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Onychogryposis (also known as onychogryphosis or ram's horn nails) [1] is a hypertrophy that may produce nails resembling claws or a ram's horn, possibly caused by trauma or peripheral vascular disease, but most often secondary to self-neglect and failure to cut the nails for extended periods of time.[2]: 783–4 [3] Onychogryposis is most commonly seen in the elderly, and some recommend avulsion of the nail plate with surgical destruction of the nail matrix with phenol or the carbon dioxide laser, if the blood supply is good.[2]: 783–4 [4]: 659
Severe congenital onychogryposis affecting all twenty nailbeds has been recorded in two families, who exhibit the dominant allele for a certain gene.[5][6] Congenital onychogryposis of the fifth toe (the little toe) is fairly common, but asymptomatic and seldom brought to the attention of medical professionals. Rather, it is brought to the attention of manicurists who routinely file the clawed toenail flat.
Causes[edit]
Onychogryposis is often caused by a single trauma (e.g toe being trampled by a horse) or repetitive micro-trauma (e.g improper footwear) to the nail or the nail matrix. It is characterized by an opaque, yellowish-brown nail plate that is distorted, grossly thickened, elongated, and partly curved like a ram's horn. Most of the time, onychogryposis only affect toenails, but when it does affect the fingernails, it will only affect one. According to Heller[7] and Zaias[8], the nail matrix produces the nail plate at an uneven rate and the direction and curvature of the nail is determined by whether the lateral or medial side grows more rapidly. Other possible causes, mostly seen in elderly, includes ichthyosis, psoriasis, syphilis, pemphigus,uricemia, impairment of the vasuclar and neuronal system as well as self-neglect or the inability to cut nails due to immobility and/or failing eyesight.[9]. Mazeration by hyperhidrosis and a hallux valgus deformity are thought to be promoting factors in inducing onychogryphosis[10].
Effects[edit]
In toenails, something as simply as ill-fitting shoes can cause onychrogryposis, but in extreme cases like the one shown to the right, damage to the ulnar nerve and median nerve are the initial causes. These nerves supply impulses to the fingers and feet, so without the proper nerve supply, the nails will begin to worsen.
If the affected nails are neglected for a extended period of time, it is possible for the thickened and rough nail to laceratethe nail bed. When the nail bed is damaged, ulceration or sores can develop which creates opportunities for infection to grow. If continued to be neglected, the patient can lose feelings in their feet, which can cause danger to the patient.
Solutions and Treatments[edit]
The pain and pressure of the nail can be similar to fungal infections of the nail or onychomycosis. It is best to consult a doctor first to determine whether or not the patient actually has onychogryposis. The treatment is dependent on the initial cause of onychogryposis. Because onychrogryposis usually happens in the elderly population, the conservative method is preferred. In most cases, the repeated use of electric drill, burs and surgical pincers to help maintain a reduction of nail plate thickness and length. Ordinary scissors can also be used after a tropical pre-treatment with chemicals such as 40% urea or 50% potassium iodine under occlusion[11].
If there is permanent direct trauma to an isolated nail, the patient can opt to remove the nail completely. This is done surgically, where the nail is removed at the root and then the matrix is destroyed chemically so the nail won't regrow. The digit (finger or toe) will be without a nail, but smooth and healthy skin will grow. Even though it might be embarrassing, it is less painful and less likely to become infected which can cause other problems.
If the cause were by repetitive micro-trauma such as from shoes or cleats, then avoiding the pressure can improve the condition. Onychrogryposis is rarely cured, but it is usually controlled.
See also[edit]
- List of cutaneous conditions
- Case Study concerning onychogryphosis [1]
References[edit]
- ^ Tosti, A; Piraccini, BM (2008). "Chapter 70 – Nail Disorders". In Bolognia, JL; Jorizzo, JL; Rapini, RP (eds.). Dermatology. Vol. 1 (2nd ed.). St. Louis: Mosby Elsevier. ISBN 978-1-4160-2999-1.
- ^ a b James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
- ^ Ram’s horn nails, Dr Nicola Mumoli (cardiologist) - Department of Internal Medicine, Ospedale Civile Livorno, Livorno, Italy, reported in Medical Journal of Australia, MJA 2011; 195 (4): 202, 15 August 2011, accessed 1 September 2011
- ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
- ^ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2103814
- ^ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2079501
- ^ Heller J. Die krankheiten der nägel. In: Jadassohn J, ed.Handbuch der Haut-und Geschlechtskrankheiten. Vol 13/2.Berlin, Germany: Springer; 1927:89-110
- ^ Zaias N. The Nail in Health and Disease. 2nd ed. Norwalk,Conn: Appleton & Lange; 1990:164.
- ^ . Horvath G, Vlcek F. Uricaemia and onychogryphosis. Cesk Dermatol. 1986;81:388-390
- ^ Samman PD. Nail deformities due to trauma. In: Samman PD, Fenton DA, eds. The Nails in Disease. 5th ed. Oxford,England: Butterworth-Heinemann; 1995:164.
- ^ Baran R, Dawber RPR. Physical signs. In: Baran R,Dawber RPR, eds. Diseases of the Nails and Their Management. 2nd ed. Oxford, England: Blackwell Scientific Publications; 1994:47-48.