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I recently had a new patient who has onycholysis of both hallux nails and 2 minor nails. She has hypothyroidism (she believes due to Hashimotos), and is being treated with Oroxine.
She finds the onycholysis very concerning, and has had 'all the pathology under the sun'. She is also quite stressed as her husband is seriously ill.
A quick web search showed a strong link between thyroid problems and onycholysis.
Spontaneous separation of nail plate at its distal end – keratin accumulates under nails.
Occurs at various speeds, but usually slowly. Usually asymptomatic.
Most due to trauma and Candida albicans or Pseudomonas infection.
Could also be due to – excessively long nails (chronic lifting of nail off bed can occur during normal activity); psoriasis (often have pitting as well); dermatitis/eczema; arterial insufficiency; hypothyroidism; congenital nail syndromes; chemicals and nail care products.
Treatment:
Removal of all detached pieces of nail.
and from my medicine notes on hypothyroidism:
Quote:
Involvement of feet:
Skin can be dry, coarse and scaly – heel fissures common.
Carotenaemia of plantar surface – due to deposition of carotene in lipid rich epidermal layers.
Metatarsophalangeal joints can be affected – insidious onset of pain and stiffness – often worse in morning (symptoms mimic rheumatoid arthritis). Onycholysis.
Depressed deep tendon reflexes with slow relaxation phase
Peripheral neuropathies (eg tarsal tunnel syndrome) may develop (Schwartz et al, 1983) – also can be a distal sensorimotor or sensory distal polyneuropathy – starts as paraesthesia and pain; touch, vibration and proprioception are decreased; the polyneuropathy most commonly start as symmetric numbness in feet
Raynauds
__________________ Craig Payne
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Another cause of onycholysis that I have seen:nail salon syndrome(which is under the category of infection).I also had a CVA pt get it.I remove the nail,no need for P and A.Many nail problems are metabolic in nature.
Onycholysis and hypothyroidism
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