[Fissural onycholysis of the thumb and incipient onycholysis of the right medius without koilonychia in a woman afflicted with a chlorotic syndrome. Cure by iron protoxalate].
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Anemia↗
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Onycholysis as a complication of systemic chemotherapy: report of five cases associated with prolonged weekly paclitaxel therapy and review of the literature.
BACKGROUND: Onycholysis has been reported in association with the use of several noncytotoxic drugs and with chemotherapy in 135 patients. Onycholysis may be precipitated by exposure to ultraviolet radiation. METHODS: The authors studied 91 patients who received paclitaxel and 187 patients who received doxorubicin. RESULTS: Onycholysis occurred in 5 of 21 patients who received > 6 courses of weekly paclitaxel, developing in the summer months in all 5 patients. It did not occur in patients who received fewer weekly paclitaxel courses or those who were treated every 3 weeks. Onycholysis did not occur in 187 patients who received doxorubicin. Review of the literature revealed that onycholysis is nearly exclusively associated with anthracycline and taxane therapy. CONCLUSIONS: Prolonged weekly paclitaxel, other taxanes, and anthracyclines cause onycholysis in some patients, which may be precipitated by exposure to sunlight. Patients receiving these drugs should protect their nails from sunlight.
Adult↗
Onycholysis and thyroid disease: report of three cases.
BACKGROUND: Onycholysis is a common disorder with many causes. It is known to be associated with thyroid disease (especially hyperthyroidism), but physicians probably do not routinely screen for underlying thyroid disease. OBJECTIVE: To study the association of onycholysis and thyroid disease. METHODS: We report three patients with onycholysis who were investigated for thyroid disease. RESULTS: In two patients, onycholysis was the presenting sign of previously undiagnosed hypothyroidism, whereas the third developed onycholysis while undergoing therapy for hypothyroidism. CONCLUSIONS: These three cases appear to suggest that patients with unexplained onycholysis should be screened for asymptomatic thyroid disease.
Adult↗
Multicenter study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity of the hand.
PURPOSE: Onycholysis and skin toxicity occur in approximately 30% of patients treated with docetaxel. We investigated the efficacy and safety of an Elasto-Gel (84400 APT Cedex, Akromed, France) frozen glove (FG) for the prevention of docetaxel-induced onycholysis and skin toxicity. PATIENTS AND METHODS: Patients receiving docetaxel 75 mg/m2 alone or in combination chemotherapy were eligible for this case-control study. Each patient wore an FG for a total of 90 minutes on the right hand. The left hand was not protected and acted as the control. Onycholysis and skin toxicity were assessed at each cycle by National Cancer Institute Common Toxicity Criteria and documented by photography. Wilcoxon matched-pairs rank test was used. RESULTS: Between August 2002 and September 2003, 45 patients were evaluated. Onycholysis and skin toxicity were significantly lower in the FG-protected hand compared with the control hand (P = .0001). Onycholysis was grade (G) 0 in 89% v 49% and G1 to 2 in 11% v 51% for the FG-protected hand and the control hand, respectively. Skin toxicity was G0 in 73% v 41% and G1 to 2 in 27% v 59% for the FG-protected and the control hand, respectively. Median time to nail and skin toxicity occurrence was not significantly different between the FG-protected and the control hand, respectively (106 v 58 days for nail toxicity; 57 v 58 days for skin toxicity). Five patients (11%) experienced discomfort due to cold intolerance. CONCLUSION: FG significantly reduces the nail and skin toxicity associated with docetaxel and provides a new tool in supportive care management to improve a patient's quality of life.
Adult↗
Onycholysis associated with weekly administration of paclitaxel.
OBJECTIVE: To report an unusual reaction associated with weekly administration of paclitaxel. CASE SUMMARIES: Onycholysis was seen in four women with recurrent ovarian cancer being treated with low-dose, weekly paclitaxel. Two of the patients had previously received higher doses of paclitaxel on an every-three-week schedule without similar reactions. Onycholysis developed between weeks 10-13 of treatment in three of the patients. In the fourth patient, it developed shortly after initiation of weekly paclitaxel. None of the reactions required dose adjustments or discontinuation of therapy. Direct toxicity to the nail bed or inhibition of angiogenesis are possible mechanisms for this reaction. DISCUSSION: Onycholysis, separation of the nail from the nail bed, is an infrequent adverse effect of drug therapy. Antineoplastic drugs have previously been reported to cause onycholysis, pigmentation, bands, thickening or thinning of the nail bed, and nail shedding. Nail changes with the taxanes, primarily docetaxel, are reported in up to 30-40% of patients. Paclitaxel is not commonly associated with dermatologic reactions, although localized skin reactions and tissue necrosis have been reported. Nail changes, pigmentation or discoloration of the nail bed, occur in 2% of patients receiving paclitaxel. CONCLUSIONS: Onycholysis is an uncommon reaction that may occur in some patients receiving weekly, low-dose paclitaxel therapy. The reaction is not life-threatening and does not warrant discontinuation of therapy. However, clinicians should be aware of the possibility of this effect and be prepared to advise patients who develop signs of nail changes.
Aged↗
Housewife onycholysis.
OBJECTIVE: The aim of this study was to evaluate the clinical and microbiological aspects of onycholysis in Iraqi housewives. METHODS: One hundred housewives with onycholysis of the finger nails were evaluated clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq between October 2002 to March 2003. Swabs were taken from those patients for microbiological evaluation in the Department of Microbiology, College of Medicine, University of Baghdad, Baghdad, Iraq. All cases with skin disorder related systemic diseases like anemia, hypothyroidism and drug intake like minocycline, oral contraceptives were excluded from the study. RESULTS: One hundred housewives with onycholysis were enrolled in the study. Their ages ranged between 17-70 years with a mean of 41.96 +/- 12.57 years. Married females were 89 (89%), while unmarried females were 11 (11%). The site of involvement was mainly the thumb (76%) followed by the ring finger (12%), the index (7%), little (6%) and middle (5%) fingers. The pattern of onycholysis was distal in 47 (47%), lateral in 30 (30%) and both distal and lateral in 23 (23%) of the patients. CONCLUSION: Onycholysis is a major problem among Iraqi housewives, most probably caused by repetitive mechanical, chemical and physical trauma; therefore, special preventive measures should be undertaken to minimize the incidence of the disease. Housewives should be encouraged to use preventive measures like using gloves and washing machines.
Adolescent↗
Photo-onycholysis: two cases induced by doxycycline.
Photo-onycholysis is a phototoxic reaction, which is usually drug-induced. It consists of the separation of the nail from the nail bed due to ultraviolet radiation. We report two cases of female patients who developed distal onycholysis while receiving doxycycline. Among the drugs that cause photo-onycholysis, the most frequently cited are tetracyclines, psoralens and fluoroquinolones. Photo-onycholysis is often distal, half-moon shaped and can be surrounded by pigmentation. Spontaneous recovery follows within a few months of discontinuing the drug.
Journal Article↗
The disappearing nail bed: a possible outcome of onycholysis.
Onycholysis is a separation of the nail plate from the underlying and/or lateral supporting structures (hyponychium, nail bed, lateral nail folds). It is a commonly seen disorder that is usually asymptomatic. We have observed a number of cases of onycholysis in which the distal nail bed appeared to shrink. The nail bed becomes keratinized and produces dermatoglyphics like the normal tip of a digit. This may explain why it is difficult to promote reattachment. If onycholysis persists, the condition is more likely to become irreversible and form the "disappearing nail bed." The best chance of resolving onycholysis is to try to identify the causative agent and institute early therapy.
Epidermis↗
Isotretinoin-induced nail fragility and onycholysis.
A 23 year old woman who presented with severe acne had been treated with 40 mg/day isotretinoin. On her monthly control, severe cheilitis and bilateral toe nail onycholysis were observed. It is well known that systemic retinoids have several side effects. Although dystropic nail, paronichia-like changes, median nail dystrophy have previously been reported with isotretinoin therapy, onycholysis is rare. In this report, we describe a case with isotretinoin induced nail fragility and onycholysis.
Acne Vulgaris↗
Onycholysis in a case of atopic eczema treated with PUVA photochemotherapy.
Onycholysis following the ingestion of psoralens and subsequent exposure to natural sunlight has been reported on several occasions and was first reported following photochemotherapy in 1978 by Ortonne and Baran from France and in 1979 by Mackie from Scotland. Mackie commented that she hoped to stimulate further reports of onycholysis induced by PUVA photochemotherapy in order to establish whether or not it was a definite complication of such treatment. Since then, there has been a dearth of similar reports. We describe a patient with severe atopic eczema and alopecia totalis who developed onycholysis of all finger nails and a toe nail during PUVA photochemotherapy.
Adult↗
Doxycycline-induced photo-onycholysis.
An uncommon manifestation of phototoxicity, photo-onycholysis results in the separation of the distal nail from the nail bed. Photo-onycholysis may follow the use of various medications or may occasionally be idiopathic. We present a case of photo-onycholysis in a patient treated with doxycycline for acne vulgaris.
Acne Vulgaris↗
Finger sucking and onycholysis in an infant.
A case of onycholysis in a 6-month-old male infant secondary to chronic finger sucking is reported. He was allowed to suck on his fingers without intervention. The onycholysis resolved after cessation of finger sucking habits when the child was a toddler.
Fingersucking↗
Benoxaprofen-induced photo-onycholysis.
Benoxaprofen (Opren) is a nonsteroidal anti-inflammatory agent used in the treatment of arthritis. Photosensitivity, including onycholysis, has been reported in the rheumatologic literature. This drug has recently been approved for use in the United States under the name of Oraflex. In order to alert the dermatology community, we report a case of photo-onycholysis which developed in a patient being treated with benoxaprofen and review the data on this drug and its side effects.
Anti-Inflammatory Agents↗
Drug-induced photo-onycholysis. Three subtypes identified in a study of 15 cases.
We have studied 15 patients with photo-onycholysis induced by tetracyclines, psoralens, or fluoroquinolones. Three distinct clinical subtypes of onycholysis were seen. Type I showed a half-moon-shaped separation that was concave distally. Type II had a circular notch opened distally and shaped as if the distal nail plate had acted as a convex lens. In type III the changes were located in the central part of the nail bed with no connection to the margins. Ultraviolet (UV) irradiation of normal fingernails with various wavelengths showed that 3% to 20% of the irradiation could penetrate the nail. The different patterns of photodamage might be caused by the nail acting as a lens. Less protection by lack of melanin and absence of sebum and stratum granulosum may favor penetration of UV irradiation and explain why the skin was not always affected.
Adult↗
Onycholysis and subungual haemorrhages secondary to systemic chemotherapy (paclitaxel).
Paclitaxel is a chemotherapic agent of the taxane family used in treatment of malignant solid tumory. We report here the case of a 40-year old woman referred to our clinic for nail changes involving all 20 digits and developed after 5 months of paclitaxel intake, due to a breast carcinoma. Clinical examination revealed red-brown discoloration of the nails associated with hematomas and onycholysis. The nail changes were very painful and the patient complained of discharge of bad-smelling yellow brown opaque fluid from underneath the nail plate. Hemorrhagic onycholysis and subungual abscesses are a possible side effect of taxane treatment that should be early recognized to prevent serious complications.
Adult↗
Spontaneous photo-onycholysis.
Three cases of onycholysis following, and apparently caused by, sun exposure are reported. No case was associated with drug ingestion or demonstrable metabolic abnormality. Cutaneous phototesting of all patients with an irradiation monochromator was within normal limits, although the action spectrum for the defect may lie in the ultraviolet-A (UV-A) region. This appears to be the first report of spontaneous photo-onycholysis.
Adult↗
Distal phalangeal metastasis of a chondrosarcoma presenting initially as bilateral onycholysis.
Onycholysis is the detachment of a nail plate from its distolateral attachments. There are numerous aetiologies: congenital, traumatic, microbial, toxic, dermatological, systemic and benign or malignant tumours. We report a case with onycholysis of the ring-fingers of both hands whose symmetrical and bilateral characteristics temporarily confused the diagnosis.
Adult↗
Photo-onycholysis due to sparfloxacin.
This paper describes a case of sparfloxacin-induced photodermatitis associated with photo-onycholysis in a 36-year-old man. He was being treated with sparfloxacin, streptomycin, ethambutol and pyrazinamide for pulmonary tuberculosis. He developed an exaggerated sunburn-like rash over the face and the dorsa of hands and feet, and painful onycholysis of finger- and toe-nails. Withdrawal of sparfloxacin resulted in resolution of the skin rash and nail tenderness.
Adult↗