Onycholysis Treatment & Management

  • Author: Melanie S Hecker, MD, MBA; Chief Editor: William D James, MD   more...
 
Updated: Feb 29, 2012
 

Medical Care

Treatment for onycholysis varies and depends on its cause. Eliminating the predisposing cause of the onycholysis is the best treatment. Onycholysis related to psoriasis or eczema may respond to a midstrength topical corticosteroid. Pulsed dye laser treatment was reported as effective for psoriasis-induced onycholysis in one small series,[12] but caution is advised until more data are available regarding this intervention. Psoralen plus ultraviolet A (PUVA) treatment has also been reported as an effective therapy for psoriatic onycholysis.[13] Note the following:

  • Patients should avoid trauma to the affected nail, and keep the nail bed dry.
  • Patients should avoid exposure to contact irritants and moisture (important).
  • Patients should clip the affected portion of the nail, and keep the nails short.
  • Patients should wear light cotton gloves under vinyl gloves for wet work.

Intralesional injection may be required for onycholysis associated with more severe psoriatic nail dystrophy. Note the following:

  • Triamcinolone 2.5-5 mg/mL diluted with normal saline is injected into the proximal nail fold every 4 weeks in a series of 4-6 sessions.
  • The proximal nail fold overlying the nail matrix is the ideal site for treatment of diseases that begin at the matrix (eg, psoriasis).
  • A 30-gauge needle is adequate for medication delivery; a topical anesthetic may be used to reduce pain.
  • Improvement should start after the initial series; continued injections depend on disease recurrence.
  • For other nail changes associated with onycholysis (eg, oil drop sign of psoriasis, distal onycholysis, subungual hyperkeratosis), the ideal location for intralesional injection is the nail bed. The pain of this procedure necessitates the use of anesthesia. This problem can be overcome by injecting the lateral nail folds in an attempt to get medication to the affected area.
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Advise patients with onycholysis to avoid contact irritants, trauma, and moisture.

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Contributor Information and Disclosures
Author

Melanie S Hecker, MD, MBA  President, Hecker Dermatology Group; Consulting Staff, Department of Dermatology, Imperial Point Medical Center, Holy Cross Hospital, and North Broward Hospital

Melanie S Hecker, MD, MBA is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Coauthor(s)

David Hecker, MD  Consulting Staff, Dermatology Specialists of Palm Beach County

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard K Scher, MD  Adjunct Professor of Dermatology, University of North Carolina; Professor Emeritus of Dermatology, Columbia University

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

  1. Passier A, Smits-van Herwaarden A, van Puijenbroek E. Photo-onycholysis associated with the use of doxycycline. BMJ. Jul 31 2004;329(7460):265. [Medline].

  2. Rabar D, Combemale P, Peyron F. Doxycycline-induced photo-onycholysis. J Travel Med. Nov-Dec 2004;11(6):386-7. [Medline].

  3. Hanneken S, Wessendorf U, Neumann NJ. Photodynamic onycholysis: first report of photo-onycholysis after photodynamic therapy. Clin Exp Dermatol. Aug 2008;33(5):659-60. [Medline].

  4. Gregoriou S, Karagiorga T, Stratigos A, Volonakis K, Kontochristopoulos G, Rigopoulos D. Photo-onycholysis caused by olanzapine and aripiprazole. J Clin Psychopharmacol. Apr 2008;28(2):219-20. [Medline].

  5. Bentabet Dorbani I, Badri T, Benmously R, Fenniche S, Mokhtar I. Griseofulvin-induced photo-onycholysis. Presse Med. Jan 12 2012;[Medline].

  6. Horio T. Spontaneous photo-onycholysis. J Dermatol. Dec 1988;15(6):540-2. [Medline].

  7. Makris A, Mortimer P, Powles TJ. Chemotherapy-induced onycholysis. Eur J Cancer. Feb 1996;32A(2):374-5. [Medline].

  8. Hogeling M, Howard J, Kanigsberg N, Finkelstein H. Onycholysis associated with capecitabine in patients with breast cancer. J Cutan Med Surg. Mar-Apr 2008;12(2):93-5. [Medline].

  9. Paravar T, Hymes SR. Longitudinal melanonychia induced by capecitabine. Dermatol Online J. Oct 15 2009;15(10):11. [Medline].

  10. Tinio P, Bershad S, Levitt JO. Medical Pearl: Docetaxel-induced onycholysis. J Am Acad Dermatol. Feb 2005;52(2):350-1. [Medline].

  11. 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].

  12. Oram Y, Karincaoglu Y, Koyuncu E, Kaharaman F. Pulsed Dye Laser in the Treatment of Nail Psoriasis. Dermatol Surg. Jan 19 2010;[Medline].

  13. Edwards F, de Berker D. Nail psoriasis: clinical presentation and best practice recommendations. Drugs. 2009;69(17):2351-61. [Medline].

  14. 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].

  15. Scotte F, Tourani JM, Banu E, et al. Multicenter study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity of the hand. J Clin Oncol. Jul 1 2005;23(19):4424-9. [Medline].

  16. Scher RK, Daniel CR. Nails: Therapy, Diagnosis, Surgery. 2nd ed. Philadelphia, Pa: WB Saunders; 1997:140, 169, 227-9.

 
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