Vitamin A-associated onycholysis

Onycholysis is a disorder of the nails, described as the separation of the nail bed from the nail plate. While onycholysis most commonly occurs due to trauma to the nail, such as after manicures or chemical exposure, it can also result from drug-induced photosensitivity. Many medications have been linked to onycholysis, including tetracyclines, psoralens, and retinoids, which are synthetic derivatives of vitamin A. Oral retinoid use has been associated with various nail changes, but there are no reports of onycholysis resulting from oral vitamin A intake. Thus, we present the case of an 85-year-old woman who presented with distal onycholysis to the fingernails, described as lifting of ends. She was prescribed a 5-day course of 10,000 units of vitamin A twice daily after a lumbar laminectomy; however, she continued over-the-counter vitamin A supplementation for 2 months after prescription completion. Given this patient's history of prolonged vitamin A intake, her symptom improvement upon supplement cessation, and the documented reports of other nail changes caused by vitamin A derivatives and isotretinoin, we believe that onycholysis is an unreported adverse effect of vitamin A therapy.