Onycholysis: What Causes It and How Can It Be Treated?

I often see women with onycholysis, or peeling of the nails. I feel like they don’t buy into my standard explanation, which is that the most common cause is mild chronic trauma to the nails. Most seem to want a miracle lotion, or a prescription for anti-fungal medication, but this isn’t always the correct form of treatment.

Onycholysis occurs in the fingernails and toenails, when the nail plate begins to peel away from the nail bed. It’s characterized by a white sheen over the nail, which is the nail plate separating from the nail bed. In the fingernails, the cause is most often trauma from manicuring, picking, and occupational injuries. In the toenails, the most frequent source is pressure and friction from walking in close-toed shoes.

Most onycholysis patients are women, and the most common cause is irritation. As mentioned before, excessive nail filing and overexposure to chemicals in manicuring products can irritate the area and cause breakage. Sometimes, a patient can even have an allergic contact dermatitis reaction to the adhesives in acrylic nails. In rare cases, onycholysis indicates iron deficiency anemia or an overactive thyroid.

To treat onycholysis, clip off the unattached parts of the nail. Keep your fingers away from water unless absolutely necessary. Use gloves when cleaning dirty surfaces, so that bacteria can’t get underneath your nails. Gloves also prevent mechanical injuries. Some even suggest using a hair dryer to blow your fingers dry, or just letting your hands air dry. Make sure you don’t cover or bandage the nails, as fungus and bacteria thrive in closed, moist areas. In more severe cases, you may need to get a prescription from a doctor.

In conclusion, if you have onycholysis, the key is to keep everything clean and dry. Thus, bacteria and infection have a minimal chance of finding a place to grow.  


Onycholysis – American Osteopathic College of Dermatology (AOCD). Onycholysis – American Osteopathic College of Dermatology (AOCD). http://www.aocd.org/?page=onycholysis. Accessed August 16, 2016.

Result Filters. National Center for Biotechnology Information. http://www.ncbi.nlm.nih.gov/pubmed/25512134. Accessed August 16, 2016.

Castor Oil Has Skincare Purposes I Didn’t Know About

A patient came to me having tried a number of remedies, including castor oil. I’ve heard of this, but I didn’t know if it had any relevance to dermatology. I decided to do some research on the topic.

The oil itself comes from the castorbean, which is native to areas of Eastern Africa and the Mediterranean. Specifically, the castorbean’s seeds contain the best source.

People know castor oil as a laxative ingredient, but it also treats skin ulcers and other wounds. It comes as an ointment or a spray, and its brand names are Granulex, TBC, Vasolex, and Xenaderm.

The oil is also found in cosmetic products like creams and lipsticks. When combined with Glyceryl Ricinoleate, it absorbs UV light. Overdoses and allergic reactions may occur if product is not used as directed.


Castor Oil/Peru Balsam/Trypsin (On the skin). National Institute of Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/pmht0009483/?report=details#uses. Published July 1, 2016. Accessed August 16, 2016.

The Four Cosmetic Intervention Techniques Backed By Science

Cosmetic intervention is a hot-button issue in the dermatology industry. There is ongoing research into what works and what doesn’t. Everyone wants protect their facial skin from damage, and everyone wants to avoid wrinkles. As a practicing physician, I only use techniques that have been proven to work through scientific studies and trials.

Right now, there are only four cosmetic intervention techniques that fulfill that criteria.

  1. Sunscreen, daily: ultraviolet (UV) light and natural aging causes most damage to the skin. Protecting your fibroblasts from UV damage lessens their impairment. It also protects the epidermis, melanocytes, and skin-associated immune cells from UV damage.
  2. Retinoids: A retinoid (topical derivative of Vitamin A) applied to the skin helps fibroblasts “wake up.” The activation of fibroblasts produces more collagen. Since fibroblasts lose function with age, retinoids help restore fibroblasts and repair normal function
  3. Fillers: Adding volume to the dermis actively stretches the fibroblasts and wakes them up. As a result, fibroblasts begin to produce more collagen, much like the response to retinoids.
  4. Carbon Dioxide Laser Resurfacing: Usually a laser will remove a thin layer of tissue. Then stem cells from hair follicles resurface new dermis and epidermis.

I recommend that my patients use options 1-3. Resurfacing works, but it’s expensive, risky, and involves significant down time.

In conclusion, these four techniques are the only cosmetic intervention methods that scientific evidence can back.  Though this may seem limiting, there is ongoing research into other techniques, as people are eager to seek out alternative methods. But since there is nothing scientific to back up alternative methods, we’ll just have to wait and see.