The disappearing nail bed: a possible outcome of onycholysis

Distal onycholysis results from separation of the nail plate from the underlying supporting structures and in most cases is a consequence of pathological conditions that affect the hyponichium1 It is a commonly seen disorder. It may have many causes some of which are infectious, contact irritant, dermatological, traumatic, systemic disease, drug, neoplastic, inherited, etc.1 It is usually asymptomatic, and it is generally the appearance of the nail that leads the patient to consult a dermatologist. We have observed a number of cases of onycholysis, usually of the great toenail, but occasionally of the thumb and index finger nail, in which the distal nail bed appeared to shrink. That area becomes apparently cornified and produced dermatoglyphics like the normal tip of a digit.1,2 This may explain why it is difficult to promote reattachment. It is generally assumed that the longer the disorder has been present, the less likely that it is to resolve 1-6 , but chronicity of onycholysis has never been specifically quantified or defined.