History

Evaluation of patients with onycholysis requires a careful history of exposure to etiologic agents.

Physical Examination

In onycholysis, 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 in onycholysis 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).

Workup

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Bentabet Dorbani I, Badri T, Benmously R, Fenniche S, Mokhtar I. Griseofulvin-induced photo-onycholysis. Presse Med. 2012 Jan 12. [QxMD MEDLINE Link].
Horio T. Spontaneous photo-onycholysis. J Dermatol. 1988 Dec. 15(6):540-2. [QxMD MEDLINE Link].
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Media Gallery

Thumb onycholysis. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/hair-nails-sweat/olysis1.jpg).
Great toe onycholysis. Courtesy of Professor Raimo Suhonen and DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/hair-nails-sweat/s/olysis7.jpg).

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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.

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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.