指甲病变专题（1） | 甲分离（Onycholysis）

甲分离，医学术语为“onycholysis”，是指指甲或趾甲从甲床分离的现象。今天我们用一篇来自于Cleveland Clinic的文章跟大家详细讲解一下这个疾病。（文末附文献综述）

文章来源：https://my.clevelandclinic.org/health/diseases/22903-onycholysis

单词：onycholysis /ɒnɪˈkɒlɪsɪs/ 甲分离

Onycholysis

Onycholysis is when your nail separates from its nail bed. It often appears after an injury to your nail, but it may have other causes, including fungi. Treatment may only involve cutting away the separated nail as it grows out, or you may need to take antifungal medications or stop using certain nail products.

Overview

What is onycholysis?

Onycholysis (on-uh-coll-uh-sis) is when a nail (nail plate) on your fingers or toes separates from the skin on which it rests (the nail bed). It typically only affects one nail.

Who does onycholysis affect?

Onycholysis affects everybody. However, it’s more common in:

People who are assigned female at birth (AFAB).

Adults.

People who have psoriasis, lichen planus, a nail fungus or tumors in their nail beds.

How common is onycholysis?

Onycholysis is common, and it generally lasts for several months or over a year. Any conditions that affect the skin underneath your nails eventually cause onycholysis.

How does onycholysis affect my body?

Onycholysis causes your nail to peel away from the nail bed. It usually doesn’t cause any pain.

Symptoms and Causes

What are the symptoms of onycholysis?

Symptoms of onycholysis include:

Nails that peel away from their nail beds.

Tough, thick nail beds.

An abnormal border between the pink area of your nail and the white edge of your nail. The border may look wavy, and the white areas may be thicker in some areas and thinner in others.

Discoloration in your nails and nail beds. They may look gray, green, purple, white or yellow.

Dents or pits (cupuliform depressions) in your nails.

Crumbling nails.

Hemorrhages underneath your nails.

Onycholysis usually isn’t painful, but what causes your onycholysis may be painful or irritating. If you have onycholysis due to injuries or fungal infections, you may experience pain and irritation.

What are the common causes of onycholysis?

The following are common causes of onycholysis:

Injuries (trauma) : Injuries to a nail or the area where your nails start to grow (nail matrix) can cause onycholysis. You can injure these areas by bumping or hitting your nails, wearing shoes that are too small or even keeping your nails in water for too long. Regularly going to a nail salon to get manicures can also cause onycholysis. Manicurists use a lot of force to trim, buff and polish your nails. Even tapping your nails on a hard surface over a long period can cause onycholysis.

Reaction to chemicals : Chemicals in nail polish, nail gloss, nail hardener, nail polish remover and fake nails can cause onycholysis.

Fungal infections : Fungal infections occur when fungus gets between your nail and nail bed, usually through cracks or cuts in your finger or toe. Fungal infections cause your nails to become thick and yellow, and they may show white spots and streaks.

Medications : Chemotherapy and some medications that cause light sensitivity can cause onycholysis. These medications include tetracycline, nonsteroidal anti-inflammatory drugs (NSAIDs), psoralens and oral retinoids (vitamin A derivatives).

Nail psoriasis : Nail psoriasis causes changes to the structure of your nails, which may include onycholysis.

Onycholysis rarely affects all of your nails. The following may cause onycholysis in all of your nails:

Iron deficiency : An iron deficiency is when you don’t have enough iron in your diet. An iron deficiency can also cause anemia.

Hyperthyroidism : Hyperthyroidism causes your thyroid gland in your neck to create and release more hormones than your body needs. Hyperthyroidism can also cause a rapid heartbeat, unexplained weight loss, increased appetite and anxiety disorders.

Is onycholysis a fungal infection?

No, onycholysis isn’t a fungal infection. However, fungal infections can sometimes cause onycholysis.

Is onycholysis contagious?

Depending on what causes your onycholysis, it may be contagious. Onycholysis caused by an injury, nail psoriasis or reaction to a medication or chemical isn’t contagious. However, onycholysis caused by a fungus may be contagious.

A person with an infection can spread the fungus to someone else through skin-to-skin contact. You can also get nail fungus by touching an infected surface (indirect contact), like walking barefoot around public pools or showers or by sharing items like towels, nail clippers and nail scissors.

Diagnosis and Tests

How is onycholysis diagnosed?

Onycholysis is easy to recognize, so you don’t necessarily need a healthcare professional to diagnose it, especially if you know its cause.

If you don’t know what’s caused your onycholysis, seeing your healthcare provider is a good idea. They’ll look closely at your affected nails to evaluate your symptoms.

What tests will be done to diagnose onycholysis?

Your healthcare provider may perform several tests to diagnose onycholysis. The tests may include:

Biopsy : Your healthcare provider will use a razor or surgical knife with a thin blade (scalpel) to scrape away a small sample of cells from your nails. The cells go to a laboratory for testing, and researchers examine them under a microscope.

Fungal test : Your healthcare provider may clip off some of your nails and order a potassium hydroxide (KOH) preparation or fungal culture to rule out a fungus as the cause of your onycholysis. If those test results aren’t clear, a fungus test known as a periodic acid-Schiff (PAS) stain can also determine the presence of a fungus.

Blood test : During a blood test, your healthcare provider will use a thin (21 gauge, slightly smaller than the size of a standard earring) needle to withdraw a small amount of blood from a vein in your arm. The blood sample goes to a laboratory for testing, and researchers examine it to check for the presence of any systemic diseases that may cause onycholysis.

Management and Treatment

Can onycholysis be cured?

There isn’t a cure for the section of your nail that’s detached from the nail bed — you can’t reattach it. But treatment can keep new nail growth attached to your nail bed.

What can I use to treat onycholysis?

If you have onycholysis because of an injury, the detached part of your nail will eventually grow out. Use nail clippers or nail scissors to remove your affected nail as it grows out.

If you have onycholysis because of a fungus, your options may include:

Oral antifungal medication : Your healthcare provider may prescribe liquid medicines or pills or tablets that you swallow with water. These medications may include terbinafine (Lamisil®), itraconazole (Sporanox®) and fluconazole (Diflucan®).

Topical antifungal medication : Topical medications come in the form of creams, ointments or gels. You rub them directly onto your nails.

Nail fungi can be difficult to treat. It’s important to finish your full course of medicine. If you stop too soon, the fungus that caused your onycholysis may come back and be harder to treat.

How do I take care of my nails?

The following tips can help you take care of your nails if you have onycholysis:

Take medications and apply treatments as instructed by your healthcare professional.

Regularly trim your affected nails.

Protect your nails from any additional damage.

Wash your hands regularly to prevent an infection. Use a clean washcloth to help reach beneath your nails.

Use antifungal or antimicrobial soaks to help prevent infection. Antimicrobial soaks may include lemon juice, vinegar, hydrogen peroxide and tea tree, orange or lemongrass essential oils.

While essential oils are safe for most people, it’s a good idea to check with your healthcare provider before trying them. You may be at risk of developing an allergic reaction.

Prevention

How can I prevent onycholysis?

The following tips can help you prevent onycholysis:

Keep your nails trimmed short. Keeping your nails short will prevent them from catching on objects and pulling further off of your nail beds.

Avoid biting your nails.

Be careful when cleaning underneath your nails. Some tools that clean underneath your nails, like cuticle sticks or nail brushes, can break the skin underneath your nails and cause an infection.

Avoid chemicals or products that can irritate your nails or the skin around your nails. These may include nail polish, nail gloss, nail hardener, nail polish remover and fake nails.

Wear gloves when doing activities that may damage your nails, like washing the dishes, playing sports or working outside.

Wear clean socks and comfortable, protective shoes. Be careful when putting down heavy objects near your feet.

Outlook / Prognosis

What can I expect if I have onycholysis?

If you and your healthcare provider can determine the cause of your onycholysis, your nails will slowly but surely regrow. Your fingernails grow slowly, and your toenails grow even slower. It may take up to six to nine months for your fingernails to grow completely out, and it may take 12 to 18 months for your toenails to grow completely out.

翻译（人工智能：豆包）

甲分离

甲分离是指指甲与甲床分离。它通常在指甲受伤后出现，但也可能有其他原因，包括真菌感染。治疗可能只涉及在分离的指甲生长时将其剪掉，或者您可能需要服用抗真菌药物或停止使用某些指甲产品。

概述

什么是甲分离？

甲分离（onycholysis）是指手指或脚趾上的指甲（指甲板）与它所附着的皮肤（甲床）分离。它通常只影响一个指甲。

甲分离会影响谁？

甲分离会影响每个人。然而，它在以下人群中更常见：

出生时被指定为女性的人（AFAB）。

成年人。

患有银屑病、扁平苔藓、指甲真菌或甲床肿瘤的人。

甲分离有多常见？

甲分离很常见，通常持续数月或一年以上。任何影响指甲下方皮肤的情况最终都会导致甲分离。

甲分离如何影响我的身体？

甲分离会导致指甲从甲床上剥落。它通常不会引起任何疼痛。

症状和原因

甲分离的症状有哪些？

甲分离的症状包括：

指甲从甲床上剥落。

坚韧、厚实的甲床。

指甲粉红色区域和白色边缘之间的异常边界。边界可能看起来呈波浪状，白色区域在某些区域可能较厚，而在其他区域较薄。

指甲和甲床变色。它们可能看起来呈灰色、绿色、紫色、白色或黄色。

指甲上的凹陷或坑洼（杯状凹陷）。

指甲易碎。

指甲下出血。

甲分离通常不会疼痛，但导致甲分离的原因可能会疼痛或刺激。如果您因受伤或真菌感染而患有甲分离，您可能会感到疼痛和刺激。

甲分离的常见原因有哪些？

以下是甲分离的常见原因：

受伤（创伤）：指甲或指甲开始生长的区域（指甲基质）受伤可能导致甲分离。您可以通过撞击或敲击指甲、穿太小的鞋子甚至将指甲长时间浸泡在水中来伤害这些区域。定期去美甲沙龙做美甲也可能导致甲分离。美甲师会用很大的力气修剪、打磨和抛光您的指甲。即使长时间在坚硬表面上敲击指甲也可能导致甲分离。

对化学品的反应：指甲油、指甲亮光剂、指甲硬化剂、指甲油去除剂和假指甲中的化学物质可能导致甲分离。

真菌感染：当真菌进入指甲和甲床之间时，就会发生真菌感染，通常是通过手指或脚趾上的裂缝或切口。真菌感染会导致指甲变厚变黄，并可能出现白色斑点和条纹。

药物：化疗和一些引起光敏性的药物可能导致甲分离。这些药物包括四环素、非甾体抗炎药（NSAIDs）、补骨脂素和口服维甲酸（维生素A衍生物）。

指甲银屑病：指甲银屑病会导致指甲结构发生变化，其中可能包括甲分离。

甲分离很少影响所有指甲。以下情况可能导致所有指甲都出现甲分离：

缺铁：缺铁是指您的饮食中没有足够的铁。缺铁也可能导致贫血。

甲状腺功能亢进：甲状腺功能亢进会导致您颈部的甲状腺产生并释放比身体需要更多的激素。甲状腺功能亢进还可能导致心跳加快、不明原因的体重减轻、食欲增加和焦虑症。

甲分离是真菌感染吗？

不，甲分离不是真菌感染。然而，真菌感染有时可能导致甲分离。

甲分离会传染吗？

根据导致甲分离的原因，它可能会传染。由受伤、指甲银屑病或对药物或化学品的反应引起的甲分离不会传染。然而，由真菌引起的甲分离可能会传染。

感染者可以通过皮肤接触将真菌传播给其他人。您也可以通过接触受感染的表面（间接接触）感染指甲真菌，例如在公共游泳池或淋浴间赤脚行走或共享毛巾、指甲剪和指甲刀等物品。

诊断和测试

如何诊断甲分离？

甲分离很容易识别，因此您不一定需要医疗专业人员来诊断它，特别是如果您知道其原因。

如果您不知道是什么导致了您的甲分离，那么去看您的医疗保健提供者是个好主意。他们会仔细观察您受影响的指甲以评估您的症状。

将进行哪些测试来诊断甲分离？

您的医疗保健提供者可能会进行多项测试来诊断甲分离。测试可能包括：

活检：您的医疗保健提供者将使用带有薄刀片（手术刀）的剃刀或手术刀从您的指甲上刮下一小部分细胞样本。细胞被送到实验室进行测试，研究人员在显微镜下检查它们。

真菌测试：您的医疗保健提供者可能会剪下您的一些指甲并订购氢氧化钾（KOH）制剂或真菌培养物，以排除真菌是导致您甲分离的原因。如果这些测试结果不清楚，一种称为过碘酸希夫（PAS）染色的真菌测试也可以确定真菌的存在。

血液测试：在血液测试中，您的医疗保健提供者将使用细针（21号，略小于标准耳环的尺寸）从您手臂的静脉中抽取少量血液。血液样本被送到实验室进行测试，研究人员检查它以检查是否存在任何可能导致甲分离的全身性疾病。

管理和治疗

甲分离可以治愈吗？

对于从甲床上分离的指甲部分，没有治愈方法——您无法将其重新连接。但是治疗可以使新的指甲生长附着在甲床上。

我可以用什么来治疗甲分离？

如果您因受伤而患有甲分离，分离的指甲部分最终会生长出来。随着指甲的生长，使用指甲剪或指甲刀去除受影响的指甲。

如果您因真菌而患有甲分离，您的选择可能包括：

口服抗真菌药物：您的医疗保健提供者可能会开液体药物或您用水吞服的药丸或片剂。这些药物可能包括特比萘芬（Lamisil®）、伊曲康唑（Sporanox®）和氟康唑（Diflucan®）。

局部抗真菌药物：局部药物有乳膏、软膏或凝胶的形式。您将它们直接擦在指甲上。

指甲真菌可能很难治疗。完成整个疗程的药物治疗很重要。如果您过早停药，导致您甲分离的真菌可能会回来并且更难治疗。

我如何照顾我的指甲？

如果您患有甲分离，以下提示可以帮助您照顾指甲：

按照您的医疗保健专业人员的指示服用药物和进行治疗。

定期修剪受影响的指甲。

保护您的指甲免受任何额外的伤害。

定期洗手以防止感染。使用干净的毛巾帮助到达指甲下方。

使用抗真菌或抗菌浸泡液来帮助预防感染。抗菌浸泡液可能包括柠檬汁、醋、过氧化氢和茶树、橙子或柠檬草精油。

虽然精油对大多数人来说是安全的，但在尝试之前与您的医疗保健提供者核实是个好主意。您可能有发生过敏反应的风险。

预防

我如何预防甲分离？

以下提示可以帮助您预防甲分离：

保持指甲短。保持指甲短可以防止它们抓住物体并进一步从甲床上拉下来。

避免咬指甲。

清洁指甲下方时要小心。一些清洁指甲下方的工具，如角质棒或指甲刷，可能会破坏指甲下方的皮肤并导致感染。

避免使用会刺激指甲或指甲周围皮肤的化学品或产品。这些可能包括指甲油、指甲亮光剂、指甲硬化剂、指甲油去除剂和假指甲。

在进行可能损坏指甲的活动时，如洗碗、运动或在户外工作时，戴上手套。

穿干净的袜子和舒适、防护性的鞋子。在脚附近放下重物时要小心。

展望/预后

如果我患有甲分离，我可以期待什么？

如果您和您的医疗保健提供者能够确定您甲分离的原因，您的指甲将缓慢但肯定地重新生长。您的手指甲生长缓慢，而您的脚趾甲生长更慢。您的手指甲可能需要长达六到九个月才能完全长出，而您的脚趾甲可能需要 12 到 18 个月才能完全长出。

最后是一篇关于《甲分离》的综述文章：

甲分离研究进展

付吉星（综述） 乔少华（审校）

泰山医学院附属聊城市第二人民医院皮肤科，山东 聊城 252601

甲分离（onycholysis）也被称为甲剥离，是指甲板从甲床自发性的分离，为最常见的甲病症状之一。

随着社会的不断发展，人民生活水平有了明显的提高，甲病越来越受到了人们的重视，因甲分离而来就诊的门诊患者有了明显的增多。甲分离发病机制目前尚不清楚，也缺少有效的治疗方法。

1 甲分离定义

甲板从甲床的自发行的分离，一般从游离缘开始逐渐向近端延伸，很少累及两侧的边缘，少数情况下，也可由近端向远端扩延或在甲板中央出现油滴状剥离。常无痛、痒等自觉症状。甲板本身没有炎症及其他明显变化，可累及一个或多个甲，好发于女性。

2 甲分离流行病学

天津长征医院曾对2007-2010三年的时间段内皮肤科2776例甲病患者进行统计分析，结果显示真菌感染为1257例，占45.28%，其次为甲沟炎及银屑病甲，分别占17.3%和4.4%。甲分离患者共有101例，占非真菌性甲病的6.6%，占总甲病患者的3.6%。

3 甲分离病因

3.1 继发于多种系统性疾病

3.1.1 普拉默指甲

有甲状腺功能亢进或减退的患者更容易出现甲分离，表现为指甲从远端自发性从甲床分离，最早常为无名指和小指的指甲，在1918年，美国内分泌学科的专家Henry Stanley Plummer首先发现并报告了这一现象，因此，甲亢患者伴随的甲分离也被称为Plummer’s nails，即普拉默指甲。

3.1.2 米瑞克指甲

由于血液中血清蛋白含量的降低而发生的甲分离也被称作米瑞克的指甲，临床上主要表现在甲板上出现与新月弧平行的横向的白色条纹。并且这些横纹常成对出现，并会延伸至整个指甲上，伴发指甲远端甲分离，当血清白蛋白的水平恢复正常时，会明显改善。

3.1.3 特里指甲

即Terry's nails，最初由Richard Terry博士发现，肝硬化患者指甲常大部分表现为白色，而且指甲远端有条状窄窄的粉红色纹理，几乎所有指甲均呈现同样的改变，看起来就像毛玻璃。通常有近80%的肝硬化的患者会出现上述的病理改变。

3.1.4 其他系统性疾病

其他会出现甲分离的全身性或系统性疾病还有：淀粉样变、多发性骨髓瘤、贫血、支气管扩张症、肺癌、卟啉病、麻风、红斑狼疮、神经炎、寻常性天疱疮、银屑病、硬皮病、梅毒等。

3.2 继发于系统性用药

3.2.1 光敏性药物

光敏性药物引起的甲分离也被称为日光性甲分离，即Photo-onycholysis，实质为一种光毒性反应。可以引起光敏性甲分离的药物有四环素、补骨脂素、氟喹诺酮类药物、氯丙嗪、氯霉素和口服避孕药等。

3.2.2 化疗药物

全身系统性应用化疗药物后经常会有甲分离的报告，国外报告的比较多的药物有紫杉醇、多西他赛（多西紫杉醇）、Mitozantrone（米托蒽醌）、氟尿嘧啶等。

3.2.3 继发于物理性损伤

因为急性或慢性物理性损伤造成的甲分离，常见于使用指甲劳动的从事农业或手工业的人员，比如剥玉米、剥棉花、剥花生等。

3.2.4 继发于化学性损伤

使用各种有机油、煤油等有机溶剂、指甲油、含有甲醛衍生物的甲硬化剂均可造成甲分离。

3.3 原发性甲分离

特指没有找到明确原因的甲分离。可能由单一的原因也可能由多种内外因素造成甲板与甲床之间的连接被破坏而出现甲板至甲床的自发性分离。

4 甲分离的治疗

侯文海应用抗组胺药物治疗甲分离120例，结果显示西替利嗪组和氯雷他定组的有效率分别为22.5%和20%，均优于对照组。

马国安曾报告一例双足趾甲肥厚的不完全甲分离，对病甲进行拔除后给予维生素E和维生素AD治疗。

当长时间的甲分离或其他原因导致甲床出现结构组织性的变化时，可能会出现甲床的萎缩或者瘢痕，甲板与甲床之间会产生空间，无法粘附，也被称为“消失的甲床”，遇到这种情况时，手术也许是一种可行的选择。

综述下载地址见附件。