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| CASE REPORT |
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| Year : 2022 | Volume
: 24
| Issue : 3 | Page : 148-149 |
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Onychomadesis following frostbite: Hitherto unknown
Pankaj Das1, Ajay Chopra2, Yogesh Kukreja3, Zenith Mohanty3, Arun Kumar Sharma4
1 Department of Dermatology, 153 General Hospital, Leh, Ladakh, Jammu and Kashmir, India
2 Department of Dermatology, Command Hospital, Chandimandir, Panchkula, Haryana, India
3 Department of Surgery, 153 General Hospital, Leh, Ladakh, Jammu and Kashmir, India
4 Department of Pathology, 153 General Hospital, Leh, Ladakh, Jammu and Kashmir, India
| Date of Submission | 23-Oct-2020 |
| Date of Acceptance | 02-Dec-2020 |
| Date of Web Publication | 21-Jan-2022 |
Correspondence Address:
Major (Dr) Pankaj Das
Department of Dermatology, 153 General Hospital, Leh, Ladakh, Jammu and Kashmir
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmms.jmms_155_20
Onychomadesis is an anomaly of nails characterized by shedding of nail plates due to temporary arrest in the activity of the nail matrix. Systemic or local factors ranging from acute febrile illnesses, auto-immune diseases, drugs, chemotherapy, trauma, etc., have been known to cause onychomadesis. We report a unique case of onychomadesis following frostbite in a serving soldier posted at high altitude and extreme cold climate area.
Keywords: Case report, frostbite, onychomadesis
How to cite this article:
Das P, Chopra A, Kukreja Y, Mohanty Z, Sharma AK. Onychomadesis following frostbite: Hitherto unknown. J Mar Med Soc 2022;24, Suppl S1:148-9 |
| Introduction | |  |
Frostbite is a severe form of cold injury which occurs when the extremities are exposed to temperatures below 0°C for durations long enough to form ice crystals in the affected tissues.[1] Other than cold temperature, the risk factors include immersion of the affected part in cold water, wind-chill factor, smoking, alcohol intake, substance abuse, and medical comorbidities such as peripheral vascular disease, diabetes, dementia, peripheral neuropathies, malnutrition, and fatigue.[2] Military personnel, skiers, hikers, and mountaineers particularly are at high risk for developing frostbite.[3] The most common complication of frostbite is surgical or auto-amputation of the affected part.[4] We report a case of onychomadesis following frostbite injury which has not been reported previously in the literature.
| Case Report | | |
A 28-year-old serving soldier of Indian Army who was posted in high altitude and extreme cold climate area at a forward post at a height of 19,500 feet for 2 months, presented with pain, numbness, and blistering of the ring, middle, and index fingers of the right hand of 2 days duration following prolonged patrolling in a snow-bound area. His systemic and general examination were within normal limits. There were no features suggestive of hypothermia. There was diffuse inflammation of the right hand with bullae seen over the dorsal aspect of the distal phalanx, abutting the nails of the index, middle, and ring fingers [Figure 1]. There was no bluish discoloration of the fingers, nor there was any motor deficit. Examination of the right hand, feet, nose, ears, and lips was within normal limits. A diagnosis of Grade-II frostbite of the index, middle, and ring fingers of the right hand was made and he was nursed in a warm environment from there on. Gradual rewarming of hands was attempted in a water bath with temperature of 37°C–39°C along with oral nonsteroidal anti-inflammatory drugs. The symptoms of pain, numbness, and signs of inflammation subsided over the next 1 week, after which the patient was sent on leave for 6 weeks. On re-evaluation after leave, painless shedding of the nails of the index, middle, and little fingers and black discoloration and loosening of the nail of the ring finger of the right hand which were affected earlier by frostbite [Figure 2]. A diagnosis of onychomadesis following frostbite was arrived at and the patient was counseled regarding the reason, course, and outcome of it. | Figure 1: Dorsal aspect of the right hand: bullae on distal parts of the index, middle, and ring fingers on the background of diffuse erythema and mild swelling of fingers
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 | Figure 2: Dorsal aspect of the right hand: Shedding of the nails of the index, middle, and little fingers and black discoloration and loosening of the nail of the ring finger. The bullae have healed with postinflammatory hyperpigmentation
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| Discussion | | |
Joseph Honore Simone Beau in 1846 described transverse grooves on the nails in typhoid fever.[5] These grooves were later termed as Beau's lines and signified temporary arrest in the activity of the nail matrix. While the width of the Beau's line denotes the duration of illness, the time of illness can be retrospectively estimated by measuring the distance of the grooves from the proximal nail fold.[6] Onychomadesis is the separation of nail plate from the nail matrix with persistent attachment to nail bed and often but not always, eventual shedding. If the illness is severe, then the groove becomes deep enough to cause the nail plate's separation from the nail matrix causing shedding of the nails. The most commonly reported cause of onychomadesis is Hand-Foot-Mouth disease.[7] Other causes are severe systemic infective illnesses, auto-immune diseases, drug and chemotherapy-induced onychomadesis, and idiopathic.[5] Trauma has been postulated to cause shedding of nails in sportsmen but is seen rarely.[8] Asymmetrical onychomadesis is rare as etiology is systemic in most cases. Our case was unique as he had selective shedding of nail plates of the affected fingers. Our literature search could not yield any other case of onychomadesis following frostbite. To the best of our knowledge, this is the first case of onychomadesis reported to be associated with frostbite.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his names and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.
Acknowledgment
The authors would like to thank Brig J B Singh, Commandant 153 General Hospital, Leh, Ladakh.
Col Animesh Vats, Prosthetic Surgeon, 153 General Hospital, Leh, Ladakh.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Handford C, Thomas O, Imray CH. Frostbite. Emerg Med Clin North Am 2017;35:281-99.  |
| 2. | Laskowski-Jones L, Jones LJ. Frostbite: Don't be right out in the cold. Nursing (Lond) 2018;48:26-33. |
| 3. | DeGroot DW, Castellani JW, Williams JO, Amoroso PJ. Epidemiology of US Army cold weather injuries, 1980–1999. Aviation, space, and environmental medicine. 2003;74:564-70. |
| 4. | Fudge J. Preventing and managing hypothermia and frostbite injury. Sports Health 2016;8:133-9. |
| 5. | Hardin J, Haber RM. Onychomadesis: Literature review. Br J Dermatol 2015;172:592-6. |
| 6. | Salgado F, Handler MZ, Schwartz RA. Shedding light on onychomadesis. Cutis 2017;99:33-6. |
| 7. | Chiu HH, Liu MT, Chung WH, Ko YS, Lu CF, Lan CE, et al. The mechanism of onychomadesis (Nail shedding) and beau's lines following hand-foot-mouth disease. Viruses 2019;11:522. |
| 8. | Hardin J, Haber RM. Idiopathic sporadic onychomadesis: Case report and literature review. Arch Dermatol 2012;148:769-70. |
[Figure 1], [Figure 2]
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