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Onycholysis - Nail and Distal Digit
Other Resources UpToDate PubMed

Onycholysis - Nail and Distal Digit

Contributors: Shari Lipner MD, PhD, Susan Burgin MD, Bertrand Richert MD, Robert Baran MD
Other Resources UpToDate PubMed

Synopsis

Onycholysis is defined as the detachment of the nail plate from its bed at its distal end and/or from lateral attachments. Detachment of the nail plate creates a subungual space that may gather dirt and keratin debris. As moisture accumulates beneath the nail, secondary infection by bacteria and yeasts can also occur.

Fingernail onycholysis is more common in women than men and is common in patients with hand dermatitis. Fingernail and toenail onycholysis is most often caused by trauma. Other causes of onycholysis include hyper- and hypothyroidism, pregnancy, porphyria, pellagra, syphilis, atopic dermatitis, psoriasis, irritant or allergic contact dermatitis, lichen planus, congenital abnormalities of the nails, onychomycosis and other infections, and underlying malignancies. Tetracycline, quinolones, oral contraceptives, and certain chemotherapeutic agents are the most frequently associated medications. Systemic retinoids may also be culprits.

Blistering diseases, such as porphyria cutanea tarda or pseudoporphyria, will give rise to pain followed by onycholysis when a subungual vesicle or bulla appears. This is induced by sunlight and is known as photoonycholysis.

In children, onycholysis is most often due to trauma particularly when one or a few nails are affected. Psoriasis, lichen planus, and congenital abnormalities are also possibilities. If these etiologies have been ruled out, a systemic cause should be explored.

Codes

ICD10CM:
L60.1 – Onycholysis

SNOMEDCT:
75789001 – Onycholysis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Yellow nail syndrome – Look for yellow nails, increased transverse curvature.
  • Psoriasis – Look for pitting, splinter hemorrhages, salmon patches of the nails, and erythematous scaly plaques on the skin. Onycholysis may be seen in psoriasis.
  • Onychomycosis – Thickened, discolored nails with subungual hyperkeratosis. Onycholysis may be seen in onychomycosis.
  • Lichen planus – Longitudinal ridging, pterygium formation, and splinter hemorrhages. Onycholysis may be seen in lichen planus.
  • Allergic contact dermatitis
  • Medication use, Porphyria cutanea tarda, Pseudoporphyria – See Photoonycholysis.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:06/04/2018
Last Updated:06/04/2018
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Patient Information for Onycholysis - Nail and Distal Digit
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Onycholysis - Nail and Distal Digit
A medical illustration showing key findings of Onycholysis : Onycholysis - lifting nail
Clinical image of Onycholysis - imageId=2281151. Click to open in gallery.  caption: '<span>Distal, dull yellow-white discoloration of the fingernail representing areas of loss of attachment of the nail plate to the nail bed after use of artificial nails.</span>'
Distal, dull yellow-white discoloration of the fingernail representing areas of loss of attachment of the nail plate to the nail bed after use of artificial nails.
Copyright © 2024 VisualDx®. All rights reserved.