Onycholysis
Onycholysis is a condition where the nail plate separates from the nail bed, usually starting at the tip of the nail and progressing backwards.
It can affect one or more fingernails or toenails and may occur as a result of trauma, infection or underlying skin conditions.
Although often painless, onycholysis can make the nail more vulnerable to damage or infection and may change the appearance of the nail.
At The London Skin and Hair Clinic, Consultant Dermatologists assess onycholysis to identify the underlying cause and advise on appropriate management. Patients seeking specialist dermatology advice in London can access expert assessment and guidance.
Onycholysis is psoriasis of the nail
Onycholysis can affect one or more nail, and may impact the whole nail or just a part of it
A Dermatologist may take a nail clipping or skin scraping to aid diagnosis
Treatment may involve keeping the nail short, gloves, and antimicrobial soaks
What causes Onycholysis?
Onycholysis can occur for a number of different reasons, and in many cases more than one factor may be involved.
Common causes include:
- repetitive trauma to the nails, such as tapping or pressure
- nail cosmetics or over-aggressive nail grooming
- fungal nail infections
- skin conditions such as psoriasis or eczema
- reactions to certain medications
In some cases, no clear cause is identified.
Who is at risk of Onycholysis?
Onycholysis can affect people of all ages.
It is more commonly seen in:
individuals with long nails or frequent nail trauma
- those with underlying skin conditions such as psoriasis
- people with fungal nail infections
Frequent exposure to water or chemicals may also increase the risk.
What are the symptoms of Onycholysis?
The main symptom of onycholysis is separation of the nail from the nail bed.
Common features include:
- a white or opaque area where the nail has lifted
- discolouration, which may appear yellow, brown or green if infection is present
- a change in nail shape or texture
- debris collecting under the nail
The affected nail may become fragile and more prone to breaking.
Onycholysis symptoms are usually painless, but discomfort can occur if the nail catches or if infection develops.
Images of Onycholysis
These images are kindly provided by DermNetNZ.org for non-commercial use, for the purpose of education and information. The images have not been modified and DermNetNZ do not endorse The London Skin and Hair Clinic. You can find a copy of the license at http://creativecommons.org/licenses/by-nc-nd/3.0/nz/.
How does a dermatologist diagnose Onycholysis?
A dermatologist will diagnose onycholysis through clinical examination of the nails.
This helps identify the pattern of separation and any signs of underlying conditions.
To determine the cause, the dermatologist may take nail clippings or skin samples for laboratory testing, particularly to rule out fungal infection.
In some cases, blood tests may be recommended if an underlying medical condition is suspected.
How is Onycholysis treated and managed?
Management of onycholysis focuses on identifying and addressing the underlying cause while protecting the nail as it regrows.
General measures may include:
- keeping the affected nail short to prevent further trauma
- avoiding irritants such as harsh chemicals or excessive moisture
- protecting the nails during daily activities
If an underlying condition such as psoriasis or fungal infection is identified, this may be treated to support nail recovery.
Nails grow slowly, so improvement may take several months as the healthy nail gradually replaces the affected area.