Onycholysis. Separation of the nail plate from the nail bed.

ONYCHOLYSIS

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.

• Onycholysis is common on the long fingernails of women.
• Candida may secondarily infect as may molds, but just curing nondermatophyte infection may not help the onycholysis.
• Consider underlying cause, e.g., psoriasis or hyperthyroidism.
  
• What if there is onycholysis of the 4th and 5th fingers of both hands? Plummer's nail is a clinical sign in which there is onycholysis, or separation of the nail from the nail bed, particularly affecting the ring and little fingers. It occurs in patients with thyrotoxicosis.

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 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. The primary process of onycholysis may become secondarily infected with Pseudomonas, creating a green color.

Differential Diagnosis

It is important to exclude other causes of onycholysis e.g., photoonycholysis (e.g. from doxycycline, onychomycosis and psoriasis. Some have used the term "simple onycholysis" to refer to the condition discussed here.

Pseudomonas infection of onycholysis of the nail causing a green color.

A mild case of onychyolysis with pseudomonas infection.

RegionalDerm

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