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Onychomadesis
Onychomadesis
	Onychomadesis appeared following a hand, foot, and mouth disease in a child.
Specialty	Dermatology

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.^[1]^: 784^[2]^: 660 One cause in children is hand, foot, and mouth disease.^[3] 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.^[4] Beau lines are transverse ridges on the nail plates.^[5] Onychomadesis might be considered a more severe version of Beau lines.^[6]

Causes

Onychomadesis has been linked to autoimmune diseases,^[7] physical trauma, pharmacological side effects, and viral infections,^[8] especially coxsackieviruses.^[9] However, in certain cases, the cause remains unknown. Athletes, especially runners, may be more likely to experience toenail involvement.^[10] A portion of patients have onychomadesis recurrently without an obvious cause.^[11] One of the most frequent causes of single-digit onychomadesis is local damage to the nail bed.^[12] When more than one finger is involved, it may indicate a systemic cause.^[13]

Diagnosis

Onychomadesis is diagnosed clinically.^[14] 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.^[6]^[15]

Treatment

Most cases of onychomadesis are minor and self-limiting.^[12] There is no specific treatment, although a conservative approach to care is suggested.^[14] Recurrent onychomadesis may be avoided by treating any underlying medical issues or stopping the offending medication.^[6]

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.^[12]

Topical administration of urea cream 40% under occlusion^[16] or halcinonide cream 0.1% under occlusion for 5–6 days^[17] has been used to treat onychomadesis in certain patients, although these therapies have not always proven successful.^[6] It has been suggested to apply basic fibroblast growth factor externally to promote fresh nail plate regrowth.^[6]

References

^ James WD, Berger TG, Elston DM (2006). Andrew's diseases of the skin: clinical dermatology (10th ed.). Philadelphia: Saunders Elsevier. ISBN 978-0-8089-2351-0.
^ Freedberg IM, Fitzpatrick TB (2003). Fitzpatrick's dermatology in general medicine (6th ed.). New York, NY: McGraw-Hill. ISBN 978-0-07-138076-8.
^ Bernier V, Labrèze C, Bury F, Taïeb A (November 2001). "Nail matrix arrest in the course of hand, foot and mouth disease". European Journal of Pediatrics. 160 (11): 649–51. doi:10.1007/s004310100815. PMID 11760019. S2CID 21944681.
^ Hardin, J.; Haber, R.M. (2015). "Onychomadesis: literature review". British Journal of Dermatology. 172 (3): 592–596. doi:10.1111/bjd.13339. PMID 25132198.
^ Shin, Ji Yeon; Cho, Baik Kee; Park, Hyun Jeong (2014). "A Clinical Study of Nail Changes Occurring Secondary to Hand-Foot-Mouth Disease: Onychomadesis and Beau's Lines". Annals of Dermatology. 26 (2). Korean Dermatological Association and The Korean Society for Investigative Dermatology: 280–283. doi:10.5021/ad.2014.26.2.280. ISSN 1013-9087. PMC 4037694. PMID 24882996.
^ ^a ^b ^c ^d ^e Braswell, Mark A.; Daniel, C. Ralph; Brodell, Robert T. (2015). "Beau lines, onychomadesis, and retronychia: A unifying hypothesis". Journal of the American Academy of Dermatology. 73 (5). Elsevier BV: 849–855. doi:10.1016/j.jaad.2015.08.003. ISSN 0190-9622. PMID 26475537.
^ Habibi, Mohammadali; Mortazavi, Hossein; Shadianloo, Shervin; Balighi, Kamran; Ghodsi, S. Zahra; Daneshpazhooh, Maryam; Valikhani, Mahin; Ghassabian, Akhgar; Pooli, Aydin H.; Chams-Davatchi, Cheyda (2008-10-29). "Nail changes in pemphigus vulgaris". International Journal of Dermatology. 47 (11). Wiley: 1141–1144. doi:10.1111/j.1365-4632.2008.03796.x. ISSN 0011-9059. PMID 18986444.
^ Ventarola, Daniel; Bordone, Lindsey; Silverberg, Nanette (2015). "Update on hand-foot-and-mouth disease". Clinics in Dermatology. 33 (3). Elsevier BV: 340–346. doi:10.1016/j.clindermatol.2014.12.011. ISSN 0738-081X.
^ Sous, Dana; Starace, Michela V.R.; Chen, Lu; Nieman, Elizabeth L.; Anadkat, Milan J.; Piraccini, Bianca Maria; Coughlin, Carrie C. (2022). "Recurrent Onychomadesis of the Toenails in Children and Adults: A Case Series". Skin Appendage Disorders. 8 (1): 31–33. doi:10.1159/000519016. ISSN 2296-9195. PMC 8787582. PMID 35118126.
^ Purim, Kátia Sheylla Malta; Leite, Neiva (2014). "Sports-related dermatoses among road runners in Southern Brazil". Anais Brasileiros de Dermatologia. 89 (4). FapUNIFESP (SciELO): 587–592. doi:10.1590/abd1806-4841.20142792. ISSN 0365-0596. PMC 4148272. PMID 25054745.
^ Suchonwanit, Poonkiat; Nitayavardhana, Sunatra (2016). "Idiopathic Sporadic Onychomadesis of Toenails". Case Reports in Dermatological Medicine. 2016. Hindawi Limited: 1–3. doi:10.1155/2016/6451327. ISSN 2090-6463. PMC 4942622.
^ ^a ^b ^c Clark, Charlotte M; Silverberg, Nanette B; Weinberg, Jeffrey M (June 2015). "What is your diagnosis? onychomadesis following hand-foot-and-mouth disease". Cutis. 95 (6): 312–320. PMID 26125214.
^ Salgado, Fernanda; Handler, Marc Z; Schwartz, Robert A (January 2017). "Shedding light on onychomadesis". Cutis. 99 (1): 33–36. PMID 28207011. Retrieved 24 April 2024.
^ ^a ^b Chu, Derek H.; Rubin, Adam I. (2014). "Diagnosis and Management of Nail Disorders in Children". Pediatric Clinics of North America. 61 (2). Elsevier BV: 293–308. doi:10.1016/j.pcl.2013.11.005. ISSN 0031-3955.
^ Wortsman, Ximena; Wortsman, Jacobo; Guerrero, Robinson; Soto, Rosamary; Baran, Robert (2010). "Anatomical Changes in Retronychia and Onychomadesis Detected Using Ultrasound". Dermatologic Surgery. 36 (10). Ovid Technologies (Wolters Kluwer Health): 1615–1620. doi:10.1111/j.1524-4725.2010.01694.x. ISSN 1076-0512. PMID 20840496.
^ Fleming, C. J.; Hunt, M. J.; Barnetson, R. St. C. (1996). "Mycosis fungoides with onychomadesis". British Journal of Dermatology. 135 (6). Oxford University Press (OUP): 1012–1013. doi:10.1046/j.1365-2133.1996.d01-1118.x. ISSN 0007-0963. PMID 8977738.
^ Mishra, D.; Sinch, Gurmohan; Pandey, S. S. (1989). "Possible Carbamazepine-Induced Reversible Onychomadesis". International Journal of Dermatology. 28 (7). Wiley: 460–461. doi:10.1111/j.1365-4362.1989.tb02507.x. ISSN 0011-9059. PMID 2777446.