Sue is a 33 year old washer woman with a history of psoriasis and hyperthyroidism, recently started on Tetracycline, who presents with separation of her fingernail from the finger. It started distally and is working proximally and Sue is concerned.

What are the causes of Onycholysis (lifting of nail plate)?

1. Psoriasis
2. Trauma
3. Fungal
4. Photo sensitivity from tetracyclines
5. Hyperthyroidism
6. SCC
7. Melanoma

What is the non pharmacological management of Onycholysis of fingernails?

1. Keep nails short
2. Avoid inserting sharp objects
3. Apply tape over free edge for months until healed
4. Avoid unecessary soaps
5. Kep hand out of water
6. Mild soap
7. Vinegar soaks 5 min 2-3 times daily

What are the principles of managament of toenail onycholysis?

1. Exclude fungal infection
2. Improve footwear to eliminate rubbing

Reading

1. Murtaghs General Practice Chapter 129 – http://murtagh.mhmedical.com/content.aspx?bookid=1522&sectionid=116046129
2. Murtaghs Practice Tips – Chapter 8 – Nail Problems – http://murtagh.mhmedical.com/content.aspx?bookid=1920&sectionid=143276631

Podcast

1. GP Core Content Podcast Episode 150 – Dermatology | Nails