Onycholysis of the fingernails: evaluation and management

Diagnosis using the nail bed and hyponychium

"Nails protect the fingertips and toes. Diseases affecting the nail can cause cosmetic disfigurement and social embarrassment. Physical functioning may be impaired. Disorders of the nail bed may cause pain or create difficulty grasping fine objects. The nail bed is the area beneath the nail plate between the lunula and the hyponychium. Disorders of the nail bed can cause onycholysis, subungual hyperkeratosis, and/or onychogryphosis. Ventral pterygium is less common. Tumors of the nail bed are rare and commonly missed."

Common nail disorders

Brittle nail, simple chronic paronychia, and onycholysis represent three of the most prevalent nail disorders. Brittle nails are characterized by increased fragility of the nail plate due to damage to the nail matrix or changes to nail plate cohesion, caused by internal and/or external factors. Simple chronic paronychia represents an inflammatory process of the lateral and/or proximal nail folds of the fingernails or toenails often preceded by damage to the cuticle. Onycholysis describes the detachment of the nail plate from its nail bed, often attributable to dermatologic conditions, infections, drug therapy, or trauma.

Nail abnormalities associated with systemic pathologies

Nail abnormalities can arise in conjunction with or as a result of systematic pathologies. These pathologies include single-organ diseases, multisystemic diseases, and drug-induced insults. Clinical signs associated with these conditions include dyschromias, vascular alterations, periungual tissue changes, textural dystrophies, contour alterations, and growth-rate alterations. The associated systemic pathologies may affect any part of the nail apparatus, including the nail matrix, the nail plate, the nail bed, the underlying vasculature, and the periungual tissues. The anatomical location and extent of damage determine the clinically manifested anomaly.

A hand surgeon's guide to common onychodystrophies

The human fingernail contributes to the precise dexterity of the fingers, enhances sensibility, allows manipulation of fine objects, and shields the fingertip from traumatic injury. Nail abnormalities are a common incidental finding in the course of a hand surgeon's daily practice. These abnormalities may be clues to systemic, dermatologic, traumatic, and infectious processes that would benefit from further evaluation and treatment. The purpose of this review is to discuss common nail dystrophies and their related diagnoses.

Treatment of Chronic Idiopathic Onychodystrophy with Intake of Carotene-rich Food

BACKGROUND

Onychodystrophy refers to the various abnormalities in nail morphology due to changes in the attachment of the nail plate, changes in nail surface or color. The treatment principle of onychodystrophy largely relies on the discovery and verification of the cause. However, preventive treatment methods offer little help to the patient due to poor compliance, and the effect of corticosteroid is only temporary.

OBJECTIVE

To evaluate the clinical efficacy of carotene-rich food intake in chronic idiopathic onychodystrophy.

METHODS

Ten patients with chronic idiopathic onychodystrophy were recommended to drink one or two cups of carrot juice daily.

RESULTS

Patients showed improvement of onychodystrophy after drinking carrot juice twice a day for at least 4 weeks. No specific adverse effects were noted.

CONCLUSION

Since there are no reliable treatment methods for chronic idiopathic onychodystrophy, we suggest a simple and compliant treatment method consisting of taking carotene-rich food, such as carrot juice, for patients with chronic idiopathic onychodystrophy.

Finger sucking and onycholysis in an infant

A case of onycholysis in a 6-month-old male infant secondary to chronic finger sucking is reported. He was allowed to suck on his fingers without intervention. The onycholysis resolved after cessation of finger sucking habits when the child was a toddler.

Trophic implications of altered body composition observed in or near the nails of hemodialysis patients

In the absence of biochemically determined nutrient status, renal nutrition specialists have been left to assume that hemodialysis (HD) patients with a stable body weight and acceptable macronutrient intakes had adequate micronutrient stores. However, at the University of California Renal Center, using physical examination and laboratory studies, approximately one in three HD patients were found to have micronutrient imbalance. The Nutrition Physical Examination (NPE), an advanced practice, nutrition-focused, physical examination, can be a timely, cost-effective strategy in assessing nutrient status. Trophic changes that have been identified in and around the nails of HD patients suggestive of protein, vitamin, or mineral imbalance include (1) Beau's lines (zinc); (2) koilonychia (iron, copper, zinc, protein); (3) leukonychia (zinc); (4) pale nail beds (iron); (5) Muehrcke's lines (protein); (6) splinter hemorrhages (V-C); (7) onycholysis (iron, niacin); and (8) chronic paronychia (zinc). While these lesions are not pathognomonic of nutrient deficiency, they do provide valuable direction in diagnostic reasoning essential to problem-solving potential maladaptive alterations in the stimulus and function of micronutrients and their enzyme systems.

Onycholysis and thyroid disease: report of three cases

BACKGROUND

Onycholysis is a common disorder with many causes. It is known to be associated with thyroid disease (especially hyperthyroidism), but physicians probably do not routinely screen for underlying thyroid disease.

OBJECTIVE

To study the association of onycholysis and thyroid disease.

METHODS

We report three patients with onycholysis who were investigated for thyroid disease.

RESULTS

In two patients, onycholysis was the presenting sign of previously undiagnosed hypothyroidism, whereas the third developed onycholysis while undergoing therapy for hypothyroidism.

CONCLUSIONS

These three cases appear to suggest that patients with unexplained onycholysis should be screened for asymptomatic thyroid disease.

Distal phalangeal metastasis of a chondrosarcoma presenting initially as bilateral onycholysis

Onycholysis is the detachment of a nail plate from its distolateral attachments. There are numerous aetiologies: congenital, traumatic, microbial, toxic, dermatological, systemic and benign or malignant tumours. We report a case with onycholysis of the ring-fingers of both hands whose symmetrical and bilateral characteristics temporarily confused the diagnosis.

Hereditary distal onycholysis--a case report

The authors present several cases of distal onycholysis from the same family. Inheritance is autosomal dominant. The clinical features include a decreased rate of growth of the nail, scleronychia, a straight or concave proximal edge of detachment, palmoplantar hyperhidrosis and marked sensitivity of the fingers to cold. The lesions of the nails are isolated. This is, to our knowledge, only the third report of such an onychopathy.