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FIGURE 4.20
Onychomadesis due to etretinate in a psoriatic patient.
FIGURE 4.21
Pseudoporphyria with onycholysis and subungual
hemorrhage. (Courtesy of JL Levy, France.)
been added to the list of photo-onycholysis-
inducing substances, for example sparfloxacin.
Photo-onycholysis induced by paclitaxel and
trastuzumab in association with aberrations of
porphyrin metabolism has recently been described.
Some severe general diseases such as scarlet
fever, sepsis, pneumonia, hepatitis , and
influenza , have been blamed for onychomade-
sis. Recurrent forms have been described.
GENETIC DISEASES
Distal onycholysis was seen in an ectodermal
dysplasia family over four generations with
Marie-Unna-type hypotrichosis. Congenital par-
tial onycholysis associated with thick and hard
nails has been reported in some families 35 ( Figure
4.23 ).
A purely tricho-onychotic ectodermal
dysplasia characterized by hypotrichosis and
onycholysis and by short, thickened, overcurved
nails without cuticle has been described as a
probable new mutation.
A family with an autosomal recessive nail
dysplasia presenting with onycholysis of the
fingers and anonychia of the toes in six genera-
tions has been described from Pakistan.
Onycholysis subsequent to subungual
hemorrhages has been observed in hyper-
FIGURE 4.22
Photo-onycholysis (PUVA) therapy.
homocysteinemia due to a defect in the
gene for tetrahydrofolate reductase. Systemic
administration of folic acid controlled the hyper-
homocysteinemia and the cutaneous lesions,
including the onycholysis.
MECHANICAL AND
PHYSICAL CAUSES
Onycholysis semilunaris is probably the
most common form. Most patients are female,
 
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