Summary
With the exception of acropustulosis, nail disease responds poorly to etretinate.
When used to treat other dermatological conditions etretinate is frequently toxic to the normal nail and may affect any or all of its epidermal components.
The desquamative dermatitis, induced by etretinate, may account for many of the drug's side‐effects on the nail. These include chronic paronychia, onycholysis, onychomadesis, nail shedding, onychoschizia, fragility and the formation of excess granulation tissue. Some of these changes resemble those found in psoriatic paronychia and similarities are drawn between psoriasis and the retinoid dermatitis which presents with identical features in the discharge from beneath the proximal nail‐fold.
The desquamative reaction in patients taking etretinate always affects the lips and, in addition, may be widespread or mainly localized to the nail apparatus.