Your toenails take a beating every day — whether you’re an avid hiker or runner logging miles on Seattle’s trails, a frequent swimmer, or simply someone who loves a good pedicure. No matter your lifestyle, the health of your nails can be affected by factors you might not expect.
You may already know about ingrown, black, or fungal toenails — but one condition that affects people across all walks of life is onycholysis, and it’s more common than you might think.
Onycholysis is the separation of the nail from the nail bed. It can result from many different causes — tight footwear is just one of them — and can affect anyone, regardless of activity level.
Causes of Oncholysis
Onycholysis typically affects only one or a few nails at a time, depending on the cause.
Trauma and Injury to the Nail
- Keeping your nails in water for too long
- Getting regular pedicures when nail tools are used too aggressively
- Reactions to chemicals found in nail polish or acrylic nails
Fungal Toenail Infections
Toenail fungus invades the nail bed and can also cause onycholysis. Nails can also become discolored, distorted, and thick.
Medications
Certain medications can cause light sensitivity that leads to nail separation. These include chemotherapy drugs, tetracycline, fluoroquinolones, NSAIDs (nonsteroidal anti-inflammatory drugs), psoralens, and oral retinoids (Vitamin A derivatives).
Nail Psoriasis
Nail psoriasis can alter the nail’s shape and damage the soft tissue beneath it, leading to onycholysis. About 30% of those with psoriasis also have psoriatic arthritis, a related condition which causes other foot problems.
Conditions Causing Onycholysis On All the Nails
- Iron deficiency
- Hyperthyroidism
Symptoms of Oncholysis
- Nails peeling from the nail bed
- An irregular border between the pink portion of the nail and the white outside edge of the nail
- A good portion of the nail is discolored and can look grey, white, purple or yellow.
- Nails look pitted
- Crumbling nails
- Bleeding underneath the nail
Treatment of Onycholysis
Once a nail has separated from the nail bed, it cannot be reattached. However, addressing the underlying cause can stop the separation from spreading and prevent it from recurring. Trimming away the detached portion allows healthy nail to grow in as the nail advances.
- Fungal nails: if you’re diagnosed with fungal toenails, our office offers a comprehensive toenail fungus treatment program, including the Lunula laser, topical treatments for the nails and surrounding skin, and treatment for your shoes. Learn more about how we treat fungal toenails here!
- Hyperthyroidism and iron deficiency: when these conditions are treated, your nails will grow out normally.
- Nail psoriasis: this condition can be difficult to treat, but options include corticosteroids, oral medications, phototherapy, and certain at-home remedies.
Prevention of Onycholysis
In addition to receiving treatment for an underlying condition, it’s also important to consider:
- Avoiding nail salons that are too aggressive in their pedicures.
- Avoid using chemicals on your nails, including nail polish, nail hardener, or fake nails.
- Wear shoes with a proper fit and a wide toe box. Get your feet measured each time you buy new shoes — even adults’ feet can change size over time.
- Prevent your feet from sliding forward in your shoes — proper lacing can make a significant difference. Learn more in our article on 4 Best Lacing Techniques to Prevent Foot Pain in Hikers.
