From the Guidelines
Onycholysis (nail shedding) of the fingernails can be caused by various factors, including repetitive trauma, psoriasis, and other noninfectious conditions, as well as fungal infections such as onychomycosis 1. The most common causes of onycholysis include:
- Repetitive trauma to the nail plate, which can result in distal onycholysis leading to the colonization of the affected space by infectious pathogens and discoloration of the nail plate 1
- Psoriasis, which can cause nail changes that mimic onychomycosis, including thinning of the nail plate, subungual hyperkeratosis, onycholysis, and dorsal pterygiium 1
- Other noninfectious conditions, such as lichen planus, Darier disease, and ichthyotic conditions, which can also produce nail changes that mimic onychomycosis 1 To prevent onycholysis, prophylactic measures such as daily use of topical emollients, protective nail lacquers, and cotton gloves should be promoted, and patients should avoid damaging or irritant regimens, including manipulation of the cuticles and nail biting 1. Additionally, the routine use of cryotherapy, such as frozen gloves, can significantly reduce nail changes in patients treated with taxanes 1. Some key points to consider in the management of onycholysis include:
- Limiting exposure to harsh chemicals by wearing gloves during cleaning
- Using moisturizers containing urea or lactic acid on nails and cuticles
- Maintaining a balanced diet rich in proteins and minerals
- Consulting a dermatologist for persistent symptoms to identify underlying conditions requiring specific treatment 1
From the Research
Causes of Onycholysis (Nail Shedding) of the Fingernails
Onycholysis, or nail shedding, can be caused by various factors, including:
- Fungal infections, such as onychomycosis, which can affect the fingernails and toenails 2, 3, 4
- Environmental factors, such as repeated exposure to water followed by dehydration, which can cause onychoschizia (lamellar dystrophy) 5
- Drug-induced nail disorders, which can be caused by certain medications, including antifungal drugs, taxanes, anthracyclines, and fluouracil 6
- Systemic conditions, such as psoriasis, which can cause nail changes, including onycholysis 3
- Trauma or injury to the nail, which can cause onycholysis 3
Fungal Infections as a Cause of Onycholysis
Fungal infections, such as onychomycosis, are a common cause of onycholysis. These infections can be caused by various types of fungi, including dermatophytes and non-dermatophyte yeasts or moulds 2. The most common dermatophyte causing onychomycosis is Trichophyton rubrum, while Candida albicans is the most common non-dermatophyte yeast 2.
Diagnosis and Treatment of Onycholysis
Diagnosis of onycholysis typically involves a detailed history and clinical examination of the affected nail, as well as diagnostic tests such as dermoscopy, diagnostic imaging, and mycological analyses 3. Treatment of onycholysis depends on the underlying cause, but may include topical or systemic medications, such as antifungal drugs, as well as surgical intervention in some cases 3, 4. In some cases, discontinuation of the offending drug or treatment of the underlying systemic condition may be necessary to resolve the onycholysis 6.