Onycholysis is a disorder in which the nail is spontaneously separated from the surface. The process usually starts from the free edge and progresses toward the root of the nail, rarely vice versa. The nail can be separated from the lower nail bed (bottom surface) and/or side nail bad. It is more common in women, usually in adulthood.
Terminology
Name ‘onycholysis’ comes from the Latin words onichos (nail) and lysis (destruction , loosening).
Latin name: Onicholisis
Causes
Onycholysis can be caused by internal, external, hereditary and unknown (idiopathic) causes.
The most common cause is prolonged exposure to moisture and repeated trauma, e.g. habit of tapping the fingers on the surface, typing on a keyboard or cash register. Accessories for manicure also can cause separation if they damage the skin and allow moisture intrusion. Some diseases and drugs also cause onycholysis.
Systemic diseases and conditions that can cause this disorder are:
- Amyloidosis and multiple myeloma
- Anemia due to iron deficiency
- Bronchiectasis
- Diabetes mellitus
- Erythropoietic porphyria
- X-type histiocytosis
- Hyperthyroidism
- Hypothyroidism
- Ischemia: damage to the peripheral circulation
- Discharge within chest
- Lupus erithematosus
- Neuritis (inflammation of nerves)
- Pellagra
- Pemphigus vulgaris
- Porphyria cutanea tarda
- Psoriatic arthritis
- Reiter’s syndrome
- Sarcoidosis
- Scleroderma
- Pregnancy
Dermatological diseases:
- Psoriasis
- Lichen planus
- Dermatitis
- Hyperhidrosis
- Congenital thickening of the nail (pachonichia congenita) and other congenital disorders
- Pemphigus vegetans
- Lichen striatus
- Atopic dermatitis
Neoplastic disorders:
- Squamous cell carcinoma of the nail bed
- Lung cancer
External factors :
- Mechanical trauma, repeated mechanical shock
- Chemical trauma, exposure to various chemicals, e.g. cosmetic products, such as 1-2 % formaldehyde , methyl methacrylate monomer, various means to strengthen the nails, ethyl cyanoacrylate glue that is used for artificial nails and nail polish, gasoline, acetone, paint thinner, tioglicilate, hydroxylamine sulfate in reducing agents
- Contact dermatitis due to prolonged contact with water, sugar in bakeries/pastry shops and exposure to destructive toxins (e.g. fluorine acid)
Biological/microbial factors:
- Skin diseases, dermatophytoses, for example, infection with Trichophiton rubrum fungi, Trichophiton mentagrophites and yeast infections , Candida albicans
- Bacterial infections (Pseudomonas bacteria)
- Viral infection (herpes simplex)
Drugs
After taking some drugs and exposure to sunlight onycholysis (photo-onycholysis) may occur. These medications may include: tetracyclines, psoralens, fluoroquinolones, chloramphenicol, chlorpromazine, chlortetracycline, oral contraceptives. Photo-reaction without taking drugs is possible, spontaneously after exposure to sunlight, or if there is porphyria, and also after hemodialysis.
Onycholysis caused by illumination which is not the consequence of a photo-reaction can occur after exposure to doxorubicin, captopril, bleomycin, 5-fluorouracil, retinoids, tetracyclines, etoposide, paclitaxel, hydroxylamine.
Other factors
The separation of the nail from the nail bed may be due to hereditary onycholysis, hereditary partial onycholysis, pressure by a foreign body, or the cause may be unknown.
Symptoms
The nails are smooth, firm and without signs of inflammation. It is not a disease of the tissues of the nail and nail color has not been changed. The change of color on the lower surface of the nail (discoloration) indicates infection. The nail usually begins separating on the free edge and progresses towards the root. The exception may occur, e.g. psoriasis of nails in which separation begins at the root of the nail, this is a symptom called onichomadesis. In rare cases, the separation is limited to the lateral parts of the nail.
Diagnosis
Based on the examination the separation of the nail from the nail bed is acknowledged, and based on the appearance of the nail, talk and examination of the whole body doctor will try to determine a possible cause. Suspected fungal and bacterial infection usually leads to the implementation of various tests for detection of microbial pathogens. Part of the nail can be taken for histological search which evaluates the appearance of the nail tissue under a microscope to look for any deviations from the norm.
Treatment
Treatment is carried out depending on the condition that caused onycholysis – the underlying illness is cured first. Diet should be varied and contain all the necessary vitamins and minerals, especially calcium. The changes usually are not permanent, but they needed months to resolve.
Separated nails need to be cut close to the edges.
Separated nail will not again return to its place, so it is necessary to wait for the new nail to grow, and it takes 4-6 months for fingers and twice as long on toes.
If onycholysis is not treated, in some cases, in particular inflammatory ones, scars may occur later in the nail bed which disturb nails’ normal growth.
If it’s not caused by an infection, an injection of corticosteroids may be given into the root of the nail every 4 weeks, a total of 4-6 times. As it is a painful procedure, it is necessary to give a local anesthetic. Continuation of this treatment depends on whether the disease has receded or nails continue to separate after completion of therapy. Application of corticosteroid fats is much less efficient. The existence of a fungal infection commonly demands taking of pills, along with local drug.
Diet rich in carotene is proven to improve the condition of nails.