Onycholysis

Onycholysis (detachment of the nail plate from the nail bed) starts in the central or lateral portion of the nail plate free margin, progresses proximally and can even involve the whole nail. The onycholytic area looks whitish because of the presence of air under the detached nail plate. It may occasionally show a greenish or brown discoloration due to colonization of the onycholytic space by chromogenic bacteria (Pseudomonas aeruginosa), moulds or yeasts. Onycholysis may be idiopathic or represent a symptom of numerous diseases (such as psoriasis, onychomycosis or contact dermatitis) or drug reactions.

Depending on the cause of the complaint (e.g. disease or impaired peripheral circulation), appropriate local treatment, systemic treatment or both is prescribed. The detached nail should be clipped away and a mild antibacterial solution (thymol 4% in chloroform) should be applied on the exposed nail bed at night. Pseudomonas infection is easily treated by using sodium hypochlorite solution or 2% acetic acid. Accurate drying of the fingers after hand washing is necessary. A hair dryer may be useful for this purpose.

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