What to do if an artificial nail is pulling the real nail up and away from the nail bed?

Management of Artificial Nail Pulling Real Nail Away from Nail Bed

The artificial nail should be removed immediately to prevent further damage, as artificial nails can lead to onycholysis (separation of the nail from the nail bed) and potential infection. 1

Immediate Management

• Remove the artificial nail carefully to prevent further damage to the natural nail 1
• Clean the nail bed thoroughly and inspect for any signs of infection or debris that may have accumulated in the space between the nail plate and nail bed 1
• If there is severe pain, a subungual hematoma (blood collection under the nail), or signs of infection, complete removal of the natural nail plate may be necessary 2, 3
• Obtain bacterial cultures if infection is suspected (look for pus, increased pain, or redness) 1, 2

Treatment Based on Severity

Mild Separation (No Pain or Infection)

• Allow the nail to dry completely after removing the artificial nail 4
• Use a hair dryer on a cool setting to dry the nail 'lytic' area, as colonizing organisms thrive in moist environments 4
• Avoid reapplying artificial nails as they can worsen the condition 1

Moderate to Severe Separation (With Pain or Early Signs of Infection)

• Apply topical antiseptics to prevent secondary infection 1
• Consider daily dilute vinegar soaks (50:50 dilution) to the affected nail twice daily to reduce inflammation and prevent infection 1
• Apply mid to high potency topical steroid ointment to nail folds twice daily if there is inflammation or pain 1

Severe Cases (With Infection or Abscess)

• If a subungual abscess or severe infection is present, complete removal of the natural nail plate is indicated 1, 2
• Clean the nail bed thoroughly and obtain cultures 1
• Initiate appropriate topical or oral antibiotics based on culture results 1
• Regular nail trimming is necessary until the nail plate grows reattached 1

Prevention of Future Problems

• Avoid application of artificial nails, especially if you've had previous nail problems 1
• Use topical emollients on periungual folds, matrix, and nail plate daily 1
• Consider protective nail lacquers to limit water loss from the nail plate 1
• Avoid damaging or irritant regimens including:
  • Manipulation of cuticles and nail biting 1
  • Using fingernails as 'tools' 1
  • Prolonged soaking in water 1
  • Exposure to solvents or harsh chemicals 1

Important Considerations

• Onycholysis may become permanent if not addressed promptly, as chronic onycholysis can lead to nail bed keratinization and persistent subungual hyperkeratosis 1
• Artificial nails have been associated with increased risk of fungal and bacterial infections, with studies showing higher colonization rates of pathogens compared to natural nails 5, 6
• The space created by nail separation can harbor pathogens including Candida albicans and Pseudomonas, which thrive in moist environments 4

Follow-up Care

• Monitor the nail for signs of proper reattachment as it grows 1
• Watch for signs of infection including increased pain, redness, warmth, or discharge 1
• Complete healing may take several months as the nail grows at a slow rate 1