Introduction
Background
Onycholysis is a nail disorder frequently encountered by dermatologists. Onycholysis is characterized by a spontaneous separation of the nail plate starting at the distal free margin and progressing proximally. The nail plate is separated from the underlying and/or lateral supporting structures. Less often, separation of the nail plate begins at the proximal nail and extends to the free edge, which is seen most often in psoriasis of the nails (termed onychomadesis). Rare cases are confined to the nail's lateral borders.
Pathophysiology
Nails with onycholysis usually are smooth, firm, and without inflammatory reaction. It is not a disease of the nail matrix, but nail discoloration may appear underneath the nail as a result of secondary infection. When onycholysis occurs, a coexistent yeast infection is suggested. Treating primary and secondary factors that exacerbate the condition is important. Left untreated, severe cases of onycholysis may result in nail bed scarring.
Frequency
United States
The incidence of onycholysis in the United States is unknown.
International
The worldwide incidence of onycholysis is unknown.
Race
Distribution of onycholysis by race is unknown; however, it has been observed in all races.
Sex
Individuals of either sex can have onycholysis; however, studies demonstrate an overwhelmingly female predilection.
Age
People of any age can present with onycholysis, although it primarily is a disease of adulthood.
Clinical
History
Evaluation of patients with onycholysis requires a careful history of exposure to etiologic agents.
Physical
- Nails are smooth, firm, and without inflammatory reaction.
- Discoloration underneath the nail may occur as a result of secondary infection.
- Spontaneous separation of the nail plate starts at the distal free margin and progresses proximally. Less often, nail plate separation may begin at the proximal nail and extend to the free edge. The nail plate is separated from underlying and/or lateral supporting structures.
- Nail plate separation can be confined to the nail's lateral borders (rare).
Causes
Endogenous, exogenous, hereditary, and idiopathic factors can cause onycholysis. Contact irritants, trauma, and moisture are the most common causes of onycholysis, but other associations exist.
- Endogenous factors
- Systemic diseases and states
- Amyloid and multiple myeloma
- Anemia (iron deficient)
- Bronchiectasis
- Diabetes mellitus
- Erythropoietic porphyria
- Histiocytosis X
- Hyperthyroidism
- Hypothyroidism
- Ischemia (peripheral, impaired circulation)
- Leprosy
- Lupus erythematosus
- Neuritis
- Pellagra
- Pemphigus vulgaris
- Pleural effusion
- Porphyria cutanea tarda
- Pregnancy
- Psoriatic arthritis
- Reiter syndrome
- Sarcoidosis
- Scleroderma
- Shell nail syndrome
- Syphilis
- Yellow nail syndrome
- Dermatologic diseases
- Psoriasis
- Lichen planus
- Dermatitis
- Hyperhidrosis
- Pachonychia congenita
- Congenital ectodermal defect
- Pemphigus vegetans
- Lichen striatus
- Atopic dermatitis
- Congenital abnormalities of the nail
- Neoplastic disorders
- Squamous cell carcinoma (of nail bed)
- Carcinoma (lung)
- Systemic diseases and states
- Exogenous factors
- Nonmicrobial factors (may be encountered at the job site, ie, as occupational onycholysis)
- Mechanical - Mechanical force (trauma), repetitive minor trauma, or maceration
- Chemical - Allergic contact dermatitis from various nail cosmetics (methyl methacrylate monomer, formaldehyde 1-2%, nail base coat/hardeners, polymerized 2-ethylcyanoacrylate adhesive used in artificial nails, nail lacquer), gasoline, paint removers, dicyanodiamide, thioglycolate, solvents, and hydroxylamine sulphate in color developer
- Chemical - Irritant contact dermatitis from prolonged immersion of nails in water, sugar onycholysis in confectioners/bakers, and exposure to highly destructive toxins (eg, hydrofluoric acid)
- Biologic/microbial factors
- Dermatophytosis (ie, Trichophyton rubrum, Trichophyton mentagrophytes infection)
- Yeast (Candida infection)
- Bacteria (Pseudomonas infection)
- Virus (herpes simplex infection)
- Nonmicrobial factors (may be encountered at the job site, ie, as occupational onycholysis)
- Drug associations
- Other factors
- Congenital onycholysis
- Hereditary partial onycholysis
- Idiopathic acquired onycholysis
- Hereditary distal onycholysis9
- Foreign body implantation
More on Onycholysis |
 Overview: Onycholysis |
| Differential Diagnoses & Workup: Onycholysis |
| Treatment & Medication: Onycholysis |
| Follow-up: Onycholysis |
| References |
| Next Page » |
References
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Bazex J, Baran R, Monbrun F, Grigorieff-Larrue N, Marguery MC. Hereditary distal onycholysis--a case report. Clin Exp Dermatol. Mar 1990;15(2):146-8. [Medline].
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Daniel CR 3rd, Daniel MP, Daniel CM, Sullivan S, Ellis G. Chronic paronychia and onycholysis: a thirteen-year experience. Cutis. Dec 1996;58(6):397-401. [Medline].
Kechijian P. Onycholysis of the fingernails: evaluation and management. J Am Acad Dermatol. Mar 1985;12(3):552-60. [Medline].
Scher RK, Daniel CR. Nails: Therapy, Diagnosis, Surgery. 2nd ed. Philadelphia, Pa: WB Saunders; 1997:140, 169, 227-9.
Scotte F, Banu E, Medioni J, et al. Matched case-control phase 2 study to evaluate the use of a frozen sock to prevent docetaxel-induced onycholysis and cutaneous toxicity of the foot. Cancer. Apr 1 2008;112(7):1625-31. [Medline].
Further Reading
Keywords
fingernail disorder, nail dystrophy, toenail disorder, nail plate separation, fingernail fungus, toenail fungus, nail fungus, nail fungal infection
