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There are certain conditions in which the nails separate from the nail bed spontaneously and fall off. The medical term for this condition is "onycholysis." The nail plate separates from its bed usually at the distal free margin and progresses proximally. Though often seen as result of over manicuring the hands, onycholysis is also associated with several medical conditions. Some of these conditions include:

  • Poor circulation in the fingers: This may be a result of exposure to sudden extreme cold, wherein the circulation of the fingers is abruptly hindered because of the sudden contraction of blood vessels supplying these parts. This condition is commonly seen in small children and can be avoided by wearing adequate protective clothing and gloves while going out in the cold. Poor circulation in fingers is also seen in chronic smokers.
  • Overactive thyroid gland: Both hypothyroidism and hyperthyroidism can lead to onycholysis.
  • Psoriasis: Although psoriasis is basically a disease involving the skin, it may also involve the nails. Nail psoriasis may be confined to just one finger nail or may involve all the finger and toe nails. The nail bed may show yellow-red discoloration, white flaky patches, and there may be pitting and excessive thickening of the nails.
  • Infection of the nails: Bacterial infections like Pseudomonas, candida infection, fungal infections like Trichophyton rubrum and Trichophyton mentagrophtes, and viral infection like Herpes simplex can cause spontaneous falling off of nails.
  • Amyloidosis: A condition where proteins start building up in the organs. Onycholysis is a characteristic feature of this condition. Apart from amyloidosis, spontaneous falling off of nails is also seen in other systemic illnesses like sarcoidosis, scleroderma, multiple myeloma, bronchiectasis, pleural effusion, leprosy and lupus.
  • Allergic contact dermatitis: Some people are particularly sensitive to nail cosmetics, paint removers, various solvents, chemicals used in color developer and gasoline. Repeated or prolonged contact with these chemicals may lead to the development of allergic contact dermatitis and falling off of nails may be a consequence.
  • Irritant contact dermatitis: Contact with sugar syrup for a long time, as seen in bakers and confectioners; immersing of fingers in water for a long time; and exposure to chemicals like hydrofluoric acid may lead to irritant contact dermatitis. Such patients may complain of onycholysis.
  • Medications: Patients on medicines like chlortetracycline, doxycycline, chlorpromazine, griseofulvin, tetracycline, and chemotherapeutic agents like bleomycin, and doxorubicin may complain of spontaneous falling off of nails.
  • Hereditary conditions: Certain hereditary conditions like congenital onycholysis and hereditary distal onycholysis can also be a cause behind falling off of nails from their nail beds.

Diagnosis

The cause behind onycholysis is determined with the help of fungal cultures and nail biopsies.

Treatment:

There are certain steps that should be taken by a patient suffering from onycholysis to avoid nail loss. These include:

  • Avoiding trauma to the nails and keeping the nail beds dry.
  • Avoiding exposure to irritant chemicals and moisture.
  • Keeping the nails short.
  • Avoiding exposure to extreme cold.
  • Wearing cotton gloves underneath vinyl gloves if one cannot avoid wet work.

Apart from these precautionary measures, treatment is directed towards curing the underlying pathology. For example, patients suffering from psoriasis may need injections of Triamcinolone every four weeks into the proximal nail fold for one to one and a half month.

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