Ischemic Onycholysis of the Hands

The document presents a case report of a 70-year-old woman with a history of ischemic cardiomyopathy and carpal tunnel syndrome who experienced onycholysis, which is the separation of the nail from the nail bed, in the third, fourth, and fifth fingers of both hands for 6 years. Despite attempts at treatment with nail hardening polish and protective measures, there was no improvement. An angio-MRI revealed severe and diffuse vascular impairment, suggesting an ischemic origin for the onycholysis. The patient was offered a daily injection of iloprost, a treatment effective for Raynaud phenomenon and digital ulcers, but she declined. The case highlights the potential role of chronic ischemia in abnormal nail growth and onycholysis, and suggests that intravenous iloprost could be a useful treatment for vascular onycholysis, especially when associated with other ischemic manifestations. No commercial support was identified for this study.