How to Continue Treating Big Toenail That is Lifted Off Bed and Dry Underneath

Overview

Onycholysis on the hallux (big toe) of a left foot. The nail has lifted about halfway off the nail bed. — Onycholysis on the hallux (the big toe).

What is onycholysis?

Onycholysis (on-uh-coll-uh-sis) is when a nail (nail plate) on your fingers or toes separates from the skin on which it rests (the nail bed). It typically only affects one nail.

Who does onycholysis affect?

Onycholysis affects everybody. However, it's more common in:

People who are assigned female at birth (AFAB).
Adults.
People who have psoriasis, lichen planus, a nail fungus or tumors in their nail beds.

How common is onycholysis?

Onycholysis is common, and it generally lasts for several months or over a year. Any conditions that affect the skin underneath your nails eventually cause onycholysis.

How does onycholysis affect my body?

Onycholysis causes your nail to peel away from the nail bed. It usually doesn't cause any pain.

Symptoms and Causes

What are the symptoms of onycholysis?

Symptoms of onycholysis include:

Nails that peel away from their nail beds.
Tough, thick nail beds.
An abnormal border between the pink area of your nail and the white edge of your nail. The border may look wavy, and the white areas may be thicker in some areas and thinner in others.
Discoloration in your nails and nail beds. They may look gray, green, purple, white or yellow.
Dents or pits (cupuliform depressions) in your nails.
Crumbling nails.
Hemorrhages underneath your nails.

Onycholysis usually isn't painful, but what causes your onycholysis may be painful or irritating. If you have onycholysis due to injuries or fungal infections, you may experience pain and irritation.

What are the common causes of onycholysis?

The following are common causes of onycholysis:

Injuries (trauma): Injuries to a nail or the area where your nails start to grow (nail matrix) can cause onycholysis. You can injure these areas by bumping or hitting your nails, wearing shoes that are too small or even keeping your nails in water for too long. Regularly going to a nail salon to get manicures can also cause onycholysis. Manicurists use a lot of force to trim, buff and polish your nails. Even tapping your nails on a hard surface over a long period can cause onycholysis.
Reaction to chemicals: Chemicals in nail polish, nail gloss, nail hardener, nail polish remover and fake nails can cause onycholysis.
Fungal infections: Fungal infections occur when fungus gets between your nail and nail bed, usually through cracks or cuts in your finger or toe. Fungal infections cause your nails to become thick and yellow, and they may show white spots and streaks.
Medications: Chemotherapy and some medications that cause light sensitivity can cause onycholysis. These medications include tetracycline, nonsteroidal anti-inflammatory drugs (NSAIDs), psoralens and oral retinoids (vitamin A derivatives).
Nail psoriasis: Nail psoriasis causes changes to the structure of your nails, which may include onycholysis.

Onycholysis rarely affects all of your nails. The following may cause onycholysis in all of your nails:

Iron deficiency: An iron deficiency is when you don't have enough iron in your diet. An iron deficiency can also cause anemia.
Hyperthyroidism: Hyperthyroidism causes your thyroid gland in your neck to create and release more hormones than your body needs. Hyperthyroidism can also cause a rapid heartbeat, unexplained weight loss, increased appetite and anxiety disorders.

Is onycholysis a fungal infection?

No, onycholysis isn't a fungal infection. However, fungal infections can sometimes cause onycholysis.

Is onycholysis contagious?

Depending on what causes your onycholysis, it may be contagious. Onycholysis caused by an injury, nail psoriasis or reaction to a medication or chemical isn't contagious. However, onycholysis caused by a fungus may be contagious.

A person with an infection can spread the fungus to someone else through skin-to-skin contact. You can also get nail fungus by touching an infected surface (indirect contact), like walking barefoot around public pools or showers or by sharing items like towels, nail clippers and nail scissors.

Diagnosis and Tests

How is onycholysis diagnosed?

Onycholysis is easy to recognize, so you don't necessarily need a healthcare professional to diagnose it, especially if you know its cause.

If you don't know what's caused your onycholysis, seeing your healthcare provider is a good idea. They'll look closely at your affected nails to evaluate your symptoms.

What tests will be done to diagnose onycholysis?

Your healthcare provider may perform several tests to diagnose onycholysis. The tests may include:

Biopsy: Your healthcare provider will use a razor or surgical knife with a thin blade (scalpel) to scrape away a small sample of cells from your nails. The cells go to a laboratory for testing, and researchers examine them under a microscope.
Fungal test: Your healthcare provider may clip off some of your nails and order a potassium hydroxide (KOH) preparation or fungal culture to rule out a fungus as the cause of your onycholysis. If those test results aren't clear, a fungus test known as a periodic acid-Schiff (PAS) stain can also determine the presence of a fungus.
Blood test: During a blood test, your healthcare provider will use a thin (21 gauge, slightly smaller than the size of a standard earring) needle to withdraw a small amount of blood from a vein in your arm. The blood sample goes to a laboratory for testing, and researchers examine it to check for the presence of any systemic diseases that may cause onycholysis.

Management and Treatment

Can onycholysis be cured?

There isn't a cure for the section of your nail that's detached from the nail bed — you can't reattach it. But treatment can keep new nail growth attached to your nail bed.

What can I use to treat onycholysis?

If you have onycholysis because of an injury, the detached part of your nail will eventually grow out. Use nail clippers or nail scissors to remove your affected nail as it grows out.

If you have onycholysis because of a fungus, your options may include:

Oral antifungal medication: Your healthcare provider may prescribe liquid medicines or pills or tablets that you swallow with water. These medications may include terbinafine (Lamisil®), itraconazole (Sporanox®) and fluconazole (Diflucan®).
Topical antifungal medication: Topical medications come in the form of creams, ointments or gels. You rub them directly onto your nails.

Nail fungi can be difficult to treat. It's important to finish your full course of medicine. If you stop too soon, the fungus that caused your onycholysis may come back and be harder to treat.

How do I take care of my nails?

The following tips can help you take care of your nails if you have onycholysis:

Take medications and apply treatments as instructed by your healthcare professional.
Regularly trim your affected nails.
Protect your nails from any additional damage.
Wash your hands regularly to prevent an infection. Use a clean washcloth to help reach beneath your nails.
Use antifungal or antimicrobial soaks to help prevent infection. Antimicrobial soaks may include lemon juice, vinegar, hydrogen peroxide and tea tree, orange or lemongrass essential oils.

While essential oils are safe for most people, it's a good idea to check with your healthcare provider before trying them. You may be at risk of developing an allergic reaction.

Prevention

How can I prevent onycholysis?

The following tips can help you prevent onycholysis:

Keep your nails trimmed short. Keeping your nails short will prevent them from catching on objects and pulling further off of your nail beds.
Avoid biting your nails.
Be careful when cleaning underneath your nails. Some tools that clean underneath your nails, like cuticle sticks or nail brushes, can break the skin underneath your nails and cause an infection.
Avoid chemicals or products that can irritate your nails or the skin around your nails. These may include nail polish, nail gloss, nail hardener, nail polish remover and fake nails.
Wear gloves when doing activities that may damage your nails, like washing the dishes, playing sports or working outside.
Wear clean socks and comfortable, protective shoes. Be careful when putting down heavy objects near your feet.

Outlook / Prognosis

What can I expect if I have onycholysis?

If you and your healthcare provider can determine the cause of your onycholysis, your nails will slowly but surely regrow. Your fingernails grow slowly, and your toenails grow even slower. It may take up to six to nine months for your fingernails to grow completely out, and it may take 12 to 18 months for your toenails to grow completely out.

Living With

When should I see my healthcare provider?

Contact your healthcare provider if:

Onycholysis appears along with other serious symptoms, including fatigue, feeling cold, dizziness or weakness, headaches, a sore tongue and a fast heartbeat.
Your symptoms don't improve after treatment.
The skin around your nails looks infected (red, purple, gray or white skin; irritation and swelling).

What questions should I ask my healthcare provider?

How can you tell that I have onycholysis?
If I don't have onycholysis, what other condition might I have?
What caused my onycholysis?
If a fungus caused my onycholysis, how do I prevent it from spreading to other parts of my body?
If a fungus caused my onycholysis, how do I prevent it from spreading to other people?
What medicines do you recommend?
Do the medicines have any side effects?
Are there any at-home treatments that you recommend?
Do the at-home treatments have any side effects?
What else should I do to help my nails recover?
Should I see a dermatologist or another specialist?

A note from Cleveland Clinic

Onycholysis causes your nails to pull up from nail beds. It usually isn't painful, but can be contagious if a fungus is the cause.

It's important to pay attention to your nails. If you haven't experienced an injury or trauma to your affected nails, it's a good idea to contact your healthcare provider as soon as you notice onycholysis. You may have a fungus, or your onycholysis may be a symptom of a more serious condition.

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Source: https://my.clevelandclinic.org/health/diseases/22903-onycholysis