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Onycholysis Treatment & Management

  • Author: Melanie S Hecker, MD, MBA; Chief Editor: William D James, MD  more...
 
Updated: Feb 09, 2016
 

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,[13] 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.[14] 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, 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 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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate 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, Texas Dermatological Society

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina at Chapel Hill School of Medicine; Professor Emeritus of Dermatology, Columbia University College of Physicians and Surgeons

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

Disclosure: Nothing to disclose.

References
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  2. Rabar D, Combemale P, Peyron F. Doxycycline-induced photo-onycholysis. J Travel Med. 2004 Nov-Dec. 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. 2008 Aug. 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. 2008 Apr. 28(2):219-20. [Medline].

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

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

  7. Makris A, Mortimer P, Powles TJ. Chemotherapy-induced onycholysis. Eur J Cancer. 1996 Feb. 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. 2008 Mar-Apr. 12(2):93-5. [Medline].

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

  10. Robert C, Sibaud V, Mateus C, Verschoore M, Charles C, Lanoy E, et al. Nail toxicities induced by systemic anticancer treatments. Lancet Oncol. 2015 Apr. 16(4):e181-e189. [Medline].

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

  12. Bazex J, Baran R, Monbrun F, Grigorieff-Larrue N, Marguery MC. Hereditary distal onycholysis--a case report. Clin Exp Dermatol. 1990 Mar. 15(2):146-8. [Medline].

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

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

  15. 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. 2008 Apr 1. 112(7):1625-31. [Medline].

  16. 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. 2005 Jul 1. 23(19):4424-9. [Medline].

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