Onycholysis

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Onycholysis
Onycholysis left hand 34yo male ring and little fingers non-fungal.jpg
Left hand onycholysis: ring and little fingers affected
Pronunciation
Specialty Dermatology   OOjs UI icon edit-ltr-progressive.svg

Onycholysis is a common medical condition characterized by the painless detachment of the nail from the nail bed, usually starting at the tip and/or sides. [1] On the hands, it occurs particularly on the ring finger but can occur on any of the fingernails. It may also happen to toenails.

Contents

Onycholysis can occur in many conditions, including psoriasis. [2] In thyrotoxicosis, it is thought to be due to sympathetic overactivity. [3] It may also be seen in infections or trauma. [4]

Causes

Treatment

Most instances of onycholysis without a clear cause will heal spontaneously within a few weeks. The most commonly recommended treatment is to keep the nail dry as much as possible and allow the nail to slowly reattach. Trimming away as much loose nail as can be done comfortably will prevent the nail from being pried upwards. Cleaning under the nail is not recommended as this only serves to separate the nail further. Bandages are also to be avoided. [11] When kept dry and away from further trauma, the nail will reattach from the base upward (i.e., from proximal to distal). The aim of treatment is also to eliminate onychomycosis that is a major cause of onycholysis. Antifungals like terbinafin and itraconazole in the form of oral pills should be given for 6 to 8 weeks. [11]

If the underlying cause of the condition is not found and the nail continues to detach despite conservative treatment, the nail bed may begin to form a granular layer of abnormal cells on its surface. After six months of detachment, this layer is likely to prevent the adhesion of any new nail tissue, possibly leading to permanent deformity. [12]

Etymology

The word onycholysis comes from onycho-, from Ancient Greek ὄνυξ ónuks 'nail', and Ancient Greek λύσις lúsis 'lysis/disintegration'. [13]

See also

Related Research Articles

<span class="mw-page-title-main">Psoriasis</span> Skin disease

Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete body coverage. Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.

<span class="mw-page-title-main">Nail disease</span> Medical condition

A nail disease or onychosis is a disease or deformity of the nail. Although the nail is a structure produced by the skin and is a skin appendage, nail diseases have a distinct classification as they have their own signs and symptoms which may relate to other medical conditions. Some nail conditions that show signs of infection or inflammation may require medical assistance.

<span class="mw-page-title-main">Psoriatic arthritis</span> Long-term inflammatory arthritis

Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that occurs in people affected by the autoimmune disease psoriasis. The classic feature of psoriatic arthritis is swelling of entire fingers and toes with a sausage-like appearance. This often happens in association with changes to the nails such as small depressions in the nail (pitting), thickening of the nails, and detachment of the nail from the nailbed. Skin changes consistent with psoriasis frequently occur before the onset of psoriatic arthritis but psoriatic arthritis can precede the rash in 15% of affected individuals. It is classified as a type of seronegative spondyloarthropathy.

<span class="mw-page-title-main">Lichen planus</span> Human chronic inflammatory disease

Lichen planus (LP) is a chronic inflammatory and autoimmune disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, but is named for its appearance. It is characterized by polygonal, flat-topped, violaceous papules and plaques with overlying, reticulated, fine white scale, commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. The hue may be gray-brown in people with darker skin. Although there is a broad clinical range of LP manifestations, the skin and oral cavity remain as the major sites of involvement. The cause is unknown, but it is thought to be the result of an autoimmune process with an unknown initial trigger. There is no cure, but many different medications and procedures have been used in efforts to control the symptoms.

<span class="mw-page-title-main">Leukonychia</span> White spots on finger and toe nails

Leukonychia is a medical term for white discoloration appearing on nails. It is derived from the Greek words leuko 'white' and onyx 'nail'. The most common cause is injury to the base of the nail where the nail is formed.

<span class="mw-page-title-main">Paronychia</span> Medical condition

Paronychia is an inflammation of the skin around the nail, which can occur suddenly, when it is usually due to the bacterium Staphylococcus aureus, or gradually when it is commonly caused by the fungus Candida albicans. The term is from Greek: παρωνυχία from para 'around', onyx 'nail', and the abstract noun suffix -ia.

<span class="mw-page-title-main">Onychomycosis</span> Medical condition

Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Fingernails may be affected, but it is more common for toenails. Complications may include cellulitis of the lower leg. A number of different types of fungus can cause onychomycosis, including dermatophytes and Fusarium. Risk factors include athlete's foot, other nail diseases, exposure to someone with the condition, peripheral vascular disease, and poor immune function. The diagnosis is generally suspected based on the appearance and confirmed by laboratory testing.

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Madarosis is a condition that results in the loss of eyelashes, and sometimes eyebrows. The term "madarosis" is derived from the ancient Greek "madaros", meaning "bald". It originally was a disease of only losing eyelashes but it currently is the loss of both eyelashes and eyebrows. Eyebrows and eyelashes are both important in the prevention of bacteria and other foreign objects from entering the eye. A majority of patients with madarosis have leprosy, and it was reported that 76% of patients with varying types of leprosy had madarosis.

<span class="mw-page-title-main">Onychauxis</span> Medical condition

Onychauxis presents with thickened nails without deformity, and this simple thickening may be the result of trauma, acromegaly, Darier's disease, psoriasis, or pityriasis rubra pilaris, or, in some cases, hereditary.

<span class="mw-page-title-main">Green nail syndrome</span> Medical condition

Green nail syndrome is an infection that can develop in individuals whose hands are frequently submerged in water resulting in discolouration of the nails from shades of green to black. It may also occur as transverse green stripes that are ascribed to intermittent episodes of infection. It is usually caused by the bacteria Pseudomonas aeruginosa and is linked to hands being constantly moist or exposed to chemicals, or in individuals who have damaged or traumatised nails. There are several activities and nail injuries or conditions that are linked to higher risk of contracting the condition.

Melanonychia is a black or brown pigmentation of a nail, and may be present as a normal finding on many digits in Afro-Caribbeans, as a result of trauma, systemic disease, or medications, or as a postinflammatory event from such localized events as lichen planus or fixed drug eruption.

Pincer nails are a toenail disorder in which the lateral edges of the nail slowly approach one another, compressing the nailbed and underlying dermis. It occurs less often in the fingernails than toenails, and there usually are no symptoms.

<span class="mw-page-title-main">Pterygium unguis</span> Medical condition

Pterygium unguis forms as a result of scarring between the proximal nailfold and matrix, with the classic example being lichen planus, though it has been reported to occur as a result of sarcoidosis and Hansen's disease.

<span class="mw-page-title-main">Psoriatic onychodystrophy</span> Medical condition

Psoriatic onychodystrophy or psoriatic nails is a nail disease. It is common in those with psoriasis, with reported incidences varying from 10% to 78%. Elderly patients and those with psoriatic arthritis are more likely to have psoriatic nails.

<span class="mw-page-title-main">Guttate psoriasis</span> Medical condition

Guttate psoriasis is a type of psoriasis that presents as small lesions over the upper trunk and proximal extremities; it is found frequently in young adults.

<span class="mw-page-title-main">Psoriatic erythroderma</span> Medical condition

Psoriatic erythroderma represents a form of psoriasis that affects all body sites, including the face, hands, feet, nails, trunk, and extremities. This specific form of psoriasis affects 3 percent of persons diagnosed with psoriasis. First-line treatments for psoriatic erythroderma include immunosuppressive medications such as methotrexate, acitretin, or ciclosporin.

Malalignment of the nail plate, also known as congenital malalignment of the great toenails or congenital malalignment syndrome, is a congenital malalignment of the nail of the great toe, and is often misdiagnosed although it is a common condition. It most commonly affects the hallucices. The nail might be discolored and develop infections. If the misaligned nail becomes embedded in the lateral nail fold it can cause pain, inflammation and erythema.

Parakeratosis pustulosa is a cutaneous condition which is exclusively seen in children, usually involving one finger, most commonly the thumb or index finger, with the affected nail showing subungual hyperkeratosis and onycholysis.

References

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  2. Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2012). "Onycholysis (Plummer's nail)". Mechanisms of Clinical Signs. Elsevier. p. 542. ISBN   978-0729540759.
  3. Talley&O'Connor (2006). Clinical Examination A Systematic Guide to Physical Diagnosis (5th ed.). Elsevier. p. 262. ISBN   978-0-7295-3762-9.
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  6. Al-Kathiri, Lutfi; Al-Asmaili, Abla (2016). "Diclofenac-Induced Photo-Onycholysis". Oman Medical Journal. 31 (1): 65–68. doi:10.5001/omj.2016.12. ISSN   1999-768X. PMC   4720947 . PMID   26816569.
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  8. Hazin, Ribhi; Tamimi, Tarek I. Abu-Rajab; Abuzetun, Jamil Y.; Zein, Nizar N. (October 2009). "Recognizing and treating cutaneous signs of liver disease". Cleveland Clinic Journal of Medicine. 76 (10): 599–606. doi: 10.3949/ccjm.76A.08113 . ISSN   0891-1150. PMID   19797460.
  9. Shah, Selina (April 2010). "Pointe shoes complicate biomechanics of ballet". Lower Extremity Review Magazine.
  10. Niema, Aqil; Aicha, Nassiri; Salim, Gallouj; Fatima Zahra, Mernissi (2019-06-30). "Nail Disorders in Patients with Chronic Renal Failure". Journal of Dermatology Research and Therapy. 5 (1). ClinMed International Library. ISSN   2469-5750.
  11. 1 2 "Onycholysis". American Osteopathic College of Dermatology. Retrieved 29 December 2016.
  12. Richard K. Scherr (1 December 1997). "The Nail Doctor: Onycholysis, or Nail Separation, Has Different Varieties". Nails Magazine.
  13. Services, ProZ com Translation. "lusis | Greek (Ancient) to English | Poetry & Literature". ProZ.com | Freelance translators and interpreters. Retrieved 2022-10-08.