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Onychodystrophy

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|Key=Onychodystrophy, toenail, toe pain |Description=Onychodystrophy refers to abnormal growth of the toenails, most commonly the big toe. It occurs due a wide variety of pathological processes such as fungal infections, trauma and systemic disease. }}

Other Names

  • Onychodystrophy

Background

  • This page refers to Onychodystrophy, or abnormal nail growth

History

Epidemiology

  • Not well defined in the literature

Pathophysiology

Illustration of the fingernail anatomy[1]
  • General
    • Defined as changes of the nail plate characterized by dystrophy (abnormal) and/or dyschromia (abnormal color)
    • Occurs due to various pathologic processes of the nails such as infectious and noninfectious disorders
    • Although commonly seen, the exactly pathophysiology is poorly understood

Etiology

  • Congenital Nail Diseases
  • Onychomycosis
  • Nail infections
  • Skin Diseases
    • Psoriasis
      • Approximately 80% of patients with psoriasis have nail involvement (Nail Psoriasis)[2]
    • Eczema
    • Lichen Planus
  • Tumors
    • Benign: Warts, digital mucoid cyst, Subungual Exostosis, Glomus tumor
    • Malignant: Squamous cell carcinoma, Basal cell carcinoma, Malignant melanoma
  • Internal Diseases
    • Chronic heart and lung disease
    • Liver cirrohosis
    • Nephritic Syndrome
  • Drug reactions
    • Antimicrobials including tetracycline
    • Chemotherapy Agents
    • Immunosuppressants including docetaxel[3], penicillamine[4]

Risk Factors

  • Unknown

Differential Diagnosis

Clinical Features

Third toe with important onychodystrophy and an erythematous nodule on the proximal nail border as a result of giant onychomatricoma[5]
  • History
    • Carefully review the patients history and cosmetic habits
    • Patients often endorse nail trimming problems, difficulty walking, discomfort in wearing shoes, pain, nail pressure and embarrassment[6]
    • Pain with their nails can affect activities of daily living
    • Nail growth is often abnormal
  • Physical Exam: Physical Exam Foot
    • Nail changes may also be a clue to other dermatological or systemic diseases
    • Beau's lines: nonspecific nail dystrophy and nail shedding
  • Special Tests

Evaluation

Candida paronychia and onychodystrophy as a manifestation of mucocutaneous candidiasis in hyper-IgE syndrome before (A) and after (B) long-term therapy with fluconazole.[7]

Radiographs

Ultrasound

  • Can provide objective measures of nail health (thickness, volume, matrix volume)
    • Not well studied, needs more research for most diseases
  • Findings[8]
    • Systemic lupus erythematosus: nail thickness and matrix volume were increased
    • Progressive systemic sclerosis: decrease in nail thickness and matrix volume
  • Unknown diagnostic value
    • Psoriasis, eczema, onychomycosis and brittle nails

Scanning Electron Microscopy

  • Nail edge clippings can be measured to assess progress
    • Thickness of the nails
    • Lamellar splitting
    • Dorsal nail surface

MRI

  • Role is not clearly delineated

Laboratory

  • Obtain nail material
    • Labs: Microscopy, Culture
    • Helps distinguish between infectious and non-infectious etiology
    • May need to be repeated several times

Classification

Superficial white onychomycosis (SWO) with Onychodystrophy[9]
  • Not applicable

Management

Nonoperative

  • Indications
    • Most cases
    • Treatment is directed at underlying disease
  • Goals
    • Resume normal nail growth, vary from less than 1.8 and to more than 4.5 mm per month
    • Improve cosmesis
  • Calcium Supplement
    • No evidence that it improves nail quality[10]

Operative

  • Indications
    • Unknown

Rehab and Return to Play

Rehabilitation

  • No clear guidelines

Return to Play/ Work

  • No clear guidelines

Complications and Prognosis

Prognosis

  • Unknown and depends on the etiology

Complications

  • Poor cosmesis

See Also

References

  1. ↑ Patel L. Management of Simple Nail Bed Lacerations and Subungual Hematomas in the Emergency Department. Pediatric Emergency Care. 2014; 30 (10): 742-745. doi: 10.1097/PEC.0000000000000241.
  2. ↑ de Jong EM, Seegers BA, Gulinck MK, Boezeman JB, van de Kerkhof PC. Psoriasis of the nails associated with disability in a large number of patients: results of a recent interview with 1,728 patients. Dermatology 1996;193:300-303.
  3. ↑ Correia O, Azevedo C, Pinto Ferreira E, Braga Cruz F, Polonia J. Nail changes secondary to docetaxel (Taxotere). Dermatology 1999;198:288-290.
  4. ↑ Bjellerup M. Nail-changes induced by penicillamine. Acta Derm Venereol 1989;69:339-341.
  5. ↑ Luce, Maria Claudia Alves, et al. "Giant onychomatricoma." Anais brasileiros de dermatologia 93 (2018): 160-161.
  6. ↑ Elewski BE. Onychomycosis. Treatment, quality of life, and economic issues. Am J Clin Dermatol 2000;1:19-26.
  7. ↑ Eberting, Cheryl Lee D., et al. "Dermatitis and the newborn rash of hyper-IgE syndrome." Archives of dermatology 140.9 (2004): 1119-1125.
  8. ↑ Wollina U, Berger M, Karte K. Calculation of nail plate and nail matrix parameters by 20 MHz ultrasound in healthy volunteers and patients with skin disease. Skin Res Technol 2001;7:60-64.
  9. ↑ Asz-Sigall, Daniel, Antonella Tosti, and Roberto Arenas. "Tinea unguium: diagnosis and treatment in practice." Mycopathologia 182.1 (2017): 95-100.
  10. ↑ Reid IR. Calcium supplements and nail quality. N Engl J Med 2000;343:1817.
Created by:
John Kiel on 18 February 2022 05:17:56
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Last edited:
4 October 2022 12:44:14
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