Onycholysis - Nail and Distal Digit
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.
L60.1 – Onycholysis
75789001 – Onycholysis
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.
Drug Reaction Data