By Gary M. White, MD
Onycholysis means separation of the nail plate from the nail bed. This usually occurs distally, such that the end of the nail lifts up. Onycholysis most commonly occurs in a woman with longer fingernails. Often the woman is cleaning under the nail, e.g., with a file, toothpick, etc. This cleaning tends to aggravate the problem as the tissue is irritated and more foreign matter and/or bacteria may be introduced. Any green color signals infection by the bacteria pseudomonas. Candida is frequently found.
The nail plate is separated from the nail bed--usually distally. Duration is important. Acute onycholysis is much more likely to be cured. Chronic onycholysis [Cutis 2001;68;8] however, may be permanent. Chronic onycholysis is typical of the big toenail resulting from trauma. Rarely, hyperthyroidism may cause onycholysis, so called Plummer's nails.
It is important to exclude other causes of onycholysis, e.g., onychomycosis and psoriasis. Some have used the term "simple onycholysis" to refer to the condition discussed here.
The patient must do two things immediately: 1) Stop cleaning underneath the nail. 2) Cut the nail way back--to within 1-2 mm of where the nail plate is still connected to the nail bed. These two interventions will provide a dry, unstressed (from the lifting forces of a long nail) environment for the nail to regrow. Depending on how much nail had to be cut back, this healing process may take from 1-4 months. (The entire fingernail takes about 6 months to grow out--longer for the toenails.)
In addition, clotrimazole solution dripped under each nail 2 times a day, in case any Candida is present, is recommended. If there is any green discoloration, gentamicin solution (e.g., Otic), dripped underneath, may be given as well.
If the above measures fail, an oral antifungal agent may be tried, e.g., fluconazole 200 mg po weekly for 6 months.
Unfortunately, if the process has been present for long enough, scarring of the nail bed may prevent the nail from ever reattaching. If the condition is recurrent despite adequate treatment, the possibility of a vaginal yeast infection as an infectious focus should be considered in the female patient.
Therapy involves cutting the nail way back.
Green indicates the presence of pseudomonas.
A mild case.
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