Onycholysis

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 1 (1 votes)

This article have been viewed 1701 times

[level-membership-for-internal-medicine-category]

193 Onycholysis

Instruction

Examine this patient’s hands.

Salient features

History

• Take a history for excessive exposure to detergents, alkalis and keratolytic agents, and demeclocycline-induced photolysis

• History of psoriasis (p. 558)

• History of thyrotoxicosis (p. 506)

• History of diabetes (fungal infection).

Examination

• Distal separation of the nail plate from the nail bed (Fig. 193.1 and see Fig. 190.1C).

image

Fig. 193.1 Onycholysis.

Proceed as follows:

• Look for nail pitting and silvery white plaques (psoriasis)

• Glance at the neck for goitre and tell the examiner that you would like to exclude thyrotoxicosis, hypothyroidism and diabetes mellitus

• Tell the examiner that you would like to exclude a fungal infection (Case 190).

Diagnosis

This patient has onycholysis (lesion), probably caused by thyrotoxicosis, as evidenced by tachycardia, exophthalmos and goitre (aetiology).

Questions

What nail changes are associated with psoriasis?

Yellow, friable nails with pitting and onycholysis (lifting of nail from the bed), distal subungual hyperkeratosis.

How would you manage these nail lesions?

• Manicure and careful debridement

• Reduction of exposure to irritants (detergents, bleaches, alkalis)

• Intradermal steroids in the area of nail matrix (these are very painful injections)

• Non-surgical removal of dystrophic nails using urea ointments.

What are Plummer’s nails?

This term refers to the onycholysis that occurs in hyperthyroidism and typically occurs in the fourth finger.

Further reading

DeNicola P, Morsiani M. Nail diseases in internal medicine. J Am Acad Dermatol. 1985;12:552-560. (review)

S Plummer (1874–1936), physician at the Mayo Clinic, Rochester, Minnesota, also described Plummer–Vinson syndrome (iron-deficiency anaemia and dysphagia).

[/level-membership-for-internal-medicine-category][not-level-membership-for-internal-medicine-category]

193 Onycholysis

Instruction

Examine this patient’s hands.

Salient features

History

• Take a history for excessive exposure to detergents, alkalis and keratolytic agents, and demeclocycline-induced photolysis

• History of psoriasis (p. 558)

• History of thyrotoxicosis (p. 506)

• History of diabetes (fungal infection).

Examination

• Distal separation of the nail plate from the nail bed (Fig. 193.1 and see Fig. 190.1C).

Buy Membership for Internal Medicine Category to continue reading. Learn more here

[/not-level-membership-for-internal-medicine-category]