Dana Sous1, Michela V R Starace2, Lu Chen3, Elizabeth L Nieman4, Milan J Anadkat5, Bianca Maria Piraccini2, Carrie C Coughlin5,6. 1. School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA. 2. Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. 3. Dermatopathology, The Institute for Dermatopathology, Newtown Square, Pennsylvania, USA. 4. Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. 5. Division of Dermatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA. 6. Departments of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
Abstract
INTRODUCTION: Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. CASE PRESENTATION: We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. DISCUSSION/ CONCLUSION: For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.
INTRODUCTION: Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. CASE PRESENTATION: We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. DISCUSSION/ CONCLUSION: For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.