A healthy young woman presents with discoloration of the distal aspect of her left 5th fingernail. The nail is not painful, and she recalls no issues with the digit in the past.
What’s the diagnosis? What causes it? How do we treat it?
It is associated with MANY conditions, including trauma, wet work, autoimmune diseases (e.g. psoriasis, systemic lupus erythematosus), lichen planus, thyroid disease, onychomycosis, allergic or irritant contact dermatitis, and even malignancy (consider subungual squamous cell carcinoma in the presence of chronic onycholysis).
Onycholysis is a predisposing condition for secondary subungual infections from dermatophytes, yeast, and bacteria (including Pseudomonas aeruginosa and Staphylococcus aureus).
Management involves identification and treatment of the underlying condition. General nail care measures for onycholysis include
- Keeping nails trimmed short
- Avoiding trauma
- Avoiding contact irritants
- Keeping nails dry (avoiding wet work)
- Avoiding all nail cosmetics
- Protecting hands from cold or windy weather