Recurrent Onychomadesis of the Toenails in Children and Adults: A Case Series

Abstract

Introduction: Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature.

Case presentation: We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments.

Discussion/conclusion: For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.

Keywords: Nail dystrophy; Nails; Onychomadesis; Pediatrics.

Fig. 1

Layering of nails with moderate thickness of the R1 and R2 toes of a child (a) and marked hyperkeratosis of the L1 toenail of a child (b).