EpistemisOnycholysis
Specialty: Skin.
Why it occurs
- Repeated mechanical trauma (microtrauma due to narrow footwear or excessive handling)
- Onychomycosis (fungal infection due to dermatophytes that destroys the hyponychium)
- Nail psoriasis (inflammation of the matrix or nail bed that alters the adhesion of the sheet)
- Chronic exposure to chemical irritants or constant humidity (common in cleaning personnel)
- Phototoxicity reactions induced by drugs such as tetracyclines or fluoroquinolones associated with sun exposure.
Initial workup
Direct examination with 20% KOH and mycological culture of the subungual debris obtained from the most proximal portion of the detachment. Biopsy of the nail bed only in cases of suspected refractory tumor or inflammatory pathology, and evaluation with Wood's light for pseudomonas.
red flags
Involvement of multiple nails simultaneously associated with intense localized pain, extensive periungual erythema with greenish purulent secretion (suggestive of infection by *Pseudomonas aeruginosa* or "green nail syndrome"), or presence of persistent asymmetrical black-blue pigmentation under the onycholytic zone that requires ruling out subungual melanoma.
Standard management
- Ciclopirox in 8% nail polish — broad-spectrum topical antifungal applied daily if mild to moderate onychomycosis is confirmed
- Terbinafine — first choice oral antifungal for extensive nail mycoses, dose of 250 mg/day for 6 to 12 weeks, monitoring liver enzymes
- 0.1% copper or zinc sulfate solution — topical antiseptic useful if pseudomonas superinfection is associated
- Strictly avoid moisture by using protective cotton gloves under nitrile gloves.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4