Title : Clinco-etiologic evaluation of onycholysis: A cross-sectional study of 130 patients
Abstract:
Background: Onycholysis (separation of nail plate from bed) can be primary (idiopathic) or secondary. Aims & Objectives: This observational, cross-sectional study estimated the frequency of various etiological factors in patients presenting with onycholysis, based on clinical, onychoscopic, microbiologic, and histopathologic evaluation. The impact on quality of life (QoL) was also assessed.
Materials & Methods: For patients with onycholysis (at least one nail), history (occupational or precipitating factors) and QoL assessment (Drake et.al nail-specific questionnaire) was done. General physical, mucocutaneous, and nail examinations were done followed by onychoscopy. Nail clippings were assessed with direct microscopy, fungal culture, and histopathology (PAS stain). Bacterial culture and patch test were done wherever indicated.
Results: Among 130 patients (12-75 years), 458 nails (17.5%) had onycholysis. Fingernails (58%) and Grade 2 onycholysis (57%) were mostly seen. Homemakers (46.3%) and trauma (48.4%) were common precipitating factors. 15.4% had anemia, 10.8% had diabetes, and most reported a mild impact on QoL (62.3%, 76.1% for finger and toenails). Onychoscopy showed additional 20 nails (18.3%) with onycholysis with the commonest pattern being transversal (76.1%). KOH (51.5%), fungal culture (36.9%), bacterial culture (40%), and patch test (4.6%- nickel sensitivity) were notable. Nail plate biopsy showed parakeratosis (91.5%- commonest finding) and PAS positivity (36.2%). Overall, onycholysis was idiopathic in 19.2%, while
secondary onycholysis (80.7%) had onychomycosis (56.1%-commonest), psoriasis (12.3%), and allergic contact dermatitis (3.8%) as causes.
Conclusions: Secondary onycholysis predominates, though primary onycholysis (diagnosis of
exclusion) is also seen in a significant proportion.
Limitation: Small sample size, hospital-based study.
