Onychophosis is one of the most common nail disorders. Despite the fact that it does not pose any serious health problems its impact on quality of life is significant.

Nails affected by onychophosis look ragged and uneven. They may also have a blackish-brown color and enlarged pits and ridges (called dents or pits). Depending on what causes your onychophosis, it might be contagious.

Causes

The condition of onychophosis occurs when the nail (nail plate) separates from the skin on which it rests, usually the nail bed. The detached section of the nail is often thick and discolored, and it can cause pain and other problems. Onychophosis isn’t a medical emergency, but it can be difficult to live with and can make your nails look unsightly. In some cases, it can even lead to other health issues.

There are many things that can cause onychophosis. These include trauma, infection, allergies, nail psoriasis, thyroid disease, and some medications. This condition can also be caused by poor personal hygiene and the use of cleaning products that can irritate the nails.

It’s important to see a dermatologist to get diagnosed and treated if you have onychophosis. A healthcare provider can take a small sample of the nails and do a fungal test or a potassium hydroxide preparation to help determine what’s causing the onycholysis. These tests can be done in the office, and they don’t require any pain or special tools. Treatment can’t reattach the sections of the nail that have separated, but it can help keep new nail growth attached to the nails. This can relieve the pain and improve the appearance of the nails. In some cases, treatments may include medicated creams and ointments.

Symptoms

Onychophosis is a condition that develops in the nails when the nail plate separates from the skin underneath. This causes the nails to appear thickened with a dull appearance and can be very unsightly. It can also be painful if the condition is severe enough. This condition can be caused by a number of things including injury, infections, and health conditions. The condition usually affects one nail at a time and can last for months or even up to a year.

Some people are more at risk for developing onychophosis than others. This includes those who regularly use nail polish and other nail products, work with their hands a lot, or have health conditions like psoriasis that can affect the nails. People who have a fungal nail infection may also be at higher risk for onycholysis.

Symptoms of onychophosis include thickened and discolored nails, nail ridges, dents in the nails, or a foul odor. The nail can also become crumbling or break off completely. In some cases, the skin around the nail can become red and inflamed. The pain is down the side of the nail, but its not ingrown.

If you are experiencing these symptoms, it is important to see a podiatrist for a diagnosis. Your doctor can perform tests like a biopsy, fungus test, or periodic acid-Schiff (PAS) stain to identify the cause of your onycholysis. In addition, your doctor can advise you on how to prevent future problems by minimizing activities that could damage the nails or nail bed.

Diagnosis

Although onychomycosis is not life-threatening, it can be painful and impact a patient’s quality of life, especially for those affected with toenails that are thickened and discolored. It is also not unusual for it to have an adverse effect on the ability to participate in sports or work.

The diagnosis of onychophosis is usually made by direct inspection and can be confirmed by the presence of well-defined, opaque white “islands” that develop on the nail plate and coalesce as the condition progresses. The diagnosis can be made more definitive by obtaining a sample of the nail for direct microscopy and culture. The etiology of onychomycosis is usually dermatophytic, although yeasts (especially Candida albicans) and nondermatophyte molds may also be implicated.

Until recently, antifungal drugs used in the treatment of onychomycosis were relatively unsuccessful. Fortunately, newer agents with broader spectrum of activity and shorter treatment regimens have been developed that are proving to be quite effective. Nevertheless, patients should be encouraged to understand that it will take several months for a cure to occur, particularly in immunocompromised individuals. Instilling realistic expectations is critical to patient compliance. Surgical treatment of onychophosis is an option for those patients with severe symptoms who are not satisfied with current medications. The decision to pursue this approach should be based on a thorough examination and history, and must take into consideration the patient’s tolerance of surgery, risk for complications, potential recurrence, and cost.

Treatment

The main goals of onychomycosis treatment are eradication of the pathogen and restoration of healthy nails. Successful management of this condition requires adherence to therapy, as well as prevention of recurrence and/or reinfection [1].

Although fungi are the main cause of onychophosis, there are many other factors that may contribute to its development: physical injuries (trauma), diseases that affect the nail matrix or surrounding skin (such as thyroid disease, psoriasis and lichen), bacterial or parasitic infections, dermatitis or other disorders that affect the nails, such as psoriasis or pseudomononas, diabetes or anemia, as well as regular use of acetone-based nail polish remover and acrylic nails. Moreover, wearing tight shoes or having hallux valgus may increase the pressure on the nail sulcus and contribute to its formation.

In addition, the use of harsh chemicals or excessive soaking in water can also cause onychogryphosis. Finally, frequent visits to a manicurist to trim and buff the nails can also lead to this condition because of the force applied to each nail.

For symptomatic patients, topical treatments such as etylenol or urea may help to reduce the thickness of the nails and improve their appearance. The more advanced changes can be treated by a podiatrist who will clean the nail change and remove the thickened portion of the nail. However, this procedure is painful and the results are usually not satisfactory.