SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

Information for Patients

View all Images (30)

Onycholysis - Nail and Distal Digit
Other Resources UpToDate PubMed

Onycholysis - Nail and Distal Digit

Contributors: Shari Lipner MD, PhD, Susan Burgin MD, Bertrand Richert MD, Robert Baran MD
Other Resources UpToDate PubMed


Onycholysis is defined as the detachment of the nail plate from its bed at its distal end and/or from lateral attachments. Detachment of the nail plate creates a subungual space that may gather dirt and keratin debris. As moisture accumulates beneath the nail, secondary infection by bacteria and yeasts can also occur.

Fingernail onycholysis is more common in women than men and is common in patients with hand dermatitis. Fingernail and toenail onycholysis is most often caused by trauma. Other causes of onycholysis include hyper- and hypothyroidism, pregnancy, porphyria, pellagra, syphilis, atopic dermatitis, psoriasis, irritant or allergic contact dermatitis, lichen planus, congenital abnormalities of the nails, onychomycosis and other infections, and underlying malignancies. Tetracycline, quinolones, oral contraceptives, and certain chemotherapeutic agents are the most frequently associated medications. Systemic retinoids may also be culprits.

Blistering diseases, such as porphyria cutanea tarda or pseudoporphyria, will give rise to pain followed by onycholysis when a subungual vesicle or bulla appears. This is induced by sunlight and is known as photoonycholysis.

In children, onycholysis is most often due to trauma particularly when one or a few nails are affected. Psoriasis, lichen planus, and congenital abnormalities are also possibilities. If these etiologies have been ruled out, a systemic cause should be explored.


L60.1 – Onycholysis

75789001 – Onycholysis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required


Subscription Required

Last Reviewed:06/04/2018
Last Updated:06/04/2018
Copyright © 2023 VisualDx®. All rights reserved.
Patient Information for Onycholysis - Nail and Distal Digit
Print E-Mail Images (30)
Contributors: Medical staff writer


Nail lifting (onycholysis) is the spontaneous separation (detachment) of the fingernail or toenail from the nail bed at the end of the nail (distal) and/or on the sides of the nail (lateral). The appearance of nail lifting may resemble a half-moon, or the free edge of the nail may rise up like a hood. Nail lifting creates space under the nail that gathers dirt and debris made of protein in the nails (keratin). As water accumulates under the nail, bacteria and yeast can also cause the area to become infected.

Nail lifting may occur with other skin conditions, such as various forms of eczema (including hand dermatitis), psoriasis, and lichen planus. Nail lifting may also occur with underlying medical problems, including thyroid disease, pregnancy, some forms of infection, and rarely some forms of cancer. Other possible causes are injury to the nails, use of nail cosmetics, and aggressive manicures.

Nail lifting may be caused by some medications, such as chemotherapy and drugs made from vitamin A. Some medications (commonly tetracycline) may interact with sunlight to cause nail lifting.

Who’s At Risk

Nail lifting may affect people of all ages. Women are affected more frequently than men.

Signs & Symptoms

Nail lifting occurs on the fingernails and the toenails. The nail separates from the end (distal) and/or the sides (lateral) of the nail bed and may even separate completely from the finger.

Self-Care Guidelines

  • Thoroughly clip away as much of the detached nail as possible, repeating this at weekly intervals.
  • Gently brush the nail and surrounding tissue with plain soap and water once daily, rinsing carefully, and then drying the area with a hair dryer.
  • Protect the nails by wearing plastic gloves worn over light cotton gloves to avoid frequent contact with water. Use any mild cleanser as an alternative to water and soap.

When to Seek Medical Care

See your doctor if the nail lifting becomes bothersome. Your doctor may perform tests for conditions or infection that may be causing the nail lifting.


In addition to the self-care measures noted above, your doctor may prescribe:
  • Treatment for any skin conditions, medical problems, or exposures that may be causing your nail lifting.
  • If bacterial or fungal infection is present, you may require antibacterial or antifungal treatment.


Bolognia, Jean L., ed. Dermatology, pp.1062, 1064. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.2001, 2003. New York: McGraw-Hill, 2003.
Copyright © 2023 VisualDx®. All rights reserved.
Onycholysis - Nail and Distal Digit
A medical illustration showing key findings of Onycholysis : Onycholysis - lifting nail
Clinical image of Onycholysis - imageId=2281151. Click to open in gallery.  caption: '<span>Distal, dull yellow-white discoloration of the fingernail representing areas of loss of attachment of the nail plate to the nail bed after use of artificial nails.</span>'
Distal, dull yellow-white discoloration of the fingernail representing areas of loss of attachment of the nail plate to the nail bed after use of artificial nails.
Copyright © 2023 VisualDx®. All rights reserved.