If you’ve been a tech for any length of time, you’ve undoubtedly seen onycholysis, 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.
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. When onycholysis is the result of a skin condition or medication, clients will have additional symptoms beyond nail separation. For example, with a skin condition, the skin surrounding the nail and cuticle may be dry and flaky. If onycholysis develops as a reaction to medication, small white marks may appear on the nails.
Onycholysis requires techs to gently clip back the unattached nail, revealing a healthy, dry nail bed. At each appointment, techs should continue to clip the loose nail away as it slowly grows out. Do not apply product until the nail has completely grown out.
Techs may clip the nail back to reveal skin that is not dry and healthy. Dirt and debris may have found their way under the nail, which creates the perfect environment for bacteria and fungus. Techs could find a thick, yellow, creamy substance under the nail that will need have developed an infection that will require a prescription.
WHAT’S A TECH TO DO?
Try to understand the possible cause of the separation. Ask clients if they are aware of a trauma, or of new product that may have irritated their skin and caused separation. If they can’t remember, ask if they are taking prescription medications, such as antibiotics, contraceptives, etc. Explain that as a possible side effect, the medication may be causing the nails to separate, and suggest a consultation with a doctor.
If techs determine that 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 and is back to prime health. This is often the next appointment. If techs suspect that the onycholysis is caused from a medical condition or prescription, clip the nail back, manicure the nail, and suggest the client inform 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. It’s important to note that the separated nail doesn’t reattach itself, but the nail that is attached will grow to the free edge. Patience is the key with onycholysis. Protect yourself and clients by being cautious.
Secondary infections from onycholysis are not uncommon, so it’s important to catch and treat onycholysis early. Techs may be tempted to apply product over a healthy nail bed once the unattached nail has been removed, thinking that it’s similar to applying to be cleaned away. Once removed, the nail bed could reveal wrinkled, moist skin. Do not apply product, regardless of how much pleading and bribing you hear from the client. Instruct the client to keep the nail dry and clean, and examine the nail on the next appointment. If the skin is not dry and healthy, refer the client to a doctor. She may product on a nail biter whose nails lack a free edge. And while it may be similar, it’s not the same, and it shouldn’t be treated the same. Water will easily find its way under product that has been applied to cover the look of onycholysis, creating ideal conditions for big problems. Techs can educate clients and protect themselves by encouraging clients to let their natural nail grow back over the nail bed completely before applying enhancements.
ONYCHOLYSIS IS THE FIRST SIGN OF FUNGAL INFECTION
Fungal infection of the nail, also known as onychomycosis, appears first as 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. Onychomycosis is much more common on the toenails than the fingernails, and often is accompanied by athlete’s foot (tinea pedis). As the fungal infection advances, the separated nail appears yellow and opaque, then appears crumbled and can brown.
In addition to being a common cause of onycholysis, onychomycosis also is easily diagnosed. All that’s required to make the call is a skin scraping that can be examined under a microscope in a doctor’s office. While once many physicians regarded onychomycosis as primarily a cosmetic problem, more recently dermatologists and podiatrists have been using oral and topical treatments that, particularly in combination, are quite effective.
For reprint and licensing requests for this article, Click here.