Onychomadesis

NewsBot · Sep 23, 2010

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Onychomadesis after a hand, foot, and mouth disease outbreak in Spain, 2009.
Cabrerizo M, DE Miguel T, Armada A, Martínez-Risco R, Pousa A, Trallero G.
Epidemiol Infect. 2010 Sep 21:1-4. [Epub ahead of print]

Few reports exist regarding the association between onychomadesis and an enterovirus infection presenting clinically as hand, foot, and mouth disease (HFMD). In February 2009, an outbreak of HFMD occurred in a Spanish nursery school, followed by onychomadesis 36-69 days later. Twelve of 17 children with HFMD developed nail shedding; enterovirus was detected in stool samples from eight (47%) of the 17. However, in only three of the children could an enterovirus serotype coxsackievirus B1 be identified. The epidemiological results of this study confirm onychomadesis as a complication in HFMD. In future outbreaks, molecular characterization of enterovirus from appropriate clinical samples should be studied.
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NewsBot · Aug 20, 2014

Onychomadesis: Literature Review
J. Hardin and R.M. Haber
British Journal of Dermatology; Accepted Article

Introduction
Onychomadesis is characterized by separation of the nail plate from the matrix with persistent attachment to the nail bed and often but not always, eventual shedding. Onychomadesis has been associated with infection, autoimmune disease, critical illness, and medications and to our knowledge a literature review of all associations with onychomadesis has not been completed previously. Most commonly, onychomadesis has been reported in association with pemphigus vulgaris, hand-foot-mouth disease, and following chemotherapy or antiepileptic medications. This article summarizes these key culprit associations, postulates the pathogenesis of nail matrix arrest and summarizes the clinical outcomes.

Methods
We conducted a retrospective review of the cases of onychomadesis reported from January 1960 until March 2013. Using the pubmed database, the literature was searched using the following terms: “Onychomadesis” and “Proximal Nail shedding”. As well, an OVID search was carried out using the same terms.

Results
A total of 56 articles have been published including our previously reported series of idiopathic onychomadesis. Articles pertaining only to Beau's lines and not true onychomadesis were excluded. Onychomadesis has been associated with autoimmune disease, other major medical illness, neonatal illness, medication induced and infection.
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NewsBot · Mar 18, 2015

Onychomadesis after hand-foot-and-mouth disease outbreak in northern Greece: case series and brief review of the literature.
Apalla Z, Sotiriou E, Pikou O, Lefaki I, Lallas A, Lazaridou E, Ioannides D.
Int J Dermatol. 2015 Mar 13.

BACKGROUND:
Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis was described as a late complication of hand-foot-and-mouth disease (HFMD). Onychomadesis outbreaks following HFMD have been reported in many countries worldwide.
AIM:
To present a case series of onychomadesis in children, following HFMD outbreak in Northern Greece, and review literature data.
METHODS:
Children with evident onychomadesis attending the outpatient clinic between November 2012 and January 2013 were included in the study. A questionnaire including demographic personal and family history information of the children was completed by the parents. Patients were clinically examined, and their pediatric and dermatological records were studied to confirm precedent HFMD. Direct microscopic examination and cultures for fungi were performed. Exposure of participants to coxsackievirus, based on serology testing during infection, was also recorded.
RESULTS:
Sixty-eight children with onychomadesis were included. The mean number of affected nails was 8.82. Fingernails were more often involved. Previous clinical diagnosis of HFMD was confirmed in 67/68 cases. The mean time from HFMD diagnosis to onychomadesis development was 39.6 days (range: 28-56 days, STD: 7.33). Direct microscopic examination, as well as cultures for fungal species, was negative for the whole sample size. All the nail changes were transient with spontaneous regrowth after 1-4 months.
CONCLUSION:
Our data indicate that onychomadesis outbreak in the region of Thessaloniki during fall-winter 2012-13 was highly related to the outbreak of HFMD. Our study reinforces existing evidence for the association between onychomadesis and HFMD
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NewsBot · Aug 21, 2015

Onychomadesis with Lichen Planus: An Under-Recognized Manifestation.
Grover C, Vohra S
Indian J Dermatol. 2015 Jul-Aug;60(4):420.

Onychomadesis or proximal separation of the nail pate usually results from severe, generalized dermatoses like bullous diseases, hand foot and mouth disease, varicella or severe cutaneous drug reactions. Although lichen planus (LP) produces varied nail manifestations (longitudinal onychorrhexis, onychoschizia, nail pigmentation, pterygium etc.), to the best of our knowledge, onychomadesis as a manifestation of nail LP is not recorded. This report presents two children with onychomadesis arising with generalized eruptive LP.
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NewsBot · Feb 17, 2017

Shedding light on onychomadesis.
Salgado F et al
Cutis. 2017 Jan;99(1):33-36.
Onychomadesis is the proximal separation of the nail plate from the nail matrix due to a temporary cessation of nail growth. It can occur in children of all ages including neonates. Diagnosis is made clinically through palpation and inspection of the nail plate. Physicians should consider underlying associations. A review of the patient's history for any viral illnesses 1 to 2 months prior to nail changes often will help identify the causative disease. Onychomadesis typically is mild and self-limited. There is no specific treatment, but a conservative approach to management is recommended with treatment of any underlying causes and supportive care. Spontaneous nail regrowth usually occurs within 12 weeks and may occur faster in children. In this article, causes of onychomadesis are described, including the connection between hand-foot-and-mouth disease (HFMD) and onychomadesis. We also explore several theories of possible mechanisms for onychomadesis; however, the precise mechanism remains unclear and further investigation is needed.

NewsBot · Aug 18, 2017

Onychomadesis in a 9-month-old boy with hand-foot-mouth disease.
Mortada I et al
Int J Emerg Med. 2017 Aug 14;10(1):26. doi: 10.1186/s12245-017-0152-9.

BACKGROUND:
Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis is described as a rare, late complication of hand-foot-mouth disease, which is a viral illness commonly seen in the pediatric age group. It is therefore important to elucidate the presentation of this entity, especially in the context of the hand-foot-mouth disease.
CASE PRESENTATION:
We report a case of onychomadesis in a 9-month old Lebanese boy who presented to the emergency department with rapidly progressing nail changes involving all four extremities. These changes appeared few days after the healing of cutaneous lesions of hand-foot-mouth disease.
CONCLUSIONS:
This case highlights the importance of recognizing the association between onychomadesis and hand-foot-mouth disease in order to avoid unnecessary treatment and to reassure the patient's parents.
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NewsBot · Jun 9, 2019

The Mechanism of Onychomadesis (Nail Shedding) and Beau's Lines Following Hand-Foot-Mouth Disease.
Chiu HH et al
Viruses. 2019 Jun 6;11(6)

BACKGROUND:
Nail changes, including onychomadesis (nail shedding) and Beau's line, following hand-foot-mouth disease (HFMD) are a common emergence at the stage of late complications of HFMD. However, the exact mechanism is still unknown. Therefore, we conducted this study to elucidate the mechanism of nail changes following HFMD.

METHODS:
We collected 11 patients suffering from onychomadesis following HFMD. Nail samples from all of them were collected. Real time reverse transcription polymerase chain reaction (RT-PCR) and sequencing for human enteroviruses (HEV) were performed. Throat swabs for RT-PCR and sequencing for HEV were performed for three cases.

RESULTS:
RT-PCR demonstrated the presence of Coxackievirus A6 (CVA6) in nail samples from three patients and one with Echovirus.

CONCLUSION:
In conclusion, we believe that the major cause of onychomadesis following HFMD is that certain novel viruses, mostly CVA6, are virulent and may damage nail matrix. Direct injury caused by cutaneous lesions of HFMD around nail matrix is a minor cause. There are still other virulent HEV which may result in onychomadesis. In addition, the novel strain of CVA6 also causes atypical clinical presentations, such as adult involvement and delayed-onset palmar and plantar desquamation. Physicians should be familiar with atypical presentations caused by novel viruses to avoid misdiagnosis and even inform patients of the possibility of onychomadesis that may take place weeks later to reassure patients.
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