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Onycholysis - Symptoms and Treatment

This separation is gradual and painless. The nail may appear whitened, or be discoloured yellow or green if infection is present. The nail may also appear damaged. The nail plate is separated from the underlying and/or lateral supporting structures. It is not a disease of the nail matrix, but nail discoloration may appear underneath the nail as a result of secondary infection. Onycholysis is a nail disorder frequently encountered by dermatologists. Onycholysis is the separation of the nail plate from the nail bed. Onycholysis is characterized by a spontaneous separation of the nail plate starting at the distal free margin and progressing proximally. Less often, separation of the nail plate begins at the proximal nail and extends to the free edge, which is seen most often in psoriasis of the nails (termed onychomadesis). Rare cases are confined to the nail's lateral borders. Any recommendations for the management of Onycholysis.

Symptoms of Onycholysis

It's not known how many people suffer onycholysis, but it can affect people of any age, sex or race. It appears to be more common in adults and in women. A local irritation is the most common insult. This may be from excessive filing, chemical overexposure in manicures or nail tip application, allergic contact dermatitis (a local reaction similar to the reaction to "poison Ivy") to nail hardener or adhesives used to attach the nail tips, or simply to prolonged immersion in water.

Causes of Onycholysis

The most common cause of onycholysis is trauma. Other possible causes include:

skin conditions (eg, psoriasis, lichen planus)
medical conditions (eg, thyroid dysfunction)
fungal infections
side effects of medication
adverse effects of chemicals (eg, nail polish remover)
prolonged immersion in water

Treatment of Onycholysis

Medical Care: Treatment for onycholysis varies and depends on its cause. Eliminating the predisposing cause is the best treatment.

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.

Surgical Care: Intralesional injection is an effective therapy if infection is not considered a contributing factor.

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.