Have you noticed your big toenails are discolored and no longer grow to the end of your toes? You may have disappearing nail disease otherwise known as onycholysis. Onycholysis is when a person’s nail detaches and separates from the pink nail bed and skin replaces the nail. Although not a serious health condition by itself, if left untreated the nail may become permanently short and thick.
When the nail pulls away from the nail bed beneath the nail turns a different color. What color it changes to depends on what is causing the onycholysis.
Some of the possible colors include:
white - air under the nail
gray - bacteria
yellowish-fungus
green - pseudomonas bacteria
purple - dried blood
Onycholysis itself is usually not painful but the toe can be painful where the nail plate is still attached on the nail bed or at the base of the nail.
Some typical causes include:
reaction to chemicals, such as nail polish, nail polish remover, or household cleaners
fungal or yeast infection in the nails
psoriasis
hypothyroidism
vitamin deficiency
faulty biomechanics
Treatment
If caught early disappearing nail disease can be treated. We recommend obtaining a nail sample to evaluate for fungus, yeast, and psoriasis. If the nail bed turns to skin the nail will not reattach and the nail will continue to be short regardless of any intervention.
Treatment includes trimming the nail back to where it is still attached to the nail bed and addressing the underlying skin conditions. Any nonattached nail needs to be removed so bacteria and debris do not collect under the nail plate.
Nails affected by psoriasis may have a round spot of nail detached from the nail bed underneath. A nail biopsy will help make the diagnosis of psoriasis. Dr. K recommends Psoothe Indigo Nail Oil to start. Prescription retinoids daily can delay the nail bed from turning into the skin allowing the nail to stick back down to the nail bed. Steroid injections into the nail bed and matrix may help but can be very painful. A dermatologist may prescribe biologics, systemics, and phototherapy if your psoriasis is severe.
Thyroid issues can cause onycholysis and heel cracks. Once the hypothyroidism is controlled often the skin and nails improve.
Vitamin and mineral deficiencies are often treated with dietary changes. A person with brittle or detaching nails may be required to take iron and biotin supplements to help the nails regain strength.
Fungal infections will not go away on their own and can take months to improve. We recommend combination therapy of topical, oral medication, and laser therapy. It can take 12 to 18 months for the nail to fully grow out.
Biomechanics can play a part. Hammer toes and arthritis in the big toe joint put stress and strain on the nail matrix and nail bed causing the nail to lift up. Avoid shoes and socks that are too tight putting pressure on the nails. Orthotics can address the first big toe arthritis and increase movement in the toe joint. Taping the end of the toe with Medipore or Kinesio tape may encourage the nail to grow to the end of the toe.
For patients with advanced nail loss KeryFlex Nail restoration is a good option. This cosmetic procedure does not address or treat the underlying condition but can certainly improve the appearance of the nail. Patients can return to activity and paint their nails immediately after application.
At Lighthouse Foot and Ankle we take the time to discuss your foot and ankle complaints. If you would like to find out more about how we can help visit our website or call us at (207) 774-0028 to make an appointment.
