Differential Diagnosis for Fingernail Plate Lifting and Burning Pain
Single Most Likely Diagnosis
- Onycholysis: This condition is characterized by the separation of the nail plate from the nail bed, often starting at the tip and progressing proximally. It can be caused by trauma, nail biting, or exposure to chemicals. The new white areas described could be the result of air entering the space between the nail plate and the nail bed, and the burning pain might be due to irritation or inflammation of the nail bed.
Other Likely Diagnoses
- Psoriatic Nail Dystrophy: Psoriasis can cause nail changes, including onycholysis, pitting, and discoloration. The burning pain in the new white areas could be indicative of an inflammatory process associated with psoriasis.
- Fungal Nail Infection (Onychomycosis): Fungal infections can cause nail lifting, discoloration, and pain. The white areas might be due to the accumulation of fungal elements under the nail.
- Nail Trauma: Physical injury to the nail can cause lifting of the nail plate and pain, especially if the trauma is recent and the nail is in the process of separating from the nail bed.
Do Not Miss Diagnoses
- Squamous Cell Carcinoma: Although rare, squamous cell carcinoma can present as a nail lesion, including nail plate lifting and pain. It's crucial to consider this diagnosis to ensure timely treatment if present.
- Melanoma: Subungual melanoma is a type of skin cancer that can occur under the nail. It might present with nail lifting, pain, and sometimes a pigmented streak in the nail. Given its potential severity, it's essential to rule out melanoma.
Rare Diagnoses
- Lichen Planus: This autoimmune condition can affect the nails, leading to thinning, ridging, and scarring, as well as nail plate lifting. It's less common than other causes but should be considered in the differential diagnosis.
- Darier's Disease: A rare genetic disorder that can affect the nails, causing red and white streaks, V-shaped nicks at the distal end, and sometimes nail plate lifting. The burning pain could be related to the disease's effect on the nail and surrounding skin.