Onycholysis (overview) L60.1

A common phenomenon caused by detachment of the nail plate from the nail bed of different causes.

One distinguishes the:

• relatively frequent partial or distal onycholysis
• rare total onycholysis. This leads to a passagere or to a (non-reversible) final nail loss(anonymity)

• External causes (onycholysis as an isolated phenomenon).
  • Toxic degenerative due to constant water contact (see below Onycholysis, partial)
  • Traumatic (constant leverage), this concerns especially the onycholysis of the toenails - here tight footwear. Also due to incorrect nail modeling (artificial nails too long, constant leverage effects on the natural nail).
  • UV -rays photoonycholysis - (without influence of sensitizing drugs)
• Primary skin diseases (with nail involvement)
  • Psoriatic diseases of hands or feet (psoriatic onycholysis)
  • Psoriatic arthritis (also without psoriatic skin manifestations)
  • Erythema multiforme
  • TEN
  • Alopecia areata (especially to be observed in alopecia areata totalis)
  • Dysplasia, ectodermal
  • Atopic dermatitis especially with acral involvement
  • Pachyonychia congenita
  • Parakeratosis Hjorth-Sabouraud
  • POPP syndrome

  • Hereditary distal onycholysis with scleronychia

• Infections
  • Yeast mycoses (Candida spp. most frequently detectable)
  • Dermatophytes
  • Molds
  • bacteria - chronic paronychia due to Pseudomonas infections
  • subungual viral warts
  • viral infections: hand-foot-mouth disease
• Medications
  • tetracyclines also griseofulvin (photoonycholysis)
  • Mycophenolate mofetil
  • Chemotherapeutic agents such as taxanes and anthracyclines (see hand-foot syndrome; see PATEO syndrome)
  • NSAIDS
  • ACE inhibitors
  • Beta-blockers
  • Thiazides
  • Allopurinol
• Metabolic/systemic diseases
  • Hyperthyroidism/hypothyroidism possibly in combination with autoimmune thyroiditis (see thyroid disorders skin lesions below); onycholysis may be an early indicator (Malan M et al. 2019)
  • Yellow-nail syndrome
  • chronic graft-versus-host disease
  • M. Crohn's disease (painful onycholysis described)
  • Chronic terminal renal failure especially in long-term dialysis (see below renal diseases, skin changes), protoporphyria erythropoetica (photoonycholysis)
• benign and malignant subungual tumors with secondary onycholysis
  • subungual exostoses
  • subungual malignant melanoma
  • subungual squamous cell carcinoma

1. Bentabet Dorbani I et al (2012) Griseofulvin-induced photo-onycholysis. Press Med 41:879-881
2. Cabanillas M et al (2011) Ischemic onycholysis of the hands. Cutis 87:287-288
3. Cantatore-Francis JL et al (2010) Hepatoerythropoietic porphyria misdiagnosed as child abuse: cutaneous, arthritic, and hematologic manifestations in siblings with a novel UROD mutation. Arch Dermatol 146:529-533
4. Edwards F et al (2009) Nail psoriasis: clinical presentation and best practice recommendations. Drugs 69:2351-1361
5. Kolde G (2014) Onychomades after hand-foot-mouth disease. Nude Dermatol 40: 137-138
6. Lau CP et al (2011) Docetaxel-induced nail toxicity: a case of severe onycholysis and topic review. Chin Med J 124:2559-2560
7. Love TJ et al (2012) Psoriatic arthritis and onycholysis -- results from the cross-sectional Reykjavik psoriatic arthritis study. J Rheumatol 39:1441-1444
8. Malan M et al (2019) Onycholysis an early indicator of thyroid disease.
   Pan Afr Med J 32:31.
9. Onelmis H et al (2012) Cutaneous changes in patients with chronic renal failure on hemodialysis. Cutan Ocul Toxicol 31:286-291
10. Shemer A et al (2013) Common nail disorders. Clin Dermatol 31:578-586
11. Vélez NF et al (2014) Simple onycholysis: a diagnosis of exclusion. J Am Acad Dermatol 70:793-794
12. Zaias N et al (2014) Finger and toenail onycholysis. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.12862.