Onycholysis

OnycholysisOnycholysis is a nail disorder frequently encountered. It is characterized by a spontaneous separation of the nail starting at the edge of progressive proximal and distal free. Nail is separated from the underlying structures and lateral support. Less separation starts at the proximal and expands, the distal free edge, as seen especially in nail psoriasis onicomadesis.
Treatment varies and depends on the cause onycholysis. It is important to remove the causative factor. Onycholysis of psoriasis can be treated with topical corticosteroids. Patients should avoid trauma, irritants and moisture. To prevent infection with bacteria and fungi indicate antibacterine and oral antifungal regimens. Severe cases left untreated can lead to permanent loss of nails and scars.
Pathogenesis
Nails with onycholysis usually are smooth, firm and without inflammatory reaction. Onycholysis is a matrix ugnhiei disease, but the underlying nail discoloration may occur as a result of secondary infection. Treatment of primary and secondary factors that exacerbate the condition is important. Left untreated, severe cases can cause scarring of the nail bed.
Causes and Risk Factors
Etiological factors may be exogenous, endogenous, hereditary or idiopathic. Contact irritants, trauma and moisture are the most common causes for onycholysis.
Systemic causes:-Multiple myeloma, amyloidosis, diabetes, bronsiectazie, erythropoietic porphyriaHistiocytosis X-, hyper-, hypothyroidism, ischemia, leprosy, lupus, Neural, pellagra-Pemphigus vulgaris, porphyria cutanea tarda, pregnancy, Reiter syndrome, psoriatic arthritis,, Sarcoidosis, scleroderma, shell nail syndrome, syphilis, yellow nail syndrome.
Causes skin:-Psoroazis, lichen planus, dermatitis, hyperhidrosis, congenital paconichiaVegetant-pemphigus, lichen streaked, atopic dermatitis, congenital abnormalities of the nails.
Causes cancer:Squamous-cell carcinoma of nail bedLung-carcinoma.
Nonmicrobieni exogenous factors:-Repetitive mechanical trauma, contact dermatitis, paints, OJE, ugnhii adhesives, gas, solvents, bleach-Irritant contact dermatitis by prolonged immersion of nails in water, sweet solutions, exposure to acids and bases.
Microbial factors:-Dermatophytosis: T. rubrum, Trichophyton mentagrophytes-Fungus-Candida-Pseudomonas bacteria, viruses-herpes simplex.
Causes photosensitivity madicamentoase by agents (sun):-Tetracycline, psoralen, fluoroquinolones, chloramphenicol, chlorpromazine, doxycycline-Minocycline, oral contraceptives, aminolevulinic acid.
Pharmacological Causes:-Doxorubicin, mitoxantrone, captopril, bleomycin, 5-fluorouracil-Retinoids, tetracycline, etoposide, paclitaxel.
Other causes:-Onycholysis congenital hereditary partial onycholysis-Onycholysis gained idiopathic congenital distal onycholysis.
Signs and symptoms
People of any age may onycholysis, although it is a disease of adults. Pacentilor careful anamnesis usually show exposure to different agents nail injury. Affected nails are smooth, firm and without inflammation. Nail bed discoloration is due to secondary infection. Spontaneous separation of the nail starts at free distal edge and progresses proximally. Less separation begins at the proximal nail and extends to the free edge. Nail is separated from the underlying structures and side.
Diagnosis
It will undertake studies to exclude onychomycosis, treatment with potassium hydroxide to reveal the nail fungus. Biopsy staining with hematoxylin and eosin nails for fungi.
Treatment
Depending on the cause onycholysis treatment must deal with underlying conditions. Patients should avoid trauma to the affected nail and keep the area dry. Must avoid exposure to irritants and wet, wear cotton socks at home and in the synthetic work if it shows a wet environment.Intralesional corticosteroid injections are associated with nail dystrophy in psoriasis.The practice of diluted triamcinolone injections in the proximal nail fold every 4 weeks in 4-6 sessions. Apply topical antifungal azoles alilamine or twice a day to avoid superinfection nail. To use concurrent onychomycosis fluconazole, itraconazole, terbinafine. The 1% 5-fluorouracil in massage twice a day for 4 months is effective for patients with psoriasis. Other regimens tested relative onycholysis results include PUVA in psoriasis, etretinat oral hydroxyurea and isotretinoin.