From the Guidelines
Onycholysis and onychomycosis are two distinct nail conditions with different causes and characteristics, and their treatment approaches differ significantly, with onycholysis management focusing on addressing the underlying cause and allowing the nail to reattach naturally, while onychomycosis requires antifungal medications such as oral terbinafine, itraconazole, or topical solutions like ciclopirox or efinaconazole for several months to eliminate the infection.
Causes and Characteristics
Onycholysis refers to the separation of the nail plate from the underlying nail bed, creating a space beneath the nail that appears white or yellow, and can result from trauma, chemical exposure, certain medications, psoriasis, thyroid disorders, or as a reaction to nail products, as noted in studies such as 1. It's not inherently infectious. On the other hand, onychomycosis is specifically a fungal infection of the nail, most commonly caused by dermatophytes like Trichophyton rubrum, and typically presents with thickened, discolored, brittle nails and may cause debris accumulation under the nail, as discussed in guidelines such as 2 and 3.
Treatment Approaches
While onychomycosis often leads to onycholysis as the infection progresses and separates the nail from the bed, not all cases of onycholysis are caused by fungal infections. Some key points to consider in the management of these conditions include:
- Onycholysis management focuses on addressing the underlying cause and allowing the nail to reattach naturally.
- Onychomycosis requires antifungal medications for several months to eliminate the infection, with options including oral terbinafine, itraconazole, or topical solutions like ciclopirox or efinaconazole, as recommended in guidelines such as 2 and 3.
- The treatment of onychomycosis can be challenging, with high recurrence rates and the potential for treatment failure, as noted in studies such as 3 and 4.
- Prevention of reinfection is also an important consideration in the management of onychomycosis, with measures including the use of antifungal powders and sprays, and the avoidance of sharing personal care items, as discussed in guidelines such as 3 and 5.
Quality of Life
Both onycholysis and onychomycosis can have a significant impact on the quality of life of patients, with problems including discomfort, difficulty in wearing footwear and walking, cosmetic embarrassment, and lowered self-esteem, as noted in studies such as 5 and 1. Therefore, it is essential to properly diagnose and manage these conditions to improve patient outcomes and quality of life. Some key points to consider in this regard include:
- The importance of addressing the underlying cause of onycholysis and allowing the nail to reattach naturally.
- The need for antifungal medications to eliminate the infection in cases of onychomycosis.
- The potential for high recurrence rates and treatment failure in onychomycosis, and the importance of prevention and management strategies to minimize these risks.
- The impact of these conditions on patient quality of life, and the need for effective management to improve patient outcomes.
From the Research
Difference between Onycholysis and Onychomycosis
- Onycholysis refers to the detachment of the nail plate from the nail bed, which can be a symptom of various nail conditions, including onychomycosis 6.
- Onychomycosis, on the other hand, is a fungal infection of the nail unit, causing discoloration, thickening, and brittleness of the affected nail plate 7, 8.
Characteristics of Onychomycosis
- Onychomycosis is the most common nail infection worldwide, with a high prevalence of mixed infections and those caused by non-dermatophyte molds (NDMs) 7.
- The infection can cause pain, difficulty with ambulation, and psycho-social problems, and can be diagnosed through various methods, including microscopy, fungal culture, and histopathology 8.
Relationship between Onycholysis and Onychomycosis
- Onycholysis can be a result of onychomycosis, as the fungal infection can cause hyperkeratosis under the nail plate, leading to detachment of the nail plate from the nail bed 6.
- However, onycholysis can also be caused by other factors, such as trauma, nail biting, or exposure to harsh chemicals, and is not exclusive to onychomycosis.