By Gary M. White, MD
Onychomadesis and periungual warts in a a child.
The term onychomadesis refers to complete separation of the nail from the proximal nail fold (matrix). It is usually due to some insult/injury to the nail matrix. Onychomadesis is, in a sense, a more severe form of Beau's lines. Specifically, when a Beau's line results in complete loss of continuity with the matrix, it is no longer a Beau's line but becomes onychomadesis.
There is complete separation of the nail from the proximal nail fold (matrix) with persistent attachment to the nail bed and often, but not always, eventual shedding.
Causes (Modified from BJD 2015;172;592)
- Autoimmune (e.g., alopecia areata, pemphigus vulgaris)
- Major medical illness (e.g., Guillain–Barré syndrome, major depressive disorder, Stevens–Johnson syndrome, Cronkhite–Canada syndrome, peritoneal dialysis, immunodeficiency, meningitis, mycosis fungoides, Kawasaki disease)
- Medication-induced (e.g., chemotherapeutic agents, antiepileptics, penicillin, azithromycin, retinoids, lead, lithium)
- Neonatal (e.g., trauma of birth, Candida albicans)
- Infection (e.g., hand, foot, and mouth disease, varicella, Candida albicans, Fusarium solani, Trichophyton tonsurans)
No treatment is available once the separation has occurred. If there is an identifiable cause that can be eliminated, future separations may be prevented.
Complete nail separation after hand, foot, and mouth disease.
Onychomadesis and periungual warts in a child.
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