손발톱박리증의 병인, 임상양상 및 치료적 접근

Onycholysis, defined as the separation of the nail plate from the underlying nail bed, is a condition frequently encountered in dermatological practice. Although often asymptomatic, it may be associated with functional impairment, cosmetic concerns, and secondary infections. A wide range of etiologies contribute to onycholysis, including dermatological disorders such as psoriasis, atopic dermatitis, lichen planus, and alopecia areata, as well as systemic diseases such as thyroid dysfunction, diabetes mellitus, and autoimmune connective tissue diseases. Exogenous factors such as medications (e.g., chemotherapeutic agents, tetracyclines, and psoralens), chemical irritants, occupational exposure, and trauma also play significant roles. Nail cosmetic procedures have emerged as a common cause of chemically induced onycholysis. Clinical evaluation should include a thorough patient history, physical examination, dermoscopy, and laboratory or mycological tests when indicated. Treatment strategies should be tailored to the underlying etiology and may involve the cessation of causative agents, management of systemic diseases, the use of antifungal or anti-inflammatory agents, and behavioral modifications. This review provides a comprehensive overview of the multifactorial causes of onycholysis and presents practical diagnostic and therapeutic approaches to help dermatologists effectively manage this condition in clinical practice.