Onychomadesis

What is Onychomadesis or Nail Shredding?

Onychomadesis or nail shredding can happen on any or all of you 20 nail units. With onychomadesis there is ‘abrasion’ (splitting or separation) of the nail plate at the proximal nail fold.

It may cause symptoms like fever, mouth sores and skin rash that is mostly seen on the hands and feet, but it’s also possible that there are no symptoms at all but suddenly you notice the nail plate separation at the proximal nail fold its usually visible in adults about 6 weeks after the infection and in children about 3-4 weeks after the infection, this nail plate deformity is called onychomadesis.

As a nail technician, understanding onychomadesis, its causes, effects, and offering support to clients is essential in helping them manage the condition as it will take time for the nail plate to recover.

What Causes Onychomadesis?

In children it is (usually) caused by a virus from the coxsackie virus family (usually the A16 variant, but it can also be caused by others) that causes Hand, foot & Mouth disease – this we see most.

It may cause symptoms like fever, mouth sores and skin rash that is mostly seen on the hands and feet, but it’s also possible that there are no symptoms at all but suddenly you notice the nail plate separation at the proximal nail fold its usually visible in adults about 6 weeks after the infection and in children about 3-4 weeks after the infection, this nail plate deformity is called onychomadesis. A doctor can confirm the virus is present by taking a sample from either the throat or feces if there are no other visible symptoms.

In adults this nail condition can be caused by a high fever, hand foot & mouth disease, body trauma or shock which causes the nail matrix to temporarily stop producing nail plate cells. It can affect any or all of the nails – in severe cases it can affect the toe nail plates and recovery takes longer, anything up to 12 weeks.

Onychomadesis Is Temporary

As soon as the fever, trauma or shock is over the nail matrix gets on with producing nail plate cells. Adults may benefit from a silk bride to stabilize the nail plate to prevent more damage while washing hair, children’s nail plates are much softer and grow faster, the excess nail plate can be gently removed with scissors after a week or 2. Recovery is faster in children than in adults.

How Can Nail Technicians Help?

As a nail technician, you can offer guidance and support to clients that suddenly see a problem at their PNF – Remember the problem was caused by something that happened 4-6 weeks ago depending on if it was a baby, child or adult.

It is very important to keep the nails clean with soap and water, making sure it’s dried well and use a nail wrap (self-adhesive bandage) to hold the nail plate together and to stop the sharp edges of the nail plate fracture from getting caught on clothes or in hair. It offers great protection and can easily be cut to size and adheres only to itself so it doesn’t pull away the nail plate or tear it when you remove it like a normal plaster may do. It’s also nice and airy – so it will not encourage other pathogens to join the party.

If annoying splinters or sharp edges occur on the nail, you can carefully remove them with a clean sponge file, take great care to not file away the rest of the healthy nail plate.

If the nail plate comes off by itself and starts to hang, you can cut it away, because by now the new nail will already be covering the nail bed.

Make sure that you do not remove it too quickly and refrain from using an E file, because the young nail plates are really delicate, and you can (accidentally) cause a lot of damage.

How to Recover the Nail Plate

Do not apply artificial nail products in the first couple of weeks, keep the nail clean and use a good quality oil to keep the nail plate flexible.

Nail Enhancements:

Avoid using any nail enhancements until the onychomadesis is about 3mm away from the proximal nail fold, this will minimize the chance of another infection disturbing the nail matrix.

Encouragement and Support:

Show empathy and understanding towards clients experiencing onychomadesis, it looks ‘weird’ in the first instance when the nail plate separation shows under the proximal nail fold and can be mistaken for a fungal infection.

Remember: Fungal infections in finger nails are rare and need to be properly diagnosed by an MD or tested for by a Medical Hand Specialist.

Do	Don’t	Nail Product	Refer to MD
Keep clean and be aware of your actions	Disguise with artificial nail products in the first weeks	Oil & Lotion	If the nail becomes infected or changes colour
For Adults: A silk bridge may make life easier		Clear (soak off) base coat, Silk Clear (soak off) top coat
For Children Keep clean and be aware of any sudden changes	Don’t use artificial nail products on babies or young children’s nails	Keep clean if needed a nail & skin oil is ok	If the nail becomes infected or changes colour

Contra indication:

If your client is going through chemotherapy or immunotherapy, inform the oncology team and get permission before applying any artificial nail products. If permission is given, your only use clear products, secondary infections can be a serious (life-threatening) problem & will not be visible under a cover color.

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