Onychogryphosis

The onicogriphosis is a thickening of the nail plate, growing hornlike with transverse grooves on the surface of the nail mode a snail shell. It is a disease of the nail, more common than you might think. It mainly affects the elderly and the elderly as it is linked to circulatory deficiencies much more frequent in the elderly.

Onychogryphosis can also be found in young patients associated with other diseases such as scleroderma or psoriasis .

The thickening of the nail is usually slow, since the affected nails tend to have a retarded growth. However, the normal thing is that the nails present a very striking thickening, because the person is unable to cut the nail at home using household utensils.

It is popularly believed that nails thicken over the years, and that is why it is normal to find a nail like this when reaching certain ages. This belief has its nuances. Obviously the aging of the person causes a loss of elasticity associated with the lack of collagen and other proteins at the dermal level. However, the nail must keep a uniformity in its thickening, and it will never exceed having more than 2-3 mm. of thickness. Onychogryphosis causes anarchic thickening of the nail plate and distorts the original shape of the nail. In these cases, this anomaly cannot be considered normal and it is necessary to go to a Podiatrist to treat the problem and advise us about the care this disease deserves.

Causes of onychogryphosis

The causes that produce the thickening of the horn-shaped nail are several and sometimes independent of each other, that is, several causes of onychogryphosis may or may not coincide in a person.

The main cause of onychogryphosis is the alteration of the nail matrix by different internal or external agents. For example, circulatory alterations cause a lack of blood supply at the level of the nail matrix, which results in a slow and anarchic growth that causes a thickened nail with cross sections that coincide with discontinuous growth stages. A blow or trauma to the matrix area also produces an abnormal growth of the nail, due to the partial destruction of the matrix cells that are permanently and irreversibly affected for life.

It is common to find an onychogryphosis nail after having suffered a blow or stomp on the nail, and often after having lost it due to this cause.

Certain dermatological diseases such as psoriasis or scleroderma can also cause thickening of the nail plate. This thickening has differences with respect to the previous one since it affects all the nails, it also affects the nails of the hands and the thickening is usually more uniform.

It seems that the cause that leads to an alteration in the production of the nail is the affectation of the matrix cells.

The nails grow from the root of the finger at a speed of about 4-5 mm per week. This growth is carried out from the nail matrix that is protected by the skin at the base of the nail below what is called the cuticle on a daily basis.

The matrix is ​​a particularly sensitive area and it is relatively easily disturbed by blows or trauma received in this area. Sometimes a stomp can cause the nail to grow badly and increase in thickness. Other times, poor blood supply at this level can cause abnormal growth.

When onychogryphosis is associated with dermatological diseases such as psorisasis or scleroderma, how it occurs has to do with increased cell production at the dermal level and the alteration in collagen synthesis.

The conclusion is that the cell matrix produces more nail cells than normal, which causes a saturation of the nail plate and the consequent thickening of the nail that is unable to carry out a correct cell turnover.

Symptoms of onychogryphosis

The symptoms of onychogryphosis are:

• Horn-shaped nail plate thickened with transverse grooves like a snail shell.
• Inability to put on shoes due to the thickness of the nail.
• Pain from conflict with the shoe. The nail does not have enough space and it digs into the nail bed.
• Appearance of calluses and hardness in the subungual area. These calluses are due to increased pressure due to the pressure exerted by the footwear on the nail.
• Appearance of nail residues under the nail, due to the alteration of the nail metabolism.
• Impossibility to cut the nail due to the hardness and thickness caused by the nail.
• The nail can change color and appear yellowish or brownish due to association with bacterial or fungal infections (caused by fungi).

How is it diagnosed?

The diagnosis of onychogryphosis is simple, since the appearance of the nail is very characteristic and leads to few mistakes. However, the complicated thing about onychogryphosis is finding the cause that has caused it and also distinguishing it or associating it with other diseases.

To rule out the coexistence of a fungal or bacterial infection, a nail plate culture can be performed. The method of identifying the fungus consists of culturing the infected material (nail plate, nail powder) in suitable culture media, such as agar or Sabouraud.

It is important to investigate about the circulatory state of the person. In people with vascular alterations of the lower limbs, this alteration of the nail plate is frequent.

It is also necessary to remember a traumatic event on the nail, such as a stomp, a blow or the fall of a blunt object on the nail.

In athletes the appearance of bruises under the nail is very common, due to the use of sports shoes. The appearance of these bruises with relative frequency can cause the nail matrix to be altered and cause an abnormal growth of the nail.

Treatment of onychogryphosis

There is no definitive treatment for onychogryphosis. At the moment that the nail matrix is ​​affected by any cause that can cause a thickening of the nail, the nail cannot recover and it is not possible to return to its original state.

This circumstance makes the treatment palliative and aimed at reducing the problems caused by the nail having the acquired thickness.

The Podiatrist can guide you about the care you should follow with this type of nails, although it is advisable to go every so often to a podiatry consultation to make a correct cut of the nail while the nail is thinned with the help of electric micromotors.

These nails are dangerous to cut at home using household instruments, since there is a risk of producing a cut under the nail. On the other hand, it is difficult to cut these types of nails with any conventional pliers or nail clippers due to the hardness that the nail plate acquires.

This recommendation makes much more sense in people with lower limb circulatory problems such as people with diabetes or peripheral circulation disorders.

How can I avoid it?

Prevention in these types of problems can only be aimed at avoiding certain risky habits since on certain occasions it is not possible to prevent the appearance of this alteration if there is another disease that produces it, as in the case of psoriasis, diabetes , arteriosclerosis, etc.

However, we must take into account the following:

• Do not wear narrow shoes that compress the foot in the toe area, which can cause trauma to the nail matrix or a decrease in blood supply at this level.
• Go to a Podiatrist if the nail has turned black or bloody after receiving a blow or stomp.
• If you are diabetic, you should visit the Podiatrist periodically to cut your toenails and guide you on their care.
• Avoid walking barefoot, which can make you more vulnerable to hitting your toes.

You should go to the podiatrist when:

• The toenail appears thickened in the shape of a horn, so that it is cut and thinned.
• If the nail changes color and appears yellowish or brownish, to investigate the cause of this alteration.
• If I am diabetic or have vascular problems in my legs, so that I can cut my nails and guide me on caring for them.
• If I have suffered a blow to my finger and the nail has turned black, so that I can treat it and prevent the nail matrix from being injured.
• Whenever I think that the nail is diseased for guidance on existing treatments.