An Update on the Disappearing Nail Bed

Abstract

Background: The nail bed may epithelialize and develop dermatoglyphics after long-standing onycholysis. We have called this phenomenon the disappearing nail bed (DNB). DNB may present as a shortened or narrow nail bed. Methods: Examination of all 20 nails was performed in each patient enrolled to the study. DNB was defined as the presence of a nail which is at least 20% shorter and/or narrower than the identical nail on the opposite hand or foot. Age, sex, and nail history were recorded. Fungal studies were done on all patients with DNB if that nail exhibited clinical signs of onychomycosis. Results: Of 540 patients, 71 (13.15%) showed DNB. Sixty patients had only the toenails involved, and 10 patients had only the fingernails involved. One patient had both toenails and fingernails involved. The average age for fingernail DNB was 67.2 years and 69.6 years for toenails DNB. Nail history was remarkable for biting in 8 patients, nail trauma in 11 patients, and surgery in 12 patients. With respect to the toenails, onychomycosis was found in 22 patients of the DNB group. Conclusions: Our study suggests that DNB is a common phenomenon, which is more likely to appear in advancing age and is associated with onychomycosis.