What is Onycholysis: Causes, Symptoms, Treatment, Prognosis, Pathophysiology, Prevention

The nails are formed by living cells in the fingers and toes. Nails are made up of the following parts.

• Nail plate – The visible portion of the nail
• Nail bed – The portion of the nail under the skin
• Cuticle – The overlapping tissue that covers the plate and base of the nail
• Nail folds – The portion of the skin that frames and supports the nail from 3 sides
• Lunula – It is the crescent or half-moon whitish colour seen that the base of the nail
• Matrix – Hidden portion of nail under the cuticle.

Nails are primarily composed of keratin which is a hardened form of protein. As new cells grow in the nail matrix, older cells are pushed out which hardens and forms finger nails. As the nails are exposed out to the environment, it can experience various condition which gives rise to an ugly appearance. Onycholysis is one such condition which is painless but hampers the aesthetic look of the nails.

Onycholysis is a condition characterised by detachment of the nails from the pink nail bed. This separation is a gradual process and is painless. It is one of the most frequent nail disorders encountered by dermatologists. The separation of the nail plate can either start at the distal free end and progress proximally or it can start at the proximal ends and progress towards the distal free end. The later condition is generally seen in association with psoriasis of the nail and is termed as onchomadesis. In very rare conditions, the disorder is confined to the lateral borders of the nail.

• Lifting of nail from the nail bed is one of the common symptoms of onycholysis.
• Irregular border between the pink of the nail and the white outer edge.
• Discoloration of the nail, with opacity over a large portion of the nail. There may be symptoms of whitish or yellowish discoloration.
• There may be deformation of the nail with pitting and indentations. There may be thickening skin underneath the edge of the nail plate.
• Onycholysis is usually painless; however, pain may be experienced if the nail gets detached from the nail bed.

The exact frequency of onycholysis is yet unknown. It is seen in all races; however, not much is known about the distribution among different races. Though the condition is seen in both sexes, the condition is more common among women. The risk of onycholysis increases with age; though, it is seen in all age groups.

Nail disorders are usually temporary and may resolve eventually. However, onycholysis may take several months to subside.

Onycholysis can be caused by multiple reasons. Broadly speaking, the causes include:

• Onycholysis Caused Due to Trauma: This includes trauma to the nails from daily activities such as tapping of long fingernails on key boards. Trauma can also be caused from inappropriate use of manicure tools as well.
• Microbial Infection of the Nails Causing Onycholysis: Infections may be caused by yeasts, bacteria, fungus and viruses. Fungal infection causes thickening of tissue under the nail which causes the nails to lift.
• Dermatological Conditions: Certain dermatological condition can cause Onycholysis. This includes psoriasis, lichen planus, hyperhidrosis, lichen striatus, dermatitis, pemphigus etc.
• Underlying Systemic Conditions: E.g. Anaemia, leprosy, psoriatic arthritis, lupus, diabetes, multiple myeloma, pellagra, thyroid issues etc. may also cause onycholysis.
• Onycholysis Caused Due to Allergic Reaction: Exposure to certain chemicals such as nail paints, nail paint remover, hair dye, gasoline etc. can cause onycholosis.
• Side Effects of Drugs: Certain drugs may cause onycholosis post exposure to sunlight. E.g., Tetracycline, doxycycline, oral contraceptives, fluoroquinolones etc.
• Congenital defects, genetic inheritance, foreign body implantation.
• Prolonged immersion of nails in water.

When affected by onycholysis, the nails appear smooth, firm without any inflammation. There is a discoloration noticed which is usually due to a secondary infection, such as yeast infection. It is important to treat the primary and secondary cause of onycholysis to prevent worsening of the symptoms. If left untreated, onycholysis may lead to nail bed scarring.

Repetitive damage over the nail can causes permanent damage and deformity. It may damage the nail bed which in turn will hinder normal nail growth.

Diagnosis is done by a thorough physical examination of the nails by an experienced physician. The nails are visually examined to check for change in shape, discoloration, thickening, detachments etc. The physician may also examine the skin and thyroid to rule out any associated condition. A biopsy may be done in cases of fungal infections.

In some cases, blood work is done to detect underlying causative disorder.

It is advised to trim the detached nail close to the skin to avoid the edges from being caught in clothing’s and being pulled off. It is advised to determine the causative disease and proceed with treatment accordingly. Treatment for iron deficiency and hyperthyroidism has proven to promote nail growth. Treatment for psoriasis also improves nail health. There are few oral medications too which may be prescribed based on the condition.

Prevention measures for reducing the risk of onycholysis include:

• Regular trimming of nails to avoid trauma to overgrown nails.
• Wearing rubber gloves during exposure to water and other chemicals.
• Avoid using cheap nail polishes and nail paint remover.
• It is advised to keep nails dry to avoid fungal infections.
• Avoid frequent exposure to harmful chemicals.

The nail is attached to the pink nail bed underneath it. Onycholysis is a condition where there is detachment of the nail from the nail bed. This is accompanied by discoloration, deformity and brittleness of the nail. The nail loses its aesthetic in appearance. Onycholysis is usually painless but can be painful if there is complete detached of the nail from the nail bed. It is advised to protect the nails during exposure to harmful to avoid damage to the nails. Maintaining short nails also helps reduce the risks of trauma to the nails. Onycholysis is a very common nail disorder and a reversible condition; however, it may take several months for the nail to grow back to its normal appearance. Onycholysis may be caused secondary to an underlying infection in the nail or due to some dermatological or systemic diseases. Hence, it must not be ignored or neglected.