Onycholysis

Key Points
Common condition affecting the finger and toenails
Can be caused by various factors
Consists of nails separating from the nail bed, accompanied by discoloration, increased opacity, and irregular growth

Onycholysis is a common condition which affects the finger and toenails. The condition consists of nails which separate from the nail bed, from the tip of the nail back. This separation will be accompanied by irregular borders and growth, and increased opacity of the nail. The condition is typically painless, but injury or infection may be accompanied by pain. Additionally, secondary infection may cause discoloration of the nail bed itself. In some cases, deformity from the formation of thickened skin at the edge of the nail plate may result.

Onycholysis may be caused by many varying factors. Repeated injury and exposure to irritants are the most common causes, but it may also develop as a result of an associated skin condition (dermatitis, psoriasis, etc.), various infectious organisms, drug reactions (including tetracyclines, oral contraceptives, and some cancer therapies), and in rare cases systemic disease (myeloma, anemia, diabetes mellitus, hyper-/hypothyroidism, Leprosy, etc.). Additionally, onycholysis may appear in various other forms, including ideopathic (without cause) or hereditary onycholysis.

Differential Diagnosis (Other conditions with similar appearance)Onychomycosis

Diagnosis
Key Points
Diagnosis based on characteristic appearance of affected nails
Nail biopsy or other testing may be performed to confirm diagnosis and rule out associated conditions

Onycholysis is typically diagnosed based on the characteristic appearance of the affected nails. A nail biopsy or other testing may be performed to confirm he diagnosis and rule out associated conditions.

Treatment
Treatment predicated on the cause of the condition
Proper hand and nail care important in preventing further progress or recurrence of the condition
Condition resolved when nails are regrown in full

The treatment of onycholysis is predicated on the cause of the condition. Typically, treatment of the associated condition will prevent further progression of onycholysis, allowing nails to begin to grow in a normal way. If the condition is due to infection, antimicrobials may be prescribed. Proper hand and nail care, including clipping of the affected area, avoiding injury or irritants, and keeping nails short, are imperative in preventing progression or recurrence of the condition. The condition is not conserved resolved until nails are regrown in full and the affected portions of the nails are gone, which may take up to a year for toenails, and from 4 to 6 months for fingernails.