What is Onychopapilloma? - Symptoms, Causes, Treatment | Onychopapilloma vs Onychomatricoma

What is Onychopapilloma?

Onychopapilloma is an uncommon benign tumor that develops in the nail bed and distal matrix and is most common in middle-aged women. It usually only affects one nail, the thumb, and its defining characteristic is a longitudinal erythronychia that starts at the nail matrix and extends to the onychocorneal band. The condition was first called "localized multinucleate distal keratosis" in 1995. In 2000, the same authors came up with the name "Onychopapilloma" to describe it.

Clinical misdiagnosis of tumors of the nail unit is more common than that of tumors of the skin. This is because many nail tumors seem like inflammatory dermatoses of the nail unit, or because the nail itself can hide the lesion. It is challenging to determine if a nail tumor is benign or malignant based on its appearance in a clinical setting. Dermoscopy can offer some insight into the diagnosis, but a nail biopsy is a gold standard for conclusively determining this condition. 


    Onychopapilloma is an uncommon benign tumor that typically affects a single nail and is distinguished by localized distal subungual keratosis. Onychopapilloma typically manifests as localized longitudinal erythronychia but can also appear as chromonychia or melanonychia. Additional signs include a distal V-shaped onycholysis, intermittent pain in the lesion when pressure is applied, dark nail discoloration, and thickening of the nail. A splinter hemorrhage is another common symptom.

    What is Onychopapilloma - Symptoms, Causes, Treatment   Onychopapilloma vs Onychomatricoma


    Onychopapilloma is a benign tumor of the nail apparatus that mostly affects the matrix, which is essential for nail growth. It is an extremely uncommon disorder that is characterized by the formation of papillary projections inside the nail matrix or the nail bed. Onychopapilloma's exact cause is not fully known, but nail injuries and viral illnesses are suggested as possible causes.


    Depending on the extent of the tumor, partial or complete nail avulsion may be necessary to expose it. The nail bed surrounding the lesion is removed in a longitudinal ellipse without a margin of safety. To prevent the lesion from returning, the closest point of the ellipse must have a distal matrix. From the hyponychium to the proximal end, the tumor is gently removed from the bone. 

    Onycholysis can develop if a nail defect is smaller than 4 millimeters and is allowed to heal on its own without treatment. Therefore, the use of absorbable sutures to seal the defect is indicated as the best course of action. 

    A defect bigger than 4mm in size needs to be closed with two lateral flaps. Onycholysis, in which the nail plate becomes thinner and more fragile, can be brought on by poor technique.  If the matrix suturing is not done properly, the nail matrix can split.

    Onychopapilloma vs Onychomatricoma

    Onychomatricoma and Onychopapilloma are two benign tumors that can impact the nail unit. Onychopapilloma can originate in either the proximal nail fold or the nail matrix, it mainly manifests in the part of the nail that is responsible for growth. It presents as a raised, wart-like lesion with an uneven or rough surface. In addition to nail plate deformities or irregularities, symptoms often include pain, soreness, or discomfort in the nail that is impacted by the condition.

    On the other hand, onychomatricoma develops from the nail matrix and is often found in the proximal nail matrix or the nail bed, which is closer to the lunula. It looks like a well-defined, hard, dome-shaped tumor with a smooth surface that is usually yellow. Even though onychomatricoma rarely causes any noticeable symptoms, it can cause the nail plate to become thickened or even deformed in rare instances.

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