Onychomadesis is characterized by proximal separation and eventual shedding of the nail plate following temporary arrest of nail matrix activity. It is commonly associated with systemic illnesses, viral infections such as hand–foot–mouth disease, autoimmune disorders, or drug-induced toxicity. While typically involving multiple nails and occurring bilaterally, onychomadesis may also arise from localized trauma or ischemia affecting the nail matrix. Emerging literature suggests that neural and vascular inputs play a critical role in regulating nail matrix keratinocyte proliferation, hydration, and structural integrity. Therefore, conditions associated with autonomic dysfunction, including denervation dermatitis, may theoretically impair nail growth through disruption of neurovascular support.

We report the case of a 7-year-old boy who developed unilateral onychomadesis following excision of a congenital lymphangioma over the right elbow. The surgery was uncomplicated, and the postoperative period was uneventful. Approximately six weeks after the procedure, his caregivers observed progressive nail plate separation involving the thumb and index finger of the ipsilateral hand. Clinical evaluation confirmed transverse grooves evolving into complete nail shedding, while no other nails were affected. There was no preceding history of systemic infection, medication exposure, or systemic inflammatory illness. The strictly unilateral distribution confined to the limb that underwent surgery suggests a localized mechanism. We hypothesize that transient postoperative ischemia, temporary nerve injury, or immobilization-related alteration in autonomic supply to the distal digits may have disrupted nail matrix homeostasis, leading to temporary growth arrest. This proposed link between disrupted neural input and onychomadesis aligns with the broader concept of denervation-associated cutaneous changes, where impaired neurovascular signaling compromises tissue turnover and repair. This case highlights the importance of recognizing post-surgical onychomadesis as a potential, self-limiting complication in pediatric upper limb procedures. Awareness of this phenomenon can help clinicians provide timely reassurance to caregivers and avoid unnecessary diagnostic investigations. Further research is needed to clarify the neurovascular mechanisms underlying localized nail matrix dysfunction.

Archita Bhattacharya is a postgraduate resident in Dermatology at IMS & SUM Hospital, Bhubaneswar, India, with a growing academic interest in pediatric dermatoses, nail disorders, and inflammatory skin diseases. She has actively contributed to clinical documentation and case-based research, including her recent work on post-surgical onychomadesis completed under the guidance of Dr. Liza Mohapatra.