Onycholysis

Definition

• Onycholysis is the separation or detachment of the nail from the nail bed, typically beginning distally and moving proximally.

• It is usually painless but may predispose to secondary infection, discolouration, and cosmetic concerns.

Aetiology

• Trauma: Repetitive impact, aggressive manicures, or nail picking

• Prolonged Water Exposure: Frequent handwashing, dishwashing, resulting in softening and irritation

• Skin Conditions: Psoriasis, eczema can weaken the nail–nail bed interface

• Fungal Infections: Candida or dermatophytes causing onychomycosis

Diagnosis

• Nail Clippings/Scrapings: To check for fungal involvement (microscopy, culture, or PCR)

• Systemic Causes: Consider psoriasis, thyroid disease, or other relevant conditions if there are additional clinical features

Management

Patient Advice

• Keep Nails Short: Reduces leverage and trauma on the nail bed

• Avoid Inserting Objects under nails to prevent further detachment

• Limit Water Exposure: Wear gloves for dishwashing or cleaning

• Mild Soaps/Shampoos: Minimises irritation

• Gentle nail care; avoid harsh manicures/pedicures

Specific Treatment

• Fungal Infection:

  • Topical or oral antifungal therapy if confirmed onychomycosis (e.g. terbinafine for dermatophytes, topical azole for candida)

• Non-Infectious (Trauma, Psoriasis):

  • Reduce repeated trauma, improve dryness, consider topical therapies (e.g. mild steroid for psoriatic changes if indicated)

• Candida Onycholysis:

  • Topical antifungal creams (e.g. clotrimazole), keep area dry, limit water immersion