Issue link: http://viewer.e-digitaledition.com/i/472042
A 50-YEAR-OLD WOMAN PRESENTS with a fingernail separating from her finger. She reports that it seemed to happen "overnight." She washes her dishes by hand twice daily, plays the piano three to five times per week, and works with a computer keyboard, updating her daily music blog. She i s o t h e r w i s e h e a l t h y a n d takes no medica- tions other than a daily multivi- tamin with iron. What's your diagnosis? Diagnosis: Onycholysis Onycholysis is the separation of a nail from the nail bed — the skin underneath the fingernail. The separation may seem to appear suddenly, but it typically occurs gradually. Mild, repetitive trauma is the most common cause of onycholysis, but sometimes the trauma can be so minor, patients are not even aware of it. Nervously tapping fingernails on a desktop or repeatedly striking finger- nails on a computer keyboard or musical instrument can cause trauma. Even the repeated trauma of manicure tools can cause onycholysis. The problem is that something is pre- venting the nail from attaching smoothly to the nail bed. O t h e r c a u s e s o f o n y c h o l y s i s may include: + Fungal infections of the nails + Pregnancy + Psoriasis + Repeated exposure to water + Medications, including some antibiotics + Thyroid disease + To preventive onycholysis, patients can: + Avoid frequent exposure to harsh chemicals + Keep nails trimmed close to prevent repetitive tapping trauma + Wear rubber gloves to avoid repetitive water exposure, which also helps to minimize the risk for nail infections Treatment Treatment for onycholysis depends upon identifying the etiology. Review for trauma issues. Evaluate for psoria- sis, thyroid disease or nail infection. In troublesome cases, I have recom- mended applying a drop of super glue under the nail and compressing it until the glue dries. This keeps the nail in place for a few days and prevents it from getting caught, snagged or pulled off during daily activities. The goal is for the new nail to attach itself to the nail bed and grow out to replace the affected area. Fortunately, many fingernail conditions, includ- ing onycholysis, are not permanent, a lt hough , e ven a f ter t reat ment , onycholysis can take many months to resolve. Sometimes onycholysis can be extremely difficult to treat and may remain refractory to all treatments. Fo r m o r e i n f o r m a t i o n , c o n t a c t C h arle s E. Cr utchf ield III, M D at C r u t c h f i e l d D e r m a t o l o g y o r v i s it CrutchfieldDermatology.com. ■ By Charles E. Crutchfield III, MD Case of the Month with Crutchfield Dermatology +++++++++++++++++++ +++ + +++ + +++++++++++++++++++ DIAGNOSTICS