ONYCHOLYSIS >Any recommendations for the management of Onycholysis. A lady who is a >cosmetologist, showed up in the office, with onycholysis of 7 fingernails in >the past 2 months. The appearance of the nails is gradually getting worse. >Would appreciate any advice. There is no evidence of any onychomycosis. The >only internal medication this lady is taking is BCP. Thanks for the help >--- >Shamsher Singh M.D. ============== From: Reviva@aol.com I have found Lac-hydrin-12 to be very beneficial for onycholysis. ================ From: jeisner@sos.sos.net (Jerry Eisner) It is possible that this may represent a combination of factors. In her profession she probably gets her hands wet frequently. Constant moistening and drying can cause or aggravate onycholysis. Is there any other evidence for finger dermatitis? Long fingernails are prone to onycholysis from the traumatic effect of having the tips of the nails hit against other hard objects. This slowly lifts the nail off the bed. Nails should be kept short. Also, in questioning some people with this problem I find they are mechanically cleaning under the nails farther and farther in an effort to keep the area clean. This continues to lift the nail away from the nail bed and worsens the problem. Mechanical cleaning with nail files and brushes should be questioned. Additionally, ultraviolet light plus certain meds, eg anti-inflamatories, can cause onycholysis. Does she use a tanning booth and take NSAIDs for example? ============= From: "Steven D. Emmet, M.D." as always, the proper therapy flows naturally from the correct diagnosis. several studies have shown that up to three koh's and cultures are necessary before one can say with some certainty that onychomycosis is not the cause; one can enhance the chances of a positive koh/culture by having the patient use a corticosteroid solution under the nails for a week or so before redoing the koh/culture. also, some fungi will not grow on dtm; this is rare but it happens. if you are now sure that it is not a tinea/monilia then drying and splitting often occur, as mentioned, from too much immersion in water. i have such patients use neutrogena hand cream, just because it gives a good occlusive layer above the nail, is inexpensive and easy to use. hope this helps! ============= From: Haines Ely Many cosmetologists wear artificaial nails. Does this patient? Most conventional wisdom has it that onycholysis is due to trapped water under the distal nail plate which encourages the growth of yeast. The candida causes separation of the nail plate from the nail bed. Having the patient use thymol 3% in chloroform under the free edge of the nail after each wetting is very effective. Excelderm or lotrimin solution also work in many cases. Keeping the area dry is the most effective treatment in my experience. I've also had luck trimming the nail back as far as it will go and applying nizoral cream to the finger tip T.I.D. till the nail grows back. Haines Ely, Grass Valley, Ca. On Thu, 8 Jun 1995, Shamsher Singh wrote: =========== From: "L.J. Gregg" <73477.361@compuserve.com> In addition the the great comments so far I would suggest emphasis on the occupation. Not only do cosmetologists get there hands wet a lot, they deal with an innumerable group of chemicals. Is there any pattern to the changes? Does she deal with artificial nails, I recently saw 7 or 8 nail onycholysis with minimal eczematous changes underneath the nail in a nail technician who is acrylate sensitive. Of course dont overlook isolated nail onycholysis due to psoriasis. =============== From: KSmithDerm@aol.com I've seen a few people who seem to have had onycholysis which is psoriasis isolated to the nails. I've got a number of patients with nail psoriasis who are doing well with Dovonex ointment [some with 10% urea added to enhance penetration] applied to the proximal nailfold [DON"T put it under the nail] bid. Don't add Sal Acid to Dovonex because the low pH will degrade the Dovonex rapidly. Helps to photograph the nails before starting Rx - it takes a couple of months to work as the nails grow out, and the photos encourage patients to stick with the treatment program when they see the improvement at the 8 week followup visit. ============ From: Kathryn Anne Zug Remember that onycholysis can be a sign of allergic contact dermatitis to acrylic nail compounds. Does this cosmetologist wear sculptured nails? Does she apply them with some frequency, even with gloves? Consider patch testing to ethyl acrylate (EA, 2-Hydroxyethyl acrylate (2-HEA), Ethylene glycol dimethacrylate (EGDMA), ethyl alpha cyanoacrylate (EACA) and Triethylene glycol diacrylate (TEGDA). This is a screening series for sculptured nail allergic contact dermatitis suggested by Koppula and Storrs from OHSU. Alternatively, consider the causes of photo-onycholysis- tetracyline among them. ============== From: Mark1105@aol.com Castellani's paint is helpful, regular or decolorized. However, I almost never see this disorder in our largely Caucasian population.