Nail Plate Separation -- Nailsplash.Com Education For Professional Nail Techs

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Date Posted: 16:04:08 01/03/00 Mon
Author: nailsplash
Author Host/IP: ip-91-165.ord.primenet.com / 206.165.91.165
Subject: Nail Plate Separation

Following is a series of conversations I've recently had by email with a reader of my website who was doing some research to solve a nail related problem. I've copied and pasted the whole series below, rather than try and re-tell the whole story. So please read on and then send me your comments!
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Hello Barb,

First let me say that I am in awe of the amount of knowledge you possess
as indicated by your responses on your FAQ page. I am an orthopedic surgeon
and am writing on behalf of my wife who suffers a similar problem as some of
the clients of your readers. After using a Nailtique nail hardener product,
she experienced a distal onycholysis (splitting away of the far nail from the
underlying nail bed) for approximately 1/3 the of the way. This was 5 years
ago and after numerous dermatologists, allergists, patch testing, blood
testing and alleged nail experts who won't accept insurance, we are still
without an answer. I know you have recommended that anyone with the problem
see a MD. I have seen more MDs in the past few years to last a lifetime. She
has had her thyroid and blood counts checked (for anemia).

Can you possibly shed some light on this problem? Again, you have a
wonderful web site and it seems you have more knowledge in this area than
most anyone I've met thus far.

Thank you so much.

Gary Gugliada, M.D.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Hi Gary,

Since I'm not a Dr., I am of course NOT licensed to diagnose. So even if I could SEE the problem firsthand, it's unlikely I could actually "diagnose" it. I'm flattered that you would ask my opinion on the subject, but honestly, if that many medical minds (yours included) can't come to a solution...... That said, now I'll attempt to help and guide as best I can. Please answer the following questions to help me understand the problem better.

1) Does she still, to this day have the nail separation?

2) Has it ever get any better or worse?

3) What remedies has she tried and/or been prescribed?

4) Is there any discoloration associated with the separation? If so, where; under the nail plate (on the bed), "in" the nail plate (as a stain of the nail), or on top of the nail plate (superficial, can be buffed or bleached away)?

5) What does the nail bed under the nail look like? Is there scar tissue now present?

6) Has she been cultured for fungal infections (specifically dermatophytes)?

7) Has she been tested for specific allergies (dermatological, such as to formaldehyde)?

8) Was there ever any sign of allergic reaction (i.e. itching, redness, blistering, etc) around the nail shortly before the detachment began?

9) What other nail products was she using at the time this problem originated? What nail products has she been using since (i.e. nail polish, etc)?

10) Digital or scanned photos would also be helpful. What is your wife's name? Where do you live? (Climate can be a consideration.)

I'll do my best to help, and would like to share your story with my newsletter readers; perhaps one of them might be able to provide some anecdotal relief!

Take Care,

----Barb!
www.nailsplash.com
barb@nailsplash.com
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Barb,

Thank you for such a quick and extensive reply. I don't think all the
"specialists" combined asked all the questions you asked. I'll have my wife
answer everything as best as possible and get the results back to you.
I wish you all the best for the next 1000 years and thank you again for
your time and consideration.

---Gary
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary's wife answers the questions posed above:

QUESTION 1) Does she still, to this day have the nail separation?

ANSWER Yes, the last 1/3 of the nail appears "white" below. This began almost immediately after using the Nailtique nail hardener 5 years ago.

QUESTION 2) Has it ever get any better or worse?

ANSWER There are times when it seems to improve, usually when the nails are short
But other tomes it seems to extend half way down from the far end.

QUESTION 3) What remedies has she tried and/or been prescribed?

ANSWER She has been to 3 dermatologists and three allergists. Initially they thought it was a Candida Albicans infection based on a DTM plate (Dermatophyte test medium) and began topical therapy with Loprox. I'll give you a run down of what was tried. Topical Lopox, then a course of Diflucan (thinking it was still a yeast) then a 6 month course of Sporonox, Daily soaks in white vinegar and water, topical steroids (thinking it was psoriasis) even though no pitting was present. Moisturizers such as Lac Hydrin were also recommended. Nothing helped.

QUESTION 4) Is there any discoloration associated with the separation? If so, where;
under the nail plate (on the bed), "in" the nail plate (as a stain of the
nail), or on top of the nail plate (superficial, can be buffed or bleached
away).

ANSWER No staining or "oil spot" sign associated with psoriasis. If you look at the white color, there appears to be a reddish hue. However, it is not similar to a "Half and half" nail or Terry's nail.

QUESTION 5) What does the nail bed under the nail look like? Is there scar tissue
now present?

ANSWER It is difficult to see under the nail and without avulsing it, I really can not say.

QUESTION 6) Has she been cultured for fungal infections (specifically dermatophytes)?

ANSWER 2 cultures, one + for C.albicans and a 2nd was negative.

QUESTION 7) Has she been tested for specific allergies (dermatological, such as to
formaldehyde)?

ANSWER She has had extensive testing and has tested positive for Formaldehyde, Quaternium 15, Cobalt, Ragweed, Dust. They further broke down the formaldehyde testing into various sub groups. She has, however, avoided all of these products for a very long time.

QUESTION 8) Was there ever any sign of allergic reaction (i.e. itching, redness,
blistering, etc) around the nail shortly before the detachment began?

ANSWER Yes, when the Nailtique was applied she experienced a painful periungual burning.

QUESTION 9) What other nail products was she using at the time this problem
originated? What nail products has she been using since (i.e. nail polish,
etc)?

ANSWER The only instigating factor seems to be the Nailtique. Lately she hardly uses anything except Almay on occasion.

QUESTION 10) Digital or scanned photos would also be helpful. What is your wife's
name? Where do you live? (Climate can be a consideration.)

ANSWER We live in New York City-I will try to photograph her nails and send them.

Thank you so much for all the time and thought you have put in. Please use our story however you'd like. Sometimes I fear she has a permanent scarring of the nail bed that will not allow the underside of the nail to adhere anymore.

Thank you again,

Gary
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Hi Gary,

I too am fearful that you may be right in that permanent scarring has occurred, which may prevent reattachment. It seems as if every remedy has already been tried; I'm not sure if there is anything else to hope for! Of course keep the nails as short as possible to prevent any further detachment and avoid all nail products (polish, removers, etc) and harsh chemicals (household cleaning supplies, etc). I will forward your question to my mailing list of professional techs to get their opinions on the situation and will also forward it to other respected authorities in the field to see what insight or hope they may have to offer. I look forward to receiving the photos and will also forward those ASAP.

----Barb
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Well, I'm stumped!

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Replies:

Re: Nail Plate Separation -- Maria, 16:01:22 01/04/00 Tue
- Re: Nail Plate Separation -- nailsplash, 12:18:27 01/09/00 Sun
Re: Nail Plate Separation -- bitch tits, 08:55:53 04/24/01 Tue