:Onychomadesis

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| caption = Onychomadesis appeared following a hand, foot, and mouth disease in a child.

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Onychomadesis is a periodic idiopathic shedding of the nails beginning at the proximal end, possibly caused by the temporary arrest of the function of the nail matrix.{{cite book | first1 = William D. | last1 = James | first2 = Timothy G. | last2 = Berger | first3 = Dirk M. | last3 = Elston | name-list-style = vanc |title=Andrew's diseases of the skin: clinical dermatology |date=2006 |publisher=Saunders Elsevier |location=Philadelphia |isbn=978-0-8089-2351-0 |edition=10th }}{{rp|784}}{{cite book |last1=Freedberg |first1=Irwin M. |last2=Fitzpatrick |first2=Thomas B | name-list-style = vanc |title=Fitzpatrick's dermatology in general medicine. |date=2003 |publisher=McGraw-Hill |location=New York, NY |isbn=978-0-07-138076-8 |edition=6th}}{{rp|660}} One cause in children is hand, foot, and mouth disease.{{cite journal | vauthors = Bernier V, Labrèze C, Bury F, Taïeb A | title = Nail matrix arrest in the course of hand, foot and mouth disease | journal = European Journal of Pediatrics | volume = 160 | issue = 11 | pages = 649–51 | date = November 2001 | pmid = 11760019 | doi = 10.1007/s004310100815 | s2cid = 21944681 }} This generally resolves without complication.

Signs and symptoms

Onychomadesis is defined by the nail plate's detachment from the matrix, its continuous connection to the nail bed, and, frequently but not always, shedding.{{cite journal | last1=Hardin | first1=J. | last2=Haber | first2=R.M. | title=Onychomadesis: literature review | journal=British Journal of Dermatology | volume=172 | issue=3 | date=2015 | doi=10.1111/bjd.13339 | pages=592–596| pmid=25132198 }} Beau lines are transverse ridges on the nail plates.{{cite journal | last1=Shin | first1=Ji Yeon | last2=Cho | first2=Baik Kee | last3=Park | first3=Hyun Jeong | title=A Clinical Study of Nail Changes Occurring Secondary to Hand-Foot-Mouth Disease: Onychomadesis and Beau's Lines | journal=Annals of Dermatology | publisher=Korean Dermatological Association and The Korean Society for Investigative Dermatology | volume=26 | issue=2 | year=2014 | pages=280–283 | issn=1013-9087 | doi=10.5021/ad.2014.26.2.280 | pmid=24882996 | pmc=4037694 }} Onychomadesis might be considered a more severe version of Beau lines.{{cite journal | last1=Braswell | first1=Mark A. | last2=Daniel | first2=C. Ralph | last3=Brodell | first3=Robert T. | title=Beau lines, onychomadesis, and retronychia: A unifying hypothesis | journal=Journal of the American Academy of Dermatology | publisher=Elsevier BV | volume=73 | issue=5 | year=2015 | issn=0190-9622 | doi=10.1016/j.jaad.2015.08.003 | pages=849–855| pmid=26475537 }}

Causes

Onychomadesis has been linked to autoimmune diseases,{{cite journal | last1=Habibi | first1=Mohammadali | last2=Mortazavi | first2=Hossein | last3=Shadianloo | first3=Shervin | last4=Balighi | first4=Kamran | last5=Ghodsi | first5=S. Zahra | last6=Daneshpazhooh | first6=Maryam | last7=Valikhani | first7=Mahin | last8=Ghassabian | first8=Akhgar | last9=Pooli | first9=Aydin H. | last10=Chams-Davatchi | first10=Cheyda | title=Nail changes in pemphigus vulgaris | journal=International Journal of Dermatology | publisher=Wiley | volume=47 | issue=11 | date=2008-10-29 | issn=0011-9059 | doi=10.1111/j.1365-4632.2008.03796.x | pages=1141–1144| pmid=18986444 }} physical trauma, pharmacological side effects, and viral infections,{{cite journal | last1=Ventarola | first1=Daniel | last2=Bordone | first2=Lindsey | last3=Silverberg | first3=Nanette | title=Update on hand-foot-and-mouth disease | journal=Clinics in Dermatology | publisher=Elsevier BV | volume=33 | issue=3 | year=2015 | issn=0738-081X | doi=10.1016/j.clindermatol.2014.12.011 | pages=340–346}} especially coxsackieviruses.{{cite journal | last1=Sous | first1=Dana | last2=Starace | first2=Michela V.R. | last3=Chen | first3=Lu | last4=Nieman | first4=Elizabeth L. | last5=Anadkat | first5=Milan J. | last6=Piraccini | first6=Bianca Maria | last7=Coughlin | first7=Carrie C. | title=Recurrent Onychomadesis of the Toenails in Children and Adults: A Case Series | journal=Skin Appendage Disorders | volume=8 | issue=1 | date=2022 | issn=2296-9195 | pmid=35118126 | pmc=8787582 | doi=10.1159/000519016 | pages=31–33}} However, in certain cases, the cause remains unknown. Athletes, especially runners, may be more likely to experience toenail involvement.{{cite journal | last1=Purim | first1=Kátia Sheylla Malta | last2=Leite | first2=Neiva | title=Sports-related dermatoses among road runners in Southern Brazil | journal=Anais Brasileiros de Dermatologia | publisher=FapUNIFESP (SciELO) | volume=89 | issue=4 | year=2014 | issn=0365-0596 | doi=10.1590/abd1806-4841.20142792 | pages=587–592| pmid=25054745 | pmc=4148272 }} A portion of patients have onychomadesis recurrently without an obvious cause.{{cite journal | last1=Suchonwanit | first1=Poonkiat | last2=Nitayavardhana | first2=Sunatra | title=Idiopathic Sporadic Onychomadesis of Toenails | journal=Case Reports in Dermatological Medicine | publisher=Hindawi Limited | volume=2016 | year=2016 | issn=2090-6463 | doi=10.1155/2016/6451327 | doi-access=free | pages=1–3| pmc=4942622 }} One of the most frequent causes of single-digit onychomadesis is local damage to the nail bed.{{cite journal |last1=Clark |first1=Charlotte M |last2=Silverberg |first2=Nanette B |last3=Weinberg |first3=Jeffrey M |title=What is your diagnosis? onychomadesis following hand-foot-and-mouth disease |journal=Cutis |date=June 2015 |volume=95 |issue=6 |pages=312–320 |pmid=26125214}} When more than one finger is involved, it may indicate a systemic cause.{{cite journal |last1=Salgado |first1=Fernanda |last2=Handler |first2=Marc Z |last3=Schwartz |first3=Robert A |title=Shedding light on onychomadesis |journal=Cutis |date=January 2017 |volume=99 |issue=1 |pages=33–36 |pmid=28207011 |url=https://www.mdedge.com/dermatology/article/128565/pediatrics/shedding-light-onychomadesis |access-date=24 April 2024}}

Diagnosis

Onychomadesis is diagnosed clinically.{{cite journal | last1=Chu | first1=Derek H. | last2=Rubin | first2=Adam I. | title=Diagnosis and Management of Nail Disorders in Children | journal=Pediatric Clinics of North America | publisher=Elsevier BV | volume=61 | issue=2 | year=2014 | issn=0031-3955 | doi=10.1016/j.pcl.2013.11.005 | pages=293–308}} Beau lines and total nail shedding can be distinguished from one another by looking at and palpating the nail plate to identify distinct nail alterations. The diagnosis can be verified by ultrasonography because the abnormality can be seen beneath the proximal nail fold.{{cite journal | last1=Wortsman | first1=Ximena | last2=Wortsman | first2=Jacobo | last3=Guerrero | first3=Robinson | last4=Soto | first4=Rosamary | last5=Baran | first5=Robert | title=Anatomical Changes in Retronychia and Onychomadesis Detected Using Ultrasound | journal=Dermatologic Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=36 | issue=10 | year=2010 | issn=1076-0512 | doi=10.1111/j.1524-4725.2010.01694.x | pages=1615–1620| pmid=20840496 }}

Treatment

Most cases of onychomadesis are minor and self-limiting. There is no specific treatment, although a conservative approach to care is suggested. Recurrent onychomadesis may be avoided by treating any underlying medical issues or stopping the offending medication.

It is advised to provide supportive treatment in addition to protecting the nail bed by keeping nails short and covering the afflicted nails with adhesive bandages to prevent snagging the nail or tearing off the partially attached nails.

Topical administration of urea cream 40% under occlusion{{cite journal | last1=Fleming | first1=C. J. | last2=Hunt | first2=M. J. | last3=Barnetson | first3=R. St. C. | title=Mycosis fungoides with onychomadesis | journal=British Journal of Dermatology | publisher=Oxford University Press (OUP) | volume=135 | issue=6 | year=1996 | issn=0007-0963 | doi=10.1046/j.1365-2133.1996.d01-1118.x | pages=1012–1013| pmid=8977738 }} or halcinonide cream 0.1% under occlusion for 5–6 days{{cite journal | last1=Mishra | first1=D. | last2=Sinch | first2=Gurmohan | last3=Pandey | first3=S. S. | title=Possible Carbamazepine-Induced Reversible Onychomadesis | journal=International Journal of Dermatology | publisher=Wiley | volume=28 | issue=7 | year=1989 | issn=0011-9059 | doi=10.1111/j.1365-4362.1989.tb02507.x | pages=460–461| pmid=2777446 }} has been used to treat onychomadesis in certain patients, although these therapies have not always proven successful. It has been suggested to apply basic fibroblast growth factor externally to promote fresh nail plate regrowth.

References

External links

[https://fpnotebook.com/Derm/Nails/Onychmds.htm Family Practice Notebook]
[https://www.visualdx.com/visualdx/diagnosis/onychomadesis?diagnosisId=52578&moduleId=19 VisualDx]

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Category:Conditions of the skin appendages