Onychomadesis: when nails detach

Onychomadesis is an uncommon condition in childhood, and its prevalence remains unclear. Its appearance often causes significant anxiety among caregivers, although it is usually a benign and self-limiting condition. Isolated cases of onychomadesis have been reported following viral infections, but it has also been described as a complication of autoimmune diseases (such as pemphigus vulgaris or alopecia areata), severe systemic disorders (including Guillain-Barré syndrome and Kawasaki disease), use of drugs (such as chemotherapy, antiepileptics, antibiotics, or retinoids), and in newborn infants following obstetric trauma or local fungal infections. In this report, we present two clinical cases illustrating different etiologies of onychomadesis (idiopathic and viral), highlighting the importance of a thorough history-taking to enable diagnosis through clinical assessment, thus avoiding unnecessary laboratory tests or diagnostic procedures. We also summarize the possible etiological mechanisms described in the literature, aiming to provide clinicians with a better foundation to guide future diagnosis. In both cases, we emphasize the value of communicating clearly with parents, as appropriate explanation helps to reassure caregivers and convey the benign, self-limiting nature of this condition.