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Partial and complete absence of nails: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Partial absence of the nail plate is understood as onycholysis, i.e. incomplete separation of the nail from the nail bed. In dermatological practice, onycholysis is the most common symptom of nail plate damage. In patients with localization of the rash in the nail bed area, characteristic symptoms of subungual psoriatic papule are detected: yellowish discoloration with a narrow erythematous rim along the periphery. The process can be combined with point depressions on the surface of the nail (the "thimble" symptom) and psoriatic paronychia. There are also a number of other dermatoses accompanied by onycholysis: lichen planus, Reiter's disease, bullous dermatoses, periungual and subungual warts. Partial absence of the nail plate can also be a consequence of a nail injury, the action of various infectious factors (yeast-like fungi of the genus Candida, pyogenic microflora), taking certain medications (tetracycline antibiotics, psoralen, thiazides), tissue perfusion disorders in vascular diseases of the extremities, diffuse connective tissue diseases. In dermatocosmetology, onycholysis often occurs as a result of injury during careless manicure with the use of metal instruments that have undergone inadequate disinfection. This is especially common with long nails. In addition, onycholysis can develop with intolerance to components of nail coatings, artificial nails, liquids that hold solvents. Onycholysis on the feet can be associated with pressure from tight or ill-fitting shoes, due to impaired peripheral circulation.
Onychomadesis is a complete absence of the nail plate or most of it. Onychomadesis is divided into reversible (unstable) and irreversible (persistent). With irreversible onychomadesis, the nail matrix is affected, the growth of the nail plate is disrupted and a connective tissue strand called pterygium is formed in its place. Pterygium is caused by lichen planus, acrodermatitis of Halopeau, bullous eczema, and dermatitis spp.
Pydermolysis, cicatricial pemphigoid, toxic epidermal necrolysis (Lyell's syndrome), onychotillomania. It should be emphasized that persistent loss of the nail may result from severe injuries to the terminal phalanx of the finger, as well as surgical removal of the nail plates during the treatment of onychomycosis. Reversible onychomadesis is associated with injuries to the nail and periungual fold, acute paronychia, bullous toxicoderma, psoriasis, deep Bo-Reilhe grooves, erythroderma of various origins, Kawasaki syndrome, intake of antibiotics, cytostatics, systemic retinoids and a number of other conditions.
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