From the Guidelines
Onycholysis should be managed by addressing the underlying cause, which may include trauma, fungal infections, psoriasis, thyroid disorders, or certain medications, and preventive measures such as topical emollients, nail lacquers, and frozen gloves/socks should be promoted, especially in patients treated with taxanes, as recommended by the ESMO clinical practice guidelines 1.
Causes and Treatment
Onycholysis is a condition where the nail separates from the nail bed, creating a white or yellowish appearance at the tip or sides of the nail. It commonly affects fingernails and toenails, particularly the thumb and big toe. Treatment depends on the underlying cause, which may include:
- Trauma: protecting the nail from further injury and keeping it dry and clean
- Fungal infections: antifungal medications like terbinafine or itraconazole for 6-12 weeks
- Psoriasis: topical steroids or vitamin D analogs
- Thyroid disorders or certain medications: addressing the underlying condition
Preventive Measures
Preventive measures should be promoted, especially in patients treated with taxanes, including:
- Topical emollients
- Nail lacquers
- Cotton gloves
- Avoiding damaging or irritant regimens
- Frozen gloves and frozen socks, which have been shown to reduce nail changes from 51% to 11% in fingernails, and from 21% to 0% in toenails 1
Management and Follow-up
Patients should see a healthcare provider if onycholysis is accompanied by pain, spreading infection, or doesn't improve, as it may indicate an underlying medical condition requiring specific treatment. Complete healing takes time—usually 3-6 months for fingernails and up to 18 months for toenails as the nail must grow out completely. The ESMO clinical practice guidelines provide recommendations for the prevention and management of onycholysis, including the use of frozen gloves and socks, and topical emollients and nail lacquers 1.
From the Research
Definition and Causes of Onycholysis
- Onycholysis is the separation of the nail plate from the nail bed, which can occur in both fingernails and toenails 2.
- The causes of onycholysis can be traumatic, such as manicuring or occupational hazards, or disease-related, such as psoriasis or phototoxic dermatitis 2.
- In toenails, onycholysis is often mechanical, resulting from pressure on the toes due to uneven flat feet or closed shoes 2.
Treatment of Onycholysis
- Treatment of onycholysis involves drying the affected area with a hair blower to prevent colonization by moisture-loving biota 2.
- Topical antifungal treatments, such as amorolfine or ciclopirox, can be effective in managing toenail onychomycosis, especially in cases of mild to moderate infection 3, 4.
- Combination therapy with oral antifungal agents, such as terbinafine, and topical treatments like amorolfine may be beneficial in treating onychomycosis, particularly for non-dermatophyte fungi 5.
Diagnosis and Evaluation
- Onycholysis is diagnosed by the whitish appearance of the separated nail plate from the nail bed 2.
- Evaluation of onycholysis involves considering the full spectrum of potential causes, including traumatic, disease-related, and environmental factors 6.
- Proper diagnosis and evaluation are crucial in determining the most effective treatment approach for onycholysis 6.