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S. Hanneken, U. Wessendorf, N. J. Neumann, Photodynamic onycholysis: first report of photo‐onycholysis after photodynamic therapy, Clinical and Experimental Dermatology, Volume 33, Issue 5, 1 September 2008, Pages 659–660, https://doi.org/10.1111/j.1365-2230.2008.02941.x
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Conflict of interest: none declared.
Photo‐onycholysis is defined as a photosensitivity reaction characterized by separation of the nail plate from its nail bed. It can occur after intake of medication or spontaneously in combination with exposure of the nails to ultraviolet light. We report the first case, to our knowledge, of photo‐onycholysis appearing after photodynamic therapy (PDT).
A 53‐year‐old woman was treated with PDT for actinic keratoses (AKs) on both hands and the fingers. Aminolaevulinic acid (ALA) 20% was applied to the back of hands and fingers. Four hours after photo‐occlusion, the lesions were irradiated with 37 J/cm2 of red light (634 nm, Aktilite®; Galderma, Dusseldorf, Germany). Because the AKs were localized very close to the nails, the photo‐occlusion involved the fingernails. It was a hot summer day, and the resulting perspiration, along with hand movements, caused the protective tape to slip, allowing the ALA cream to reach under the third nail of the right hand, which was subsequently also irradiated. The PDT treatment was very painful, especially at the accidentally affected nail. The pain lasted for 1 week and was treated symptomatically with cooling; the patient abstained from taking analgesics because of intolerance. The treated areas were protected with gloves for 24 h. There was no additional sunlight exposure and no intake of photosensitizing medication. Eight days after PDT, the third nail on the right hand showed a colour change and separation of the nail plate from the nail bed (Fig. 1). After 7 weeks, there was partial remission of the photo‐onycholysis, and complete remission occurred after 3 months.
