Why do toenails fall off?

What causes human toenails to fall off aside from infections?

• at the age of almost 55, I find my toenails softening and becoming less and less strong. I was in my daughters hot-tub and when I got out, I found all my toenails coming off. Is this a sign of diabetes???

• Answer:

  It is not per se a symptom of diabetes. Excessive urination, thrist, intermittently blurred vision, acetone-smelling breath and extreme hunger are more typical signs of diabetes. It is very unusual that your toenails suddenly just came off when exposed soaking in warm water. Nail fungus can exist in the nail and nail bed, causing the nail to thicken over a series of months and raise. It does not hurt. Some women also notice changes in their nails and skin after menopause. I have seen hormone replacement therapy (a pill daily) help. It might also be possible to use a topical estrogen cream on the area of concern if you don't tolerate the medication. A thyroid condition (hypothyroidism) can cause changes in the nails - usually becoming brittle. Finally very poor circulation in the lower extremity could cause changes in the feet and nail beds...though I would expect more (dramatic!) changes than just in the nails if that were the case. In sum, this condition requires a history and physical exam by your doctor for a work-up, a diagnosis, and treatment if warranted.