<b><i>Introduction:</i></b> Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. <b><i>Case Presentation:</i></b> We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. <b><i>Discussion/Conclusion:</i></b> For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.

Cutaneous side effects of childhood cancer therapies contribute to patient morbidity and can negatively affect quality of life. Traditional cancer therapies target rapidly dividing tissues; thus, many of their side effects inevitably involve the skin, nails, and mucosal surfaces. It is important for clinicians to recognize cutaneous reaction patterns and understand the underlying mechanisms of chemotherapeutic agents to detect and manage symptoms early and allow for continuation of therapy. In this scoping review, we discuss common cutaneous reactions to traditional classes of chemotherapeutic agents and antineoplastic antibodies in children, with specific examples from each drug class.

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