Issue: 2016 > July > photo quiz

Answer to Photo Quiz: Spontaneous, painful nail haemorrhages and onycholysis in a patient at high altitude

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This patient developed spontaneous nail changes due to doxycycline-induced photo-onycholysis. Doxycycline in combination with prolonged and intense exposure to the sun (UVA/UVB) causes a phototoxic reaction in which the nail plate detaches from the nail bed with superimposed nail haemorrhaging.1-3 Her toenails were spared, because she wore hiking boots with subsequently no exposure to sunlight. Doxycycline-induced photo-onycholysis without other skin photosensitivity is a rare phenomenon, medical practitioners should be aware of. The nail abnormalities disappeared spontaneously after she stopped taking doxycycline. The prognosis is good with usually complete nail recovery in three to six months.


The authors report no conflicts of interest. No funding or financial support was received.


  1. Rabar D, Combemale P, Peyron F. Doxycycline-induced photo-onycholysis. J Travel Med. 2004;11:386-7. 
  2. Badri T, Ben Tekaya N, Cherif F, Ben Osman Dhahri A. Photo-onycholysis: two cases induced by doxycycline. Acta Dermatovenerol Alp Pannonica Adriat. 2004;13:135-6. 
  3. Chandran NS, Aw DC. Drug-induced photo-onycholysis: an often-neglected phenomenon. Intern Med J. 2013;43:1349-50.