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, [16] 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. [17] Note the following:
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Patients should avoid trauma to the affected nail, and keep the nail bed dry.
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Patients should avoid exposure to contact irritants and moisture (important).
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Patients should clip the affected portion of the nail, and keep the nails short.
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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:
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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.
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The proximal nail fold overlying the nail matrix is the ideal site for treatment of diseases that begin at the matrix (eg, psoriasis).
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A 30-gauge needle is adequate for medication delivery; a topical anesthetic may be used to reduce pain.
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Improvement should start after the initial series; continued injections depend on disease recurrence.
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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.
Activity
Advise patients with onycholysis to avoid contact irritants, trauma, and moisture.
Prevention
Patients with onycholysis should avoid contact irritants, trauma, and moisture.
Keep nail beds dry.
Keep nails short; clip affected portions.
Wear light cotton gloves under vinyl gloves for wet work.
Docetaxel-induced onycholysis may be prevented by wearing a frozen glove for 90 minutes during infusion of the chemotherapeutic agent. [18, 19]
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Thumb onycholysis. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/hair-nails-sweat/olysis1.jpg).
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Great toe onycholysis. Courtesy of Professor Raimo Suhonen and DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/hair-nails-sweat/s/olysis7.jpg).
