Recurrent Toenail Loss in Young Adult Male
Case at a Glance
A 25-year-old healthy male presents with annual complete loss of a toenail that falls off spontaneously or can be easily removed without pain. The condition has been recurring for multiple years despite normal appearance of surrounding tissue.
Patient's Story
The patient reports that for several consecutive years, one of his toenails completely detaches and falls off at least once annually. He describes the nail as becoming loose prior to detachment, appearing aesthetically unpleasing, but causing no pain or discomfort. The patient can sometimes remove the loose nail manually due to its poor adherence. He denies any trauma, injury, or associated symptoms. The patient has no significant medical history except for seasonal allergic rhinitis and maintains good general health with no tobacco, alcohol, or recreational drug use.
Initial Assessment
Physical examination revealed a nail that appeared structurally compromised with poor adherence to the nail bed. The patient's vital signs were normal, and he appeared in good general health. Height: 177cm, Weight: 86kg, BMI within normal range. No signs of acute infection or inflammation were present around the affected digit.
The Diagnostic Journey
The patient initially consulted his primary care physician, who performed a basic examination and reportedly ruled out fungal infection through visual assessment. However, the physician acknowledged limitations in dermatological expertise and suggested specialist consultation. Due to financial constraints, the patient sought alternative medical opinions. A subsequent medical professional raised suspicion for onychomycosis (fungal nail infection) based on the clinical presentation, contradicting the initial assessment.
Final Diagnosis
Suspected onychomycosis (fungal nail infection) requiring confirmatory testing. The recurrent pattern of nail loss and clinical presentation are consistent with chronic fungal infection of the nail unit.
Treatment Plan
Recommend mycological examination including KOH preparation and fungal culture to confirm diagnosis. If positive, initiate appropriate antifungal therapy which may include topical antifungal agents for mild cases or systemic antifungal medication for severe/recurrent cases. Patient education regarding nail hygiene and prevention of reinfection.
Outcome and Follow-up
Patient was reassured that the condition, while aesthetically concerning, is not medically dangerous or urgent. However, proper diagnosis and treatment are recommended to prevent continued recurrence and potential secondary complications. Follow-up scheduled pending diagnostic confirmation and treatment initiation.