What is onychauxis. How does it affect nail appearance and health. What are the main causes of this nail disorder. How can onychauxis be treated effectively. What home remedies can help manage thickened nails.

Understanding Onychauxis: A Common Nail Disorder

Onychauxis is a nail condition characterized by abnormal thickening of the fingernails or toenails. This disorder, also known as nail hypertrophy, can significantly alter the appearance and health of affected nails over time. As the condition progresses, nails may become curled, discolored, and separated from the nail bed.

While onychauxis shares some similarities with fungal nail infections, it’s important to note that this condition is not caused by fungi. However, individuals with onychauxis may be at an increased risk of developing fungal infections due to changes in nail structure and health.

Who is at risk for onychauxis?

Onychauxis tends to be more prevalent among older adults, with the likelihood of developing this condition increasing with age. This age-related trend suggests that natural changes in nail growth and structure over time may contribute to the development of onychauxis.

Recognizing the Symptoms of Onychauxis

Identifying onychauxis early can help manage the condition more effectively. Common symptoms include:

• Abnormal thickening of the nails
• Separation of the nail plate from the nail bed
• Yellow or white discoloration of the nails
• Red or black coloration if left untreated
• Brittle, crumbling nail edges
• Pain in severe cases

As onychauxis progresses, symptoms may worsen. Nails can become extremely thick, making them difficult to trim or maintain. This increased thickness can also lead to curling of the nails, further complicating treatment and management of the condition.

Exploring the Causes of Onychauxis

Onychauxis can result from various factors, and identifying the underlying cause is crucial for effective treatment. Some of the most common causes include:

Genetic Factors

Heredity plays a significant role in the development of onychauxis. If one or both parents have this nail condition, offspring are more likely to develop it as well. This genetic predisposition underscores the importance of understanding family medical history when assessing risk factors for onychauxis.

Trauma to the Nails

Both acute and chronic trauma can lead to onychauxis. Acute trauma, such as stubbing a toe or dropping a heavy object on the nail, can cause immediate damage that results in thickened nail growth. In some cases, this thickening may be temporary and resolve as the nail heals.

Chronic trauma, on the other hand, is often associated with prolonged pressure or stress on the nails. Athletes, dancers, and runners may be particularly susceptible to onychauxis due to the constant impact on their feet. Additionally, wearing ill-fitting shoes that are too tight or small can contribute to the development of this condition over time.

Medical Conditions

Several medical conditions can increase the risk of developing onychauxis:

• Acromegaly: This rare hormonal disorder, characterized by excessive growth hormone production, can lead to denser nail growth.
• Psoriasis: More than half of individuals with psoriasis may experience nail psoriasis, which can cause thickening and brittleness of the nails.
• Diabetes: People with diabetes commonly develop thick nails, either as a direct complication of the disease or due to reduced circulation.
• Darier disease: This genetic skin disorder can cause nail abnormalities, including unusual thickness and discoloration.
• Pityriasis rubra pilaris: A rare skin condition that can lead to nail thickening, discoloration, and shedding.

Circulatory Issues

Reduced circulation can impair proper nail growth by limiting the supply of nutrients to the nail bed. This can result in thickened, abnormal nail growth characteristic of onychauxis.

Infections

While onychauxis itself is not caused by infections, yeast or fungal infections in the nail bed or surrounding area can lead to symptoms similar to onychauxis, including discoloration and nail thickening.

Is Onychauxis Contagious?

Onychauxis is not a contagious condition and cannot be directly transmitted from person to person. While it’s possible to inherit a genetic predisposition for this condition, physical contact with affected nails does not increase the risk of developing onychauxis.

However, it’s important to note that individuals with onychauxis may be more susceptible to fungal nail infections, some of which can be contagious. Therefore, maintaining good nail hygiene is crucial for preventing secondary infections.

Treatment Options for Onychauxis

The approach to treating onychauxis typically falls into two main categories: medical treatments and home remedies. It’s worth noting that treatment is not always necessary unless the condition causes pain or significantly interferes with daily activities. However, many individuals seek treatment for cosmetic reasons or to address underlying health concerns.

Medical Treatments

Medical interventions for onychauxis focus on addressing underlying causes and managing severe symptoms:

1. Treating underlying conditions: Identifying and treating any medical conditions contributing to onychauxis can help alleviate symptoms and prevent further nail thickening.
2. Nail removal: In extreme cases where the nail becomes excessively thick and painful, a doctor may recommend partial or complete removal of the affected nail. This option is typically considered when the nail thickness prevents proper care and causes significant discomfort.

Home Remedies

Several home care strategies can help manage onychauxis and improve nail appearance:

• Regular nail trimming: Keeping nails neat and trimmed can help manage thickness and prevent further complications.
• Proper nail hygiene: Maintaining clean, dry nails can reduce the risk of secondary infections.
• Moisturizing: Applying moisturizer to the nails and surrounding skin can help keep them flexible and less prone to brittleness.
• Protective footwear: Wearing well-fitting shoes that don’t put excessive pressure on the nails can help prevent further thickening.

Preventing Complications of Onychauxis

While onychauxis itself may not always be preventable, especially in cases with a strong genetic component, there are steps individuals can take to minimize complications and maintain overall nail health:

Regular Nail Inspections

Conducting routine examinations of your nails can help detect changes early. Look for signs of thickening, discoloration, or separation from the nail bed. Early detection allows for prompt intervention and can prevent the condition from worsening.

Proper Foot Care

For those prone to onychauxis, particularly in the toenails, proper foot care is essential. This includes:

• Keeping feet clean and dry
• Wearing breathable footwear
• Avoiding walking barefoot in public areas to reduce the risk of fungal infections
• Using clean nail tools and avoiding sharing them with others

Addressing Underlying Health Conditions

Managing any underlying health conditions, such as diabetes or circulatory issues, can help reduce the risk of developing onychauxis or prevent its progression. Regular check-ups with a healthcare provider can ensure that these conditions are well-controlled.

When to Seek Professional Help

While mild cases of onychauxis can often be managed at home, there are situations where professional medical advice should be sought:

• If the thickened nails cause significant pain or discomfort
• When there are signs of infection, such as redness, swelling, or discharge around the nail
• If the nail thickening is accompanied by other unexplained symptoms
• When home remedies fail to improve the condition after several weeks

A dermatologist or podiatrist can provide a comprehensive evaluation and recommend appropriate treatment options based on the severity of the condition and any underlying factors.

Living with Onychauxis: Long-term Management Strategies

For many individuals, onychauxis becomes a chronic condition requiring ongoing management. Developing a long-term strategy can help maintain nail health and minimize the impact on daily life:

Adapting Nail Care Routines

As nails thicken, traditional nail care tools and methods may become less effective. Consider investing in specialized tools designed for thicker nails, such as heavy-duty nail clippers or electric nail files. These can make routine maintenance easier and safer.

Exploring Cosmetic Solutions

For those concerned about the appearance of thickened nails, there are cosmetic options available. Nail polishes specifically formulated for thicker nails can help improve their appearance. However, it’s important to choose breathable formulas that won’t exacerbate the condition.

Maintaining Overall Health

Since onychauxis can be influenced by overall health status, maintaining a healthy lifestyle is crucial. This includes:

• Eating a balanced diet rich in nutrients that support nail health, such as biotin, iron, and zinc
• Staying hydrated to promote healthy nail growth
• Engaging in regular physical activity to improve circulation
• Managing stress, which can impact overall health and potentially affect nail growth

Regular Medical Check-ups

Scheduling regular appointments with a healthcare provider or specialist can help monitor the progression of onychauxis and adjust treatment plans as needed. These check-ups also provide an opportunity to address any new concerns or complications that may arise.

By implementing these long-term management strategies, individuals with onychauxis can effectively cope with the condition and maintain optimal nail health. While the thickening may not be entirely reversible, proper care and management can significantly improve nail appearance and function, minimizing the impact on daily life.

Advances in Onychauxis Research and Treatment

As medical understanding of nail disorders continues to evolve, researchers are exploring new approaches to treating and managing onychauxis. Some promising areas of investigation include:

Targeted Therapies

Scientists are working on developing treatments that specifically target the mechanisms causing nail thickening. These may include topical medications or oral supplements designed to normalize nail growth patterns.

Laser Therapy

While primarily used for treating fungal nail infections, some studies suggest that certain types of laser therapy might help improve the appearance of thickened nails associated with onychauxis. Further research is needed to determine the long-term efficacy of this approach.

Nutritional Interventions

Ongoing research is exploring the role of specific nutrients in nail health and growth. Future treatments may involve targeted nutritional supplements to support healthier nail development in individuals prone to onychauxis.

Genetic Research

As the genetic factors contributing to onychauxis become better understood, there is potential for developing gene-based therapies or preventive strategies for those with a hereditary predisposition to the condition.

While these areas of research hold promise, it’s important to note that new treatments typically undergo extensive testing before becoming widely available. Individuals currently managing onychauxis should continue to follow established treatment plans and consult with healthcare providers about any emerging options that may be suitable for their specific case.

In conclusion, onychauxis, while often a benign condition, can significantly impact nail appearance and function. Understanding its causes, recognizing symptoms early, and implementing appropriate management strategies can help individuals maintain healthy nails and prevent complications. As research progresses, new treatments may offer additional options for those affected by this common nail disorder. Regular consultation with healthcare professionals remains crucial for optimal management and staying informed about the latest developments in onychauxis care.

Definition, Pictures, Symptoms, Treatment, and More

Overview

Onychauxis is a nail disorder that causes fingernails or toenails to grow abnormally thick. Over time, the nails may become curled and turn white or yellow.

This thickening of the nail may force the nail plate (the part you paint with nail polish) to separate from the nail bed. Though toenail fungus can cause similar symptoms, onychauxis isn’t caused by a fungus. However, your risk for developing a fungal infection increases if you have this nail disorder.

Onychauxis, which is sometimes called hypertrophy of the nail, is more common in older adults. The older you get, the more likely you are to experience this condition.

Symptoms of onychauxis include:

• abnormal thickening of the nail
• separation of the nail plate from the nail bed
• yellow or white appearance
• red or black coloring if left untreated
• brittle crumbling around the edges of the nail
• pain

Symptoms may become more severe if onychauxis is left untreated. The nails may begin to curl, and they may become so thick it’s impossible to trim or maintain them. That, in turn, can make treating the nail disorder more difficult.

Onychauxis may be the result of several conditions or issues. Your doctor can diagnose what the underlying issue for your abnormal nail growth is.

The most common causes for onychauxis include:

• Hereditary causes. If one or both of your parents have this nail condition, you’re more likely to develop it.
• Acute trauma. Stubbing your toe or dropping a heavy object on it can cause trauma to your nail bed and nail plate. The trauma may cause nail thickening. In some cases, this may be temporary until the nail heals.
• Chronic trauma. Individuals who inflict a good deal of pressure on their feet for long periods of time, such as athletes, dancers, or runners, may be more likely to develop this nail disorder. The long-term stress on the nail beds and nail plates may trigger the unusual growth. Wearing shoes that are too tight or too small can also cause this condition.
• Acromegaly. This hormonal disorder is the result of too much growth hormone. Though rare, it can cause nails to growth denser.
• Psoriasis. This skin condition causes thick patches of scaly skin, and it can cause nails to grow thicker and more brittle. More than half of people with psoriasis will experience nail psoriasis, too.
• Reduced circulation. Without a proper supply of nutrients, your nails may be unable to grow properly.
• Diabetes. People with diabetes commonly develop thick nails. This may be a complication of the disease, or it may be the result of reduced circulation, which is also common with diabetes.
• Darier disease. A genetic skin disorder, Darier disease causes wart-like blemishes that may be yellow, emit a strong odor, and are hard to the touch. This condition can also cause nail abnormalities, including white and red stripes in the nail plate and unusual thickness.
• Infection. A yeast or fungal infection in the nail bed or around the nail plate can cause symptoms, including discoloration and thicker nails.
• Pityriasis rubra pilaris. This rare skin condition causes chronic inflammation and reddish-orange scales or blotches on the skin. It can also lead to nail thickening, discoloration, and shedding.

Onychauxis isn’t contagious, and it can’t be spread from person to person directly. It’s possible you could inherit the gene that increases your risk for this condition from a parent. However, touching the nails of a person with this disorder will not increase your risk for developing it.

That being said, people who have onychauxis may be more likely to develop a toenail fungus as a result of this condition. Some types of toenail fungus can be spread through contact with another person.

Treatment for onychauxis falls into two main categories: medical treatments and home remedy options. There isn’t standard treatment for this condition. Instead, your doctor will decide a course of action based on a suspected cause and your specific symptoms.

It’s important to note that you don’t have to treat this condition unless it becomes painful and interferes with your day-to-day activities. However, many individuals will seek out a treatment or diagnosis for an underlying condition because the nails may be unsightly.

Medical treatments for onychauxis

Treat underlying conditions. If you have this nail growth issue, your doctor may want to identify potential issues that could be causing it. In some cases, there isn’t an underlying issue, but if one can be found, it can be treated. Treatment means the thick growths and discoloration may stop.

Removal of the affected nail. In extreme cases, your doctor may choose to remove a portion or all of the thickened nail. This is an option when the nail becomes so thick you experience severe pain and can’t properly care for it on your own anymore.

Home remedy options

Keep neat, trimmed nails. Trimming your nails frequently will help with their appearance. It may also ease some pain if nails rub against shoes and cause discomfort. If your nail clippers aren’t thick enough to tackle the job, talk with your doctor about any special tools you may need. Eventually, you may need to see a podiatrist, a doctor who specializes in the treatment of conditions and diseases of the foot, ankle, and lower limbs.

Wear comfortable shoes. Tight shoes may cause onychauxis, and they may make symptoms, especially pain, worse. A professional shoe fitting can help you decide if you need a wider shoe option so your toes have plenty of room. Wide-toe shoes may be a smart option if you frequently experience pain from toenails rubbing against your shoes.

Paint with a polish. Nail polish may help cover the discoloration, but it will not end or stop the abnormal growth.

Move more. Boost circulation in your lower extremities by walking, riding a bicycle, or otherwise moving more. The increase in blood, oxygen, and other nutrients may end the unusual nail growth issue.

Onychauxis may seem worrisome, but it’s rarely dangerous and unlikely to cause serious side effects.

In some cases, onychauxis can be treated. This is especially true when the abnormally thick nails are the result of an underlying condition, such as an infection or trauma. It may take time — nails do grow slowly — but it’s likely you can recover normal nail growth.

If onychauxis is left untreated, you may eventually experience complications like curled toenails, thick nails that cannot be trimmed, and pain. In this case, a doctor may have to help you trim and maintain the nails so that they don’t interfere with your day-to-day life.

Unfortunately, it may not be possible to prevent onychauxis. However, keeping your nails trimmed and clean, wearing light shoes with wide toes, and getting exercise may all help reduce your risk for this nail disorder. If you believe you may be developing onychauxis, make an appointment to see your doctor. Early treatment may help stop and reverse the condition.

Nail disorders

Nail disorders

• The Leading Dermatological Society for GPs
• Website author – Dr Tim Cunliffe (read more)

LAST UPDATED: Jun 12, 2023

Introduction

This chapter, which is set out as below, provides an overview of nail disorders. For detailed information on paronychia please refer to the related chapter. 

• History
• Clinical findings
• Images
• Investigations
• Management

History

Anatomy of the nail (figure 1)

The nail (also called the nail plate) is firmly attached to the nail bed; it is less adherent proximally, apart from the posterolateral corners. Approximately one‐quarter of the nail is covered by the proximal nail fold, and a narrow margin of the sides of the nail plate is often occluded by the lateral nail folds. Underlying the proximal part of the nail is the white lunula; this area represents the most distal region of the matrix. The nail matrix is a localised region beneath the proximal nail, which produces the major part of the normal nail plate. 

Terminology used in nail disorders

• 
  Pits – punctate surface depressions in the nail plate, more commonly affecting fingers than toes

• 
  Onycholysis – the distal and/or lateral separation of the nail plate from the nail bed. Psoriatic onycholysis can be considered the reference point for other forms of onycholysis and is typically distal (ie affecting the free margin of the nail), with variable lateral involvement. Isolated islands of onycholysis present as ‘oil spots’ or ‘salmon patches’ in the nail bed. All the other common causes of onycholysis are associated with diminished adherence of the nail plate to the nail bed as a primary (idiopathic) or secondary event: the latter include trauma, fungal infection, eczema, and drug reactions

• 
  Subungual hyperkeratosis – excessive scaling under the nail. This is often due to a fungal infection or psoriasis. Warts, and rarely a squamous cell carcinoma, can produce a scaly mass under the nail

• 
  Longitudinal ridges – the presence of lines or ridges that run along the length of the nail

• 
  Transverse ridges – the presence of lines or ridges that run across the nail

• 
  Melanonychia – black or brown pigmentation of the nail plate

• 
  Leukonychia – white discoloration of the nail plate

• 
  Pterygium – the winged appearance achieved when a central fibrotic band divides a nail proximally in two. The most common cause is lichen planus, it can be idiopathic

• 
  Paronychia – inflammation of the nail fold

Clinical findings

This section is set out as follows:

• 
  Congenital nail disorders (a brief introduction)
• 
  Red-brown-black nail discolouration  
• 
  Yellow or white-yellow nails with or without onycholysis, thickening of the nail, or, subungual hyperkeratosis
• 
  White nail discolouration (leukonychia)
• 
  Other colour changes
• 
  Nail pitting 
• 
  Longitudinal ridges
• 
  Transverse ridges
• 
  Various nail disorders 
• 
  Skin lesions
• 
  Drug-induced nail disorders

Congenital nail disorders

• 
  The clinical findings range from the complete loss of nails (anonychia), eg in some cases of congenital ectodermal dysplasia, to thickened and discoloured nails seen in pachyonychia congenita. Congenital nail disorders are very rare and are not considered further on this website

Red-brown-black discolouration (figures 2-22)

Longitudinal melanonychia is a term used to describe a hyperpigmented band that runs longitudinally from the proximal nail fold to the free end of the nail plate. The first diagnosis to consider is melanoma, although there are several benign causes.

• 
  Subungual melanoma
• 
  A differential diagnosis of subungual melanoma should be considered in the presence of any new or changing solitary black, brown, and occasionally red (in hypomelanotic lesions) line 
• Hutchinson’s sign – pigment affecting the nail fold, is very suspicious of melanoma

• 
  Black-skinned individuals, Asians, Hispanics, and Middle Easterners frequently have benign longitudinal pigmented bands. The number and width of the bands increase with age. However, the presence of a new, solitary band in an adult could represent a melanoma

• 
  Other causes of longitudinal melanonychia include benign melanocytic naevi, trauma, pregnancy, Addison’s disease, post-inflammatory hyperpigmentation, a number of medications, and HIV positive patients in untreated cases as well as in those receiving zidovudine 
  
   





• 
  Subungual haematoma – a collection of blood in the space between the nail bed and nail plate that may be associated with an episode of trauma, or more commonly, a period of vigorous activity where no trauma is recollected. Sometimes, especially with the toenails, there may be no history of trauma. The following are clinical clues to a subungual haematoma:
• 
  Usually red or red-black colour depending on the age of the bleed. Brown is not a colour usually seen
• 
  Dermoscopy may reveal the following:
  • 
    That the haemorrhage is broken up into several zones, some of which are homogenous, and some which have droplets of blood that may be seen separated from the main zone of pigmentation
  • 
    The pigment may not be continuous in the longitudinal axis, with clear nail at either the proximal or distal margin
  • 
    The pigment may vary in any axis with much more irregularity at the lateral margins when compared to a subungual melanoma
  • 
    Blood may be seen as a discrete layer of material on the lower aspect of the nail plate at the free margin

• 
  Over time (usually several months) there is normal proximal nail growth, and a gradual distal drift of the pigment
• 
  An anecdotal clinical observation is that traumatic causes of subungual bleeding are associated with a proximal white transverse band in many instances. This is more common for trauma to digits of the hand than the foot

Onychomycosis (fungal infection)

• Onychomycosis usually cause a yellow-white discolouration, but occasionally it can be black
• Unlike melanocytic pigment, which starts in the matrix, the pattern of onychomycosis usually extends from the distal free edge with proximal progression
• Early reassurance can be given if the pigmented change and dystrophic nail can all be trimmed away with no disturbance of surrounding skin and there is no sign of a more proximal origin to the pathology
• Suspicion of fungus should always be explored by mycological assessment and in particular culture. There is a wide variety of potential organisms. Some of the pigmented fungi are non-dermatophytes and may represent a therapeutic challenge likely to be surmounted only if the pathogen is known – some cases of Aspergillus do respond to treatment

Medications

• Chloroquine may produce blue‐black pigmentation of the nail bed, and other antimalarials may produce longitudinal bands of pigmentation on the nail bed or in the nail
• Hyperpigmentation due to increased melanin in the nail and nail bed has been noted after treatment with cytotoxic drugs

Glomus tumour

• A glomus tumour is a benign vascular neoplasm, which most commonly presents as a red-blue area of discoloration under the nail. Lesions are usually tender, particularly following change in temperature or pressure

Splinter haemorrhages 

• Seen as 1-3 mm, red or brown-black, longitudinal bands of the nail bed (not plate)
• They are usually due to trauma, but can be secondary to a number of conditions including psoriasis, tinea, and most importantly subacute bacterial endocarditis

Yellow or white-yellow nails with or without onycholysis, thickening of the nail, or, subungual hyperkeratosis (figures 23-37)


​Tobacco smoking

• Can result in yellow-brown discoloration of nails and fingertips


Trauma 

• Most commonly affects the big toenails, and is seen mainly in very active individuals, those with poor footwear, and in the elderly
• The nail becomes discoloured (yellow-brown), thickened, and then onycholitic
• The nails can start to grow out laterally, such changes can become gross when they are termed onychogryphosis

Tinea unguium

• Tinea unguium is a dermatophytic fungal infection
• The toenails are affected more often than the fingernails, indeed if there are no changes to the nails on the hands then tinea is much more likely than psoriasis
• The clinical features may be asymmetrical, but not always, and include onycholysis, subungual hyperkeratosis (which is often crumbly), and sometimes interdigital infection

Psoriasis 

• 
  Psoriasis tends to be more symmetrical then with tinea
• Findings include pits, distal and lateral onycholysis, ‘oil-drops’, subungual hyperkeratosis, an uneven nail surface, paronychia, transverse midline depressions in the thumbnails, and occasionally splinter haemorrhages

Paronychia

• 
  Paronychia can lead to various nail changes such as discolouration, onycholysis and transverse ridging

Medications 

• Onycholysis can occur secondary to a number of drugs including tetracyclines (photo-onycholysis), cardiovascular drugs (particularly practolol and captopril),  trimethoprim/sulfamethoxazole, indomethacin, isotretinoin, isoniazid, and some cytotoxic drugs eg doxorubicin and 5-fluorouracil


Yellow Nail syndrome 

• A very rare condition characterised by hypercurved, transversely thickened, smooth, yellow nails. It is associated with lymphoedema, pleural effusion, and (usually) ascites

---


White nail discolouration – leukonychia (figures 38-44)


Minor trauma 

• A common cause, and tends to cause focal areas of leukonychia

Tinea unguium

• Tinea unguium can cause a superficial infection


Terry’s nails

• A whiteness of most of the nail, except the distal edge
• Most commonly associated with cirrhosis, but also with a number of other systemic conditions including diabetes, cardiac failure, malabsorption and thyrotoxicosis


Half-and-half nails 

• Describes nails where there is a proximal white zone and distal (20–60%) brownish sharp demarcation
• Associated with renal failure 


Transverse leukonychia (Mees’ lines)

• The 1–2 mm wide transverse band is in the arcuate form of the lunula 
• Reflects a systemic disorder, drugs such as chemotherapy, or systemic infection that affect matrix function


Beau’s lines 

• Narrow horizontal grooves in the nail plate, which often have a white colour, and occur when nail growth temporarily slows
• Beau’s lines can follow infection, trauma, or systemic illness 

---


Other colour changes (figures 45-46)


Pseudomonal nail infection 

• Occurs most commonly secondary to other nail pathology
• Characterised by green-blue, or occasionally black, discolouration


Other drug-induced nail changes 

• A bluish colour is seen with mepacrine, and hydroxyurea has been reported to result in blue lunulae

---

Nail pitting (figures 47-48)

• Can arise from psoriasis (small regular pits), eczema (larger and more irregular pits), and alopecia areata (causes small pits. Can be a bad prognostic sign for hair regrowth)
• Isolated pits can be a normal finding 

---


Longitudinal ridges (figures 49-61)


​A few ridges are seen in normal nails.

Peripheral vascular disease can cause longitudinal ridges. 

Myxoid cyst


• 
  A myxoid cyst is seen around the proximal nail fold
• The cyst has a smooth shiny surface, and a clear jelly-like fluid may be expressed
• As a result of pressure the cyst often causes a lateral groove in the nail, a few mm across, which extends the length of the nail

Median nail dystrophy (syn. median canaliform dystrophy) and habit-tic nail deformity (HTND)

• These conditions cause confusion in the literature as both have been described as having very similar appearances
• It is the author’s view that habit-tic nail deformity should be the term used where there is the suggestion of repetitive trauma to the nail matrix, caused by rubbing or picking with another finger
• Both conditions tend to affect one or both thumbnails; other nails can be affected
• A longitudinal depression with cross ridges giving a ‘washboard’ or ‘fir tree’ appearance 
• In more severe cases, there can be paronychia, loss of the cuticle, and/or hypertrophy of the lunulae
• HTND generally responds well to habit reversal, although sometimes permanent nail dystrophy can result if the damage has been long-term. Median nail dystrophy tends to improve gradually 

Darier’s disease

• 
  Darier’s disease can cause longitudinal ridges with V-shaped nicks at the free end of the nail

Lichen planus

• 
  In lichen planus the fingernails are more frequently affected than toenails, with initial involvement of two or three fingernails before subsequent involvement of the remaining digits
• The most common changes are thinning of the nail plates and longitudinal ridges. Adhesion between the epidermis of the dorsal nail fold and the nail bed may cause partial destruction of the nail (pterygium unguis)
• Rarely, the nail is completely shed. One variant of nail lichen planus is associated with trachyonychia (see below)   

Trachyonychia

• Describes a rough surface affecting all of the nail plate, which is often associated with longitudinal ridging
• It can be idiopathic, or associated with alopecia areata, psoriasis, lichen planus, and ichthyosis vulgaris
• When the condition occurs on all the twenty nails of the fingers and toes, it is known as twenty-nail dystrophy

---


Transverse ridges (figures 62-67)

Eczema

• Eczema can cause irregular transverse ridging, with thickening and sometimes discolouration 

Chronic paronychia

• 
  Refer to the chapter Chronic paronychia

Beau’s lines

• Horizontal grooves in the nail plate that occur when nail growth temporarily slows
• Beau’s lines can occur after infection, trauma, or systemic illness


Onychomadesis 

• Similarly results from temporary growth arrest of the nail plate, but differs from Beau’s lines in that the full thickness of the nail is involved, causing a proximal separation of the nail plate from the nail bed
• It most frequently occurs several months after hand-foot-and-mouth disease but can occur after other viral infections
• Nails affected by Beau’s lines or onychomadesis regrow normally with time

---


Various nail disorders (figures 68-72)


Nail cosmetic dystrophy

• From artificial nails, can cause onycholysis, ridging, sepsis and marked atrophy

Nail biting 

• Nails are typically short, with up to 50% of the nail bed exposed. The free edge may be even or ragged. Surface change may include splitting of the nail into layers 

Lamellar nail dystrophy 

• Characterised by the distal free end of the nail splitting into layers. It is seen more commonly in women, and is generally associated with frequent immersion in water 


Clubbing

• Increased transverse and longitudinal nail curvature with hypertrophy of the soft‐tissue components of the digit pulp

Thyroid acropachy of Grave’s disease 

• Swelling of distal digits with overgrown nail plates that has a similar appearance to clubbing. Nails may lift off the nail bed


Koilonychia 

• A concavity of the nailplate
• It is common in infancy as a benign feature of the great toenail
• In adults the most common systemic association is with iron deficiency and haemochromatosis, although the majority of adults with koilonychia demonstrate a familial pattern


Pincer nail deformity 

• A transverse over-curvature of the nail plate
• Usually caused by ill-fitting footwear but it can occur in patients with psoriasis, SLE, Kawasaki disease, cancer, end-stage renal disease, and some genetic syndromes (eg paronychia congenita)
• Patients often have pain at the borders of the nail where the nail plate curves into the tips of the digits 

---


Skin lesions (figures 73-82)

Many skin lesions can affect the nail including:

• 
  Warts
• 
  Myxoid cyst – seen around the proximal nail fold. The cyst has a smooth shiny surface, and a clear jelly-like fluid may be expressed. As a result of pressure the cyst often causes a lateral groove in the nail, a few mm across, which extends the length of the nail
• 
  Pyogenic granuloma – a red papule or nodule that bleeds very easily. Needs to be differentiated from malignancy
• 
  Bowen’s disease – a red or skin-coloured scaly lesion
• 
  Squamous cell carcinoma – a nodule, ulcer, or occasionally a verrucous-like mass. Can cause partial or complete nail destruction 
• 
  Melanoma – in addition to longitudinal melanonychia, subungual melanoma can sometimes grow, destructively, under the nail 
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  Acquired fibrous nodule – presents as a smooth-edged lesion, commonly in the periungual tissue as opposed to within the nail unit
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  Periungual fibroma – associated with tuberous sclerosis (Koenen tumour). They present as smooth, firm, flesh-coloured lesions that emerge, usually, from the nail folds
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  Subungual exostosis – a firm nodule that develops below the nail bed. As it grows upwards the nail plate separates from the bed. The big toenail is the most commonly affected digit

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Drug-induced nail disorders

• 
  Attached is a very useful overview of drug-induced hair and nail disorders written by Dr Shailee Patel and Dr Antonella Tosti, Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine

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Images

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Investigations


Suspected fungal infection


• 
  In order to prevent high rates of false negative results it is important to the cut the nail back and remove the subungual debris by careful curettage or by using a scalpel blade, and sending all of the specimen for mycology. Simply asking the patient to provide a nail clipping will miss many cases of fungal infection





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Management

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  General measures
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  Good hand care – protect hands from solvents and other chemicals by using gloves. Do not use soap, but use plenty of emollients. Avoid manicures 
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  Patients should take good care of their feet by washing, frequent airing, and wearing sensible footwear 
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  Nails should be cut straight (as opposed to curved) and not too short, in order to prevent ingrowing toenails
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  Patients with troublesome nails who are not able to manage them on their own should be seen regularly by a chiropodist
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  Patients with suspected melanoma or squamous cell carcinoma should be referred urgently to Secondary Care (two-week wait)
  
   
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  Patients with potentially destructive lichen planus of the nails should be referred urgently to dermatology, as early intervention may prevent long-term nail damage
  
   
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  For fungal infection of the nail refer to the chapter Tinea unguium
  
   
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  Pseudomonal nail infection – it is important to try and correct any underlying nail pathology. Treatments reported as helping include vinegar, 1% hydrogen peroxide cream, gentamicin drops, ciprofloxacin drops
  
   
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  Most other nail conditions, including psoriasis, provide a major therapeutic challenge

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Diseases of the nails on the hands and feet: symptoms, photos, treatment

Very often nails become a vulnerable part of the human body. In addition to the fact that all kinds of malfunctions of our body are reflected in their condition, the nail plates still suffer from their own diseases, and are also subjected to various domestic injuries. Do your nails hurt but don’t know why? Have you experienced deformation and discoloration of your nails, but have no idea how to cure them? In our article, we will look at the most common nail diseases, talk about their treatment methods, and also learn about preventive measures to keep your nails healthy. You’ll learn why your fingernails hurt, look at the warning signs of a serious illness, and find some helpful tips on how to treat affected nails.

Contents

1. Most common nail diseases
2. Most common symptoms of nail diseases
3. Methods of treatment of diseases of the nails
4. Prevention of nail diseases

The most common nail diseases

When problems with toenails or fingernails begin, you should immediately consult a doctor to identify the disease in order to start treatment as soon as possible. Each disease has its own symptoms and affects the condition of the nail plates in different ways. Let’s talk about what are the most common diseases of the nails on the hands, as well as on the feet, you may encounter.

Mycosis

Mycosis is a type of fungal infection that occurs on the skin and nails. As a rule, infection with this fungus occurs when the basic rules of personal hygiene are not observed and during contact of a sick person with a healthy one. Mycosis involves a fairly long treatment with various drugs, including creams, sprays, varnishes, as well as oral antifungal agents.

At the first symptoms of a nail disease, you need to go to a doctor who will tell you how to quickly and effectively cure this disease. If your nails have dramatically changed their color, begin to crumble or exfoliate, and itching and pain appear around the nail plates, then these are the first signs of a fungal infection. If you find a fungus, it is better not to postpone a visit to a specialist. Even considering that today there are a lot of drugs against mycosis, you should not treat nails at home, because the consequences can be the most unpleasant.

Psoriasis

This non-infectious skin disease of the nails affects the natural plates on the hands and feet. The main cause of this disease is considered to be disorders in the immune system that provoke inflammatory processes in the affected areas. Genetic inheritance is the second reason for the occurrence of such a disease as psoriasis of the nails on the hands and feet.

The first signs of this disease are an unpleasant yellow color of the nail plates, which gradually begin to exfoliate and acquire a rough surface. Often during this disease of the nails, a complete or partial separation of the nail plate occurs. During these processes, the nails do not hurt, and rejection is not accompanied by inflammation. Sometimes small capillaries break under the nail, which leads to hemorrhage in the form of red or pink spots.

The treatment of psoriasis is a rather laborious process that requires a complex effect and the use of strong medications. Similar diseases of the nails on the hands, as well as on the legs, are recommended to be treated only under the supervision of a qualified doctor.

Onycholysis

Onycholysis is one of the most common types of nail plate dystrophy. A similar disease of natural nails leads to their deformation. Since there is a violation of the connection of the nail with the soft tissues of the bed, a free space is formed under the free edge. The nail plate above the affected area changes its shade, becoming an unsightly yellow, brown or bluish-white color. A progressive disease can provoke rejection of the entire nail, and then it will be very difficult to eliminate this defect. That is why, when the first signs of onycholysis are detected, it is necessary to immediately involve a doctor who can prescribe the correct treatment.

The causes of this disease of the toenails can be different. These are the consequences of various diseases, and the reaction of the skin to household chemicals. And also rejection of nails may indicate that you have some kind of disturbance in the digestive, cardiac or nervous system. Sometimes onycholysis occurs due to prolonged use of antibiotics and is a symptom of an infectious disease.

Nail deformation due to trauma

If the nail is injured, it reacts sensitively to damage, changing its color and deforming. In such a situation, changes in the appearance of the nails are completely natural, so there is no need for special treatment. It is only necessary to carry out mandatory prevention of damage. Sometimes, after injury, the nail begins to peel off the skin and falls off. The regeneration of a new plate can take 6 to 8 months.

The most common symptoms of nail diseases

Nail problems are a serious test for any person, because any disease is accompanied by unpleasant and sometimes painful sensations . At the same time, it’s not worth talking about the appearance of the nail plates. That is why it is very important to recognize the characteristic symptoms of a particular disease in time in order to seek help from a dermatologist or mycologist. Let’s look at the most common bells indicating the presence of some kind of nail disease.

• Changing the color and shape of the nail plates. This is a drastic change in the appearance of the nails. This is a signal to go to a specialist.
• The appearance of itching and redness is the first sign of fungal diseases of the toenails, as well as on the hands. In this case, self-treatment can have dangerous consequences.
• Stratified nails sometimes indicate a lack of vitamins and nutrients. And sometimes it is the initial stage of a fungus or psoriasis.
• Hemorrhage under the nail plate, discoloration of the skin on the fingertips. Similar symptoms are a characteristic sign of a nail disease such as psoriasis, or a signal of the presence of a fungus.

Methods for the treatment of nail diseases

Often, problems with nails indicate problems in the human body, so the treatment is complex and systemic, and it should be prescribed exclusively by a specialist. We list the main ways in which you can cure fingernails and toenails.

1. Medical treatment. With psoriasis and fungus, special drugs are prescribed. After conducting the necessary tests, the doctor will determine which pathogen is present in your skin. Based on the results of scraping or sowing, a specialist prescribes medications with which you can cure a person by relieving him of the disease of the nail plates on his hands. And in order to reduce the harm from therapy, the doctor will advise you to take more and supportive means for the liver and gastrointestinal tract. It is not recommended to treat such diseases on your own, since there is a risk of causing even more harm to your body.
2. External treatment. Most often, all kinds of ointments and creams are used as aids to combat the disease of toenails and hands. Your doctor will tell you how to use certain drugs.
3. Medical varnishes. Auxiliary remedy for the elimination of certain problems with the nail plates.
4. Surgical removal. Often there are situations when the nail can no longer be saved, it remains only to remove it. In this case, the doctor prescribes treatment with detailed instructions, which describes all the nuances of rehabilitation, lists the list of medications and signs their use. It is very important to cure the skin under the affected nail, since it is there that pathogenic organisms develop. With the right medical approach, a new nail grows healthy in 6-12 months.

The above methods of treating the nail plates on the hands are always used in tandem, which is determined by the doctor.

Prevention of nail diseases

The health and beauty of your nails is the result of certain efforts. Compliance with the following rules for nail care will help you avoid many diseases, while maintaining the natural attractiveness of your hands for a long time.

• Healthy lifestyle. A balanced diet, lack of stress and the correct daily routine will not only benefit your nails, but also have a positive effect on the general condition of the body.
• Get your manicure done by professionals only. When choosing a master, make sure that manicure tools are thoroughly disinfected and sterilized.
• Practice good hygiene. In public swimming pools, saunas and gyms, wear flip-flops, do not touch the floor with your skin.
• Choose anatomically correct and high quality shoes. Calluses, corns and sweating contribute to the reproduction of the fungus.
• Get rid of the bad habit of biting your nails.
• Use quality varnishes and decorative finishes.
• Make prophylactic strengthening baths and masks for nails.

These tips will help you keep your nails in order. Problems with fingernails require the immediate intervention of an experienced specialist who will tell you how to properly treat the disease . We bring to your attention an interesting video dedicated to this exciting and relevant topic for many. Take care of your health and stay beautiful!

What are nail diseases? Types and classification, description with photo

Every girl strives for her ideal. A modern girl takes care of her health, nutrition, appearance: hair, figure, face, and of course manicure. Well-groomed hands are a complete image, this is aesthetics, this is confidence, this is a great mood.

However, our nails are prone to diseases. According to the state of the nail plate, changes in the work of our internal organs can be determined. It is worth paying attention not only to its color, shape, but also texture. The nails of a healthy person look smooth, without spots, shiny, pale pink or beige. A healthy fingernail grows on average by ~3 mm per month, and is renewed in 3-4 months.

Important! After each removal of gel polish, pay attention to the condition of your nails yourself. Do not hide problems under a layer of varnish, this is your health, it is better to prevent the development of a problem than to start and treat it later.

Classification of nail diseases

Classification of nail diseases are divided into the following groups.

Non-infectious

• Hereditary or congenital
• acquired (injury)

Infectious

• Fungal
• bacterial
• viral
• tumor

Nail lesions include:

• Changes in the nail plate (color, thickness, size, shape, surface, strength)
• change of the nail bed (skin under the nail plate)
• change of periungual folds.

Types of diseases

Next, we will consider some diseases that affect the nail plate on the hands. Having found any modifications on the nails, you should seek the advice of a doctor.

Leukonychia

Leukonychia is the appearance of white spots, dots or stripes on the nail plate. Leukonychia is false and true. How to distinguish them? With true pressure on the nail, white spots grow along with the nail plate and do not disappear when pressed. With a false one, the stain remains in place and disappears when pressed.

The reasons for the appearance can be both external and internal factors. External ones include: improperly performed manicure, injuries of the upper phalanx of the finger, work without gloves with detergents, paints, solvents.
Internal: taking medications, heavy metal poisoning, dermatoses, systemic diseases, metabolic disorders.

Gapalonychia

Gapalonychia is a pronounced softening of the nail plate, as a result of which cracks form on the free edge of the nail, the nail easily bends and breaks off. There may be several reasons for congenital predisposition, lack of vitamins A and B, Ca, iron, improper manicure, contact with chemical reagents, and impaired absorption of food.

Onycholysis

Onycholysis is the detachment of the nail plate from the nail bed from the side of the free edge or side ridges, a so-called pocket is formed. As a rule, no more than half of the nail plate exfoliates, the separated part has clear boundaries. The causes of onycholysis can be different: mechanical and chemical trauma, improper processing of the cuticle and manicure, medication, dermatosis, infection (bacterial or fungal).

Onychomycosis

Onychomycosis is a fungal nail infection. This disease develops very slowly, therefore, visible changes in the nail, their color, thickness indicate that the process has already been started and treatment is ahead. Causes of appearance: family predisposition, visiting common areas, non-compliance with personal hygiene, diabetes, decreased immunity.

Bo lines

Bo lines – parallel to the free edge of a strip up to 1 mm deep. The nail plate is wavy. Reasons for the appearance of the Bo Line: incorrect manicure, mechanical trauma to the nail fold, the presence of a fungal or infectious disease, stress, food poisoning.