Onycholysis, or separation of the nail plate from the nail bed, may look painful, but thankfully isn’t in most cases. In this condition, the nail acts as a lever, prying itself away from the skin.
Onycholysis has been linked to multiple mechanical and chemical causes as well as skin and systematic diseases and the medications used to treat them.
The good news is that most nails re-attach in time with proper diagnosis and correction of the cause. Once the diagnosis is made and the client is treated, it can take anywhere from three to six months for the nails to re-attach, depending on the extent of the lifting. Toenails may take twice as long.
What Are the Symptoms of Onycholysis?
Nails suffering from onycholysis are usually marked by an opaque section of nail that stands in contrast to the healthy pink of an attached nail.
Depending on the cause, the nail may collect thickened skin underneath the edge of its nail plate and the nail surface may become deformed with pits or indentations.
Onycholysis is usually painless, as the separation occurs gradually. Pain may occur if the nail is further detached from the nail bed as a result of trauma or if an active infection sets in. A bacterial or yeast infection may develop in the space under the nail.
“Once that space opens up you can develop any kind of infection underneath it,” says Doug Schoon, vice president of science and technology for Creative Nail Design. “An area has opened that’s normally been clean and closed.
That infection can turn the loose portion of the nail a white, yellow, or green shade. Generally, if the infection appears to be green, it’s a bacterial infection and if it appears to be white it is a yeast infection. This has to be controlled before the nail will re-attach. The nail can only take so much damage without being permanently deformed; if it has gone too far the nail changes may be permanent. And in some cases the nail won’t be able to re-attach.
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Accompanying skin irritations may be a sign of contact or allergic dermatitis, which is marked by dry, chapped skin or patchy, red, scaly, and inflamed skin.
What Are the Causes of Onycholysis?
Although a number of factors can cause onycholysis, Schoon says the number-one cause is physical trauma. “Many nail techs tend to overfile nails,” says Schoon. “In the old days they were taught to rough up the nails so product would adhere better, but today’s products are high quality and don’t require that. This technique creates excess friction, which can burn the sensitive tissue of the nail beds.” Over-vigorous manicuring around the eponychium and under the free edge can also cause the nail plate to separate from the nail bed. Even typing and finger tapping can take a toll on nails. Because they appear so strong, it’s easy to forget that nails can be vulnerable to certain types of injury. But even tiny traumas can, over time, result in onycholysis.
The number one cause of nail separation is physical trauma.
“There’s not a whole lot that keeps the nail plate attached to the nail bed,” says Schoon. “You can easily break the hyponychium seal. Any repeated pressure or injury can have a zipper effect on the torn skin under the nail plate and cause even more detachment.”
Chemical overexposure in manicures or nail tip application, nail enhancement products, allergic contact dermatitis to nail hardener or adhesives used to attach nail tips, psoriasis, or even prolonged immersion in water can also cause the nail plate to separate from the nail bed.
Fingernails aren’t the only ones that take abuse. Toenails spend much time in shoes that can be too small or too big and also take abuse from active sports such as running. When the free edge extends beyond the fingertip or end of the toe, the nails take the brunt of the pressure. Over time, this can result in separation of the nail plate from the nail bed.
Other minor traumas include habitual finger sucking, nail biting, and using the nails as tools. A blunt trauma to the nail such as getting a finger smashed in a window or door can also cause onycholysis.
Older people may also suffer more from onycholysis because their skin and nails aren’t as strong as they used to be and the attachment between the nail plate and nail bed isn’t as strong as it once was, says Schoon.
How to Treat Onycholysis
Treatment for onycholysis varies and depends on its cause, but eliminating the predisposing cause is the best treatment.
Clients should avoid trauma to the affected nail (or nails) and keep the nail bed clean and dry. They should also avoid exposure to contact irritants and keep their hands out of water as much as possible. If the client is planning on putting her hands in water she should wear light cotton gloves under vinyl gloves. Nails should be kept short and neatly clipped.
Schoon advises against removing the separated nail with nippers or any other implement. “If you do, you’re performing a medical procedure and nail techs aren’t licensed for these procedures,” he says.
If you think a client has onycholysis immediately refer her to her physician for diagnosis and treatment.
Because so many things can cause onycholysis, your client’s doctor may examine her to check for other skin conditions or medical problems such as thyroid disease. If a fungal infection is suspected, the doctor may clip the nail and should scrape a sample of tissue from beneath the nail plate for laboratory testing. “This is the only way to prove that a fungal infection is the culprit,” says Schoon.
Depending on the underlying cause your client’s doctor may prescribe medication to treat the cause.
Considerations When Working With Clients Who Have Separating Nails
If more than one of your clients suffers from onycholysis, you may want to take a look at how you are performing your services. You may be filing too aggressively or manicuring too vigorously.
Before you begin a service, especially on a new client, ask her about her lifestyle. If she works in an office environment and is often typing you can suggest she keep her nails no longer than fingertip length. The same thing goes for clients who love to garden or take part in an activity that can put stress on their nails.
Shorten artificial enhancements to reduce trauma. If you remove the enhancements you may worsen the onycholysis.
If you’re servicing a client with onycholysis, avoid injuring the affected nail, and keep the nail bed dry. “Whatever the nail tech does, she should be as gentle as possible,” advises Schoon.
Do not apply nail enamel or polish remover or any other chemicals that may further irritate the nail.
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