Differential diagnosis of retronychia, onychomycosis and onychomadesis
  • Bianca Maria Wahlen
    Department of Anesthesia, Hamad Medical Corporation, Doha, Qatar
  • Ayman El-Menyar
    Department of Surgery, Clinical Research of Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar
  • Ayman Elkholy
    Department of Dermatology, Andrology & STDs, Mansoura University, Egypt & Al Malakiya Clinics, Doha, Qatar


Retronychia, onychomycosis, onychomadesis, big toe, kinesio tape


Background: In rare dermatology cases the differential diagnosis is challenging, e.g. when one nail is growing below another, the provisional diagnosis could be confusing. It may present as chronic paronychia, candidiasis, bacterial infections, rheumatoid arthritis, psoriasis, subungual tumours, or cysts.
Case description: We present a case of iatrogenic rupture of the nails of both big toes following a commonly known recommendation from physiotherapists in the initial stages of hallux valgus or chronic arthritis by using kinesio tape to prevent the big toe from fixation in the valgus position. The initial provisional diagnosis of retronychia was revised, and a final diagnosis of onychomadesis was made. The patient’s complaint was solved after around one year without any specific therapy.
Conclusion: The differential diagnosis for onychomadesis needs a careful and detailed history that may prevent a patient from a frightening diagnosis and painful, long-lasting treatments.



  • Cathcart C, Walker-Date S, Belgi A, Jeyakanth P. BH08 A clinical case of retronychia, a rarely described post-traumatic proximal ingrown nailplate: a condition of the ‘nail’, Br J Dermatol 2023;188: ljad113.161.
  • Grover C, Gaurav V. Surgical management of retronychia. J Cutan Aesthet Surg 2022;15:332–334.
  • Lee S-M, Lee J-H. Effects of balance taping using kinesiology tape in a patient with moderate hallux valgus: a case report. Medicine (Baltimore) 2016;95:e5357.
  • Braswell MA, Daniel CR, Brodell RT. Beau lines, onychomadesis, and retronychia: a unifying hypothesis. J Am Acad Dermatol 2015;73:849–855.
  • Sous D, Starace MVR, Chen L, Nieman EL, Anadkat MJ, Piraccini BM, et al. Recurrent onychomadesis of the toenails in children and adults: a case series. Skin Appendage Disord 2022;831–33.
  • Baumgartner M, Haneke E. Retronychia: diagnosis and treatment. Dermatol Surg 2010;36:1610–1614.
  • Litaiem N, Drissi H, Zeglaoui F, Khachemoune A. Retronychia of the toenails: a review with emphasis on pathogenesis, new diagnostic and management trends. Arch Dermatol Res 2019;311:505–512.
  • de Berker DA, Richert B, Duhard E, Piraccini BM, André J, Baran R. Retronychia: proximal ingrowing of the nail plate. J Am Acad Dermatol 2008;58:978–983.
  • Dahdah MJ, Kibbi AG, Ghosn S. Retronychia: report of two cases. J Am Acad Dermatol 2008;58:1051–1053.
  • Haneke E. Commentary on ‘nail unit reconstruction after surgery for refractory retronychia’. Dermatol Surg 2023;49:1035–1036.
  • Hardin J, Haber RM. Onychomadesis: literature review. Br J Dermatol 2015;172:592–596.
  • Mello CDBF, Souza MDRE, Noriega LF, Chiacchio ND. Retronychia. An Bras Dermatol 2018;93:707–711.
  • Sechi A, Iorizzo M, Piraccini BM, Cannata G. CO2 laser-assisted avulsion of the proximal nail plate as a new treatment strategy in patients affected by retronychia. Dermatol Surg 2023;49:976–977.
  • Cabete J, Lencastre A. Recognizing and treating retronychia. Int J Dermatol 2015;54:e51–e52.
  • Leung AKC, Lam JM, Leong KF, Hon KL, Barankin B, Leung AAM, et al. Onychomycosis: an updated review. Recent Pat Inflamm Allergy Drug Discov 2020;14:32–45.
  • Wortsman X, Calderon P, Baran R. Finger retronychias detected early by 3D ultrasound examination. J Eur Acad Dermatol Venereol 2012;26:254–256.
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    Published: 2024-02-12
    Issue: 2024: Vol 11 No 3 (view)

    How to cite:
    Wahlen BM, El-Menyar A, Elkholy A. Differential diagnosis of retronychia, onychomycosis and onychomadesis. EJCRIM 2024;11 doi:10.12890/2024_004326.