Hyponychium - UW Departments Web Server
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Transcript of Hyponychium - UW Departments Web Server
• Detachment of the nail plate from the nail bed beginning distally
Onycholysis
• Detachment of the nail plate from the nail bed beginning distally
Onycholysis
The Nail Unit
Hyponychium
Hyponychium
Onycholysis – Pathogenesis
Onycholysis• Systemic Dx• Cutaneous Dz• Drug• Local• Idiopathic
Modified from Ray LF, Arch Dermatol 88:181-185, 1963
Onycholysis – Systemic Dz• Raynaud• Thyroid (↓ or ↑)• Iron (?)• Pregnancy• Syphilis• Other – DM,
porphyria, anemia, pellagra, etc.
acrocyanosis
Onycholysis – Systemic Dz• Raynaud• Thyroid (↓ or ↑)• Iron (?)• Pregnancy• Syphilis• Other – DM,
porphyria, anemia, pellagra, etc.
Fe deficient
Onycholysis – Systemic Dz• Raynaud• Thyroid (↓ or ↑)• Iron (?)• Pregnancy• Syphilis• Other – DM,
porphyria, anemia, pellagra, etc.
Fe deficient
Onycholysis – Cutaneous Dz• Psoriasis• LP• Eczema• Hereditary
– EB, Darier, other• Other
– alopecia areata– hyperhidrosis– keratoderma– lichen striatus– epidermal nevus– pemphigus, other
Psoriasis - PE• PE
Onycholysis – Drug• Photo
– captopril– cyclines– fluoroquinolones– NSAID’s– oral contraceptives– phenothiazines– thiazides
• Non-photo– chemotherapeutics– retinoids– cloxacillins– cyclines (?)
minocycline
Onycholysis - Local• Trauma
– manicure– repetitive action– foreign body– thermal– microwave
• Infection• Chemical
– irritant– allergic
• Tumor
trauma
Onycholysis - Local• Trauma
– manicure– repetitive action– foreign body– thermal– microwave
• Infection• Chemical
– irritant– allergic
• Tumor
trauma
Onycholysis – Idiopathic• Chronic exposure
to H2O• F >> M• Peak 20’s-30’s
• Maceration• Trauma• Loss of hyponychial seal• Potential space → real space• Colonization
– bacteria– yeast
• 2o Infection
Onycholysis – Pathophysiology
Onycholysis – Therapy• Exclude
underlying causes• Clip unattached
nail– cave, lever– monthly– measure
• Drying agent– 15% sulfacetamide
in 50% EtOH• Avoid bandages,
cosmetics, artifical nails, trauma
Onycholysis – Systemic Antifungals?Simple – No• Clean nail bed• Normal plate• No subungual
debris
Complex – Yes• Thickened plate• Subungual debris• KOH/ culture/
path
• Chemotherapy– Paclitaxel– Adriamycin– Navelbine– ? 5-FU, other
Profound Onycholysis with Onychia
• Chemotherapy– Paclitaxel– Adriamycin– Navelbine– ? 5-FU, other
• Hand-Foot syndrome– Pain– Swelling– Erythema– Neuropathy
Profound Onycholysis with Onychia
• Chemotherapy– Paclitaxel– Adriamycin– Navelbine– ? 5-FU, other
• Hand-Foot syndrome– Pain– Swelling– Erythema– Neuropathy
• Eroded nail bed– Discharge– Superinfection
Profound Onycholysis with Onychia
Rx – Maintenance
• Clip unattached plate
• Burow soaks• Directed
antibiotics• May limit dose of
drug
Profound Onycholysis with Onychia
4.5 months
DH, Onycholysis with Pain & Rash• Painful (2/10) L
thumb • Splinter 9 mo ago• ? Growing out• LBP• Rash umbilicus, red
& flaky, painful (5/10), partially responsive to TAC
DH, Onycholysis with Pain & Rash• FSE – mild
periumbilicalerythema
• X-ray unremarkable
6” Tiemann:105-1437 $3521-11
Double-action Nail Splitter
Paronychia
Chronic
Acute
