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Under the Microscope: Onycholysis

by Staff Writer | June 24, 2011

What is it? Onycholysis is a condition that causes nails to separate from the nail bed beginning at the distal end of the nail (under the free edge). The nail itself will appear healthy, often maintaining its shape and strength. Techs will be able to see the separation easily on natural nails and through light-colored enhancement products. The section of the nail that is separated will appear white in color, as there is air between the nail and the bed. When onycholysis is the result of a skin condition or medication, clients will have additional symptoms beyond nail separation.

How do you get it? So many factors can contribute to nail separation that the exact cause of onycholysis can be difficult to determine. The three most common causes are 1) the skin being exposed to an irritant; 2) some type of trauma to the nail; 3) over-exposure to water. Some skin conditions, such as eczema or psoriasis, can also cause onycholysis. Other times the condition is caused by medications, such as oral contraceptives, radiation, and some prescription drugs. More serious health issues, such as thyroid problems, may also cause nails to separate from the nail bed.

How is it treated? Secondary infections from onycholysis are not uncommon, so it’s important to catch and treat onycholysis early. Of course, treatment depends on identifying the cause of the problem for that particular sufferer. For example, treatment of hyperthyroidism will allow the nails to regrow normally and nail infections can be treated with antimicrobials. Onycholysis related to psoriasis or eczema may respond to a topical corticosteroid. In general, clients should clip the affected portion of the nail and keep the nails short, keep the nail bed dry, avoid exposure to contact irritants, and wear gloves for wet work. The portion of nail that has separated will not reattach to the nail bed, so you will have to wait until the nail is fully regrown for the condition to be completely gone.

What can a tech do? If the onycholysis is due to trauma or a skin irritant, trim the nail back, manicure the nail, and let the client know an enhancement can be added as soon as the nail has grown out. If the onycholysis is caused from a medical condition or prescription medication, clip the nail back, manicure the nail, and advise the client to see her doctor. In either case, do not apply product over the area. Instruct clients to keep the area dry between appointments. As clients see the nail grow, they can clip, file, or buff the nail at home.

What else? Fungal infection of the nail, also known as onychomycosis, appears first an onycholysis. Dermatologists estimate these fungal infections account for 50% of all nail disorders they treat. Recent studies suggest that as much as 13% of the U.S. population has a fungal infection of one or more nails. As the fungal infection advances, the separated nail appears yellow and opaque, then appears crumbled and can brown.

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