Onycholysis
Onycholysis is a disorder of the nail in which there is painless, spontaneous detachment of the nail plate from the nail bed resulting in the formation of a well-demarcated, white, opaque area on the nail. Onycholysis can be primary in which case it is idiopathic or it could be secondary to another cause. For example, it could be secondary to trauma, infection, psoriasis, certain drugs (tetracyclines, psoralens etc) and even systemic disorders (amyloidosis, diabetes etc). The clinical presentation is that of a well-defined area of detached nail that appears white compared to rest of the attached nail which is pink. There is accumulation of thickened, hyperkeratotic skin under the detached nail. Sometimes an island of onycholysis occurs under the nail and the appearance is termed as an oil spot sign. In addition, the oil spot sign is yellowish rather than white. For onycholysis, the treatment aims to wait for the detached nail to grow out and to keep the new nail attached to the nail bed. It includes general measures like regularly clipping the affected nail areas and avoiding irritants. Secondly, antimicrobial soaks can be used to prevent the development of secondary infection. Moreover, specific measures like removing the causative drug or treating the causative infection helps to treat onycholysis.