Onycholysis is the separation of the nail plate from the nail bed, which can be caused by a number of different issues including injury, fungal infection, and underlying health conditions such as psoriasis, alopecia, lichen planus, or eczema. Treatment options for onycholysis include:
- Topical antifungal imidazole or allylamine: Apply twice daily to avoid superinfection of the nail.
- Oral broad-spectrum antifungal agent: May be used for cases with concomitant onychomycosis.
- Corticosteroids: Treat noninfectious causes of onycholysis. Intralesional and topical corticosteroids are designed to treat any noninfectious inflammatory condition associated with onycholysis with minimal risk for systemic absorption.
- Topical pyrimidine antagonists: Inhibit cell growth and proliferation. They are reported to be effective in the treatment of nail pitting and onycholysis associated with psoriasis.
- Ciclopirox topical solution: Contains a synthetic antifungal agent, ciclopirox, and is intended for topical use on the nails.
- Nail avulsion in combination with topical therapy: This approach can be time-consuming, temporarily disabling, and painful.
- Systemic antifungal agents: Terbinafine and itraconazole are the most widely used, with fluconazole rapidly gaining acceptance. These medications offer shorter treatment courses, higher cure rates, and fewer relapses.
- Physical treatments: Laser and photodynamic therapies have become popular based on the success of clinical trials, but they are expensive.
It is important to note that treatment is not without adverse effects, and risks should be explained to patients before initiating therapy.
