far. Could you please tell me what to do?

Lifting of the nails off the nail bed is referred to as onycholysis. When it occurs with extreme pain or discomfort, it is possible that you could be allergic to the hair dyes that you come into contact with. Another possibility is a yeast infection of the nail bed, which is more common in people whose hands are wet a great deal, which may be the case since you are a hairdresser. This can only be determined by taking samples of the nail and doing what is called a KOH wet mount to see if there are yeast cells present and by doing a culture to see if there is other fungus present. If this is unsuccessful, then the nail plate itself can be sent to a laboratory where it can be processed in a similar fashion to a biopsy (it is not a real biopsy) to see if there is anything in the nail that did not show up on the KOH and culture. Other causes of onycholysis include thyroids disorder, allergy to nail cosmetics, and allergy to certain foods. All of these things need to be evaluated and assessed by a dermatologist familiar with nail disorders.

In regard to Lyme Disease, this is not known to be a cause of nail lifting or onycholysis. Sculptured nails can cause onycholysis, of course, but if they have not been worn for years, it is not likely that they are the cause. Likewise there are certain medications that can cause onycholysis, some of which include antibiotics. For example, the tetracyclines can cause what is called photo-onycholysis, where the nails lift in the person who takes the antibiotic and then goes out into the sunlight. These possible causes need to be investigated by your dermatologist.

Once the cause is determined, then the proper treatment can be instituted. One other condition that can cause onycholysis is psoriasis, which usually affects the skin, but can involve the nails only (without skin involvement) in about 5% - 10% of individuals. This also would have to be diagnosed by a dermatologist. But the history that you present does not render the diagnosis of psoriasis very likely.

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