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Onycholysis (loose nails): causes, symptoms & treatments

Dr Roger Henderson
Reviewed by Dr Roger HendersonReviewed on 13.10.2023 | 3 minutes read
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Onycholysis is a medical term that means a loose nail that falls off or comes away from the underlying structures. The nail separates from the skin underneath it, which is known as the nail bed. It can either partially come off or fully come away at which point the nail will fall off. 

The part of the nail that has come away from the bed will look white and opaque. It can be quite disconcerting; however, it is common and isn’t usually a sign of anything serious. In most cases, the nail will likely grow back although be prepared as this is a slow process!

Common causes of onycholysis

The most common cause of onycholysis is trauma. This can be a high force trauma such as dropping something heavy on your nail or low-level trauma over a length of time such as repeatedly wearing shoes that are too small.

Other causes are very broad and include genetics, medication and skin conditions. A change in your body's normal state can also result in onycholysis, for example pregnancy, changes in your thyroid function, conditions such as diabetes and other autoimmune conditions (where your body's own immune system attacks itself) such as psoriasis, lupus, and pemphigus. Certain medications can also contribute to the occurrence such as:

  • tetracycline antibiotics
  • fluoroquinolones
  • retinoids
  • some nail products

In an extremely small number of people, onycholysis can be a symptom of cancer although in the majority of people this is not the cause.

How to treat onycholysis

This really depends on what the cause is and how severe it is. Once a nail has detached from the nail bed it cannot reattach, so it is mainly about preventing more harm to the nail and treating any underlying cause.

Keep the area as clean and dry as possible. Carefully trim down the nail, leaving any nail that is still attached with a margin, making sure not to damage the nail or nail bed any further. A podiatrist can help with this. Protect any remaining nail as much as you can, by avoiding things that could cause any further damage.

Do nails regrow and how long do they take?

If the nail bed is not damaged and any underlying cause is eliminated, or that cause has been treated, then the nail should grow back. It is unfortunately a very slow process. Fingernails can take an average of 6 months to grow back completely but for toenails it's at least twice as long.

When should I see my doctor?

If you have onycholysis and have not had trauma to the nail then it is best to get it checked out with your doctor to see if there could be an underlying cause.

Depending on what they find on their assessment, they may send off nail clippings to look for any infection and also blood tests to check for any underlying cause.

If you have had trauma or injury to the nail, it is best to visit a podiatrist to check you have not damaged the nail bed or nail matrix.

Any signs of infection which include redness, swelling and increasing pain means you should be assessed by your doctor.

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Dr Roger Henderson
Reviewed by Dr Roger Henderson
Reviewed on 13.10.2023
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