Onychodystrophy is a change in the structure, shape, and color of nails due to abnormally occurring trophic processes, congenital or acquired. Visually, the pathology is manifested by turbidity, thinning of the nail plates, signs of transverse or longitudinal stratification, roughness, peeling, the appearance of furrows and pinpoint indentations, partial or complete destruction of the nail. Onychodystrophy is diagnosed based on the clinical picture, microscopy of scrapings from the lesion. For early detection of pathology, a study of blood serum for the activity of alkaline phosphatase is used. The treatment is long-term, the basis is vitamin and mineral complexes, massage, physiotherapy.
Onychodystrophy is a set of pathological changes in nails caused by violations of the trophic nail apparatus. The disease has no age, seasonal, gender, racial characteristics, and is not endemic. Onychodystrophy can be a symptom of somatic pathology or be diagnosed as an independent pathological process. A big problem in the diagnosis of onychodystrophy is its similarity to the manifestations of onychomycosis. Ambiguity of diagnosis entails problems in treatment. Due to the presence of additional biological inclusions (conditionally pathogenic microbes, fungi-contaminants) in scrapings from the lesion, cases of diagnostic errors, incorrect administration of antimycotic agents have become more frequent, which leads to the development of complications, violates the quality of life of patients. The urgency of the problem is dictated by the fact that onychodystrophy can be the first manifestations of serious systemic pathology.
The nail is a horny plate, the chemical composition of which is individual and genetically programmed, which determines different manifestations of onychodystrophy that occur under the same conditions. Reproduction of horn cells, innervation, blood supply is provided by the epidermal matrix of the nail bed, on which the nail is located. The essence of pathological manifestations of onychodystrophy is related to the quality of adhesion of the nail plate and the nail bed.
The triggers of onychodystrophy can be congenital anomalies, dermatoses, diseases of internal organs, intoxication, vitamin deficiency, lack of minerals in the body, injuries of various genesis, stress, tumors. The pathology is based on the imbalance of self-regulating cellular metabolism, which, in combination with extracellular trophic disorders, leads to onychodystrophy through several stages of structural changes in tissues. The degree of severity of trophic changes at each stage determines the clinic of the disease.
The infiltration stage is characterized by the accumulation of metabolic products from blood and lymph in the cell or intercellular substance, deformation of the nail plate. Decomposition leads to the disintegration of the ultrastructures of cells and intercellular matter, changes in metabolic processes in the horny tissue, nail stratification. Pathological protein synthesis disrupts the keratinization process, deforming the nail. The transformation stage leads to an inversion of substances necessary for normal growth and development of the nail: instead of proteins, fats and carbohydrates, one thing is synthesized, the connection of the nail with the nail bed is lost, its color changes. This is how nail dystrophy arises and develops.
There is no comprehensive universally recognized classification in modern dermatology. In our opinion, the most convenient is the division of onychodystrophy by the causes of their occurrence with an emphasis on the specifics of clinical manifestations. There are congenital onychodystrophy, as a consequence of gene mutations and the transmission of hereditary predisposition, and acquired onychodystrophy – a heterogeneous result of trophic disorders. Congenital onychodystrophy is clinically manifested by the following types:
- Onychomadesis – manifests itself in the form of rapid separation of the nail from the bed from the distal edge, most often as a result of injury or inflammation; inherited genetic predisposition to pathology.
- Coilonychia is a hereditary predisposition to a spontaneously occurring oval depression in the center of the nail plate.
- Anonychia – congenital absence of a nail plate, transmitted from generation to generation.
- Platonychia is a congenital pathology in the form of an even, flat nail.
- Micronychia – congenital short, small nail plates on the hands, less often on the legs.
- Hippocratic nails – a hereditary anomaly with convex nail plates, “drum fingers”.
Acquired onychodystrophy can be independent nosologies or an integral part of the symptom complex of somatic pathologies, dermatoses, visually manifested in the form of changes in the nail plates. The first group (isolated diseases) includes:
- Onychoschisis is a dystrophic stratification of the nail across into several components without inflammation phenomena;
- Transverse furrows Bo (manicure onychodystrophy) – a rainbow-shaped depression in the nail from edge to edge, the most common type of onychodystrophy;
- Median canaliform onychodystrophy – a distinctive feature is the “herringbone symptom”: the central crack – the trunk, from which the furrows-branches depart, is a consequence of trauma;
- Onycholysis – loss of connection with the nail bed while maintaining the integrity of the latter with a slow detachment of the nail due to injury or infection;
- Onychogriphosis – hyper-thickening and curvature of the nail of an age-related nature;
- Leukonychia is a pathological coloring of nails as a result of matrix dysfunction. It can be dotted (small spots of different diameters), striped (the appearance of one wide or several narrow whitish stripes transversely to the axis of the nail – the Murke line), total (with whitish gaps across the entire surface of the nail), partial (half of the nail is white, the remaining part is unchanged);
- Hyperpigmentation – occurs as a consequence of the accumulation of hemosiderin, melanin. It is manifested by yellow nail syndrome (consists of a triad of signs: onychodystrophy, somatic pathology, disease of the lymphatic system); drug pigmentation (occurs as a result of the use of tetracycline antibiotics, resorcinol, cosmetic lacquers); sub-elbow dystrophy (characterized by longitudinal hemorrhages in the sub-elbow space due to injury to the nail bed).
Acquired onychodystrophy, as part of other diseases, can be represented by various forms. So, onychorexis – dystrophic stratification of the nail along – is considered one of the signs of lichen planus, eczema, psoriasis. Longitudinal furrows of the nail, arising from a lack of iron, protein or folic acid, may indicate disorders in the cardiovascular system, rheumatoid arthritis. The Mi lines – white stripes across the nail – are a symptom of arsenic poisoning. Scleronychia is an extreme hardness of the nail and hapalonychia is a very soft breaking nail, they are a symptom of endocrine disorders. Trachionychia – a cloudy, rough, delaminating, “sandy” nail – usually occurs with immunodeficiency. “Thimble” onychodystrophy – the speckled surface of the nail with indentations resembling a thimble accompanies psoriasis.
Symptoms and diagnosis
Clinical manifestations of onychodystrophy correspond to its varieties. However, there are common clinical signs of the disease associated with a violation of the strength, elasticity, color shades of nails. Strength suffers due to trophic disorder. Visually, longitudinal, transverse striations, furrows, and depressions are visible in the thickness of the horny layers of nails. Pigmented disorders, infections change the flesh color of the nail to whitish or yellow. The contours of the nails are transformed, the nail plates become excessively convex or atypically flat. The priority symptom is a complete or partial loss of connection of the nail with the matrix. Such changes may be accompanied by phenomena of local inflammation or be asymptomatic. Subjective sensations are not observed except in cases when onychodystrophy is a symptom of somatic pathology.
The diagnosis of onychodystrophy is made by a dermatologist based on anamnesis, clinical picture. It is mandatory to take scraping from nails on mushrooms. For early diagnosis, blood serum is examined for the activity of alkaline phosphatase (alkaline phosphatase). More accurate diagnosis is facilitated by such research methods as dermatoscopy, confocal microscopy. They differentiate onychodystrophy with dermatomycosis, true pemphigus, Lever’s pemphigoid, During’s dermatitis, epidermolysis bullosa, acrodermatitis, lichen planus, psoriasis, eczema, Deverji’s disease, Darye’s dyskeratosis, gonorrhea, leprosy, syphilis.
Therapy is carried out under the supervision of a dermatologist. If possible, exclude the cause that caused onychodystrophy, perform etiotropic therapy. The treatment is complex. Priority is given to minerals, vitamins, amino acids, which are essential elements for restoring the chemical composition of the nail. Drugs that improve microcirculation in tissues, angioprotectors, immunostimulating, restorative agents are used; drugs that improve the emotional sphere of the patient. In severe cases, corticosteroids, retinoids, quinolines, cytostatics are prescribed.
Locally apply warm baths on herbs, with sea salt, essential oils, nourishing and moisturizing creams. Paraffin applications with natural wax, ozokerite, mud are effective. Ionophonophoresis with vitamins, UVI, PUVA therapy, diathermy, acupuncture, massage have proven themselves well. Keratolytic patches are used as prescribed by a doctor.
In order to prevent onychodystrophy, it is necessary to eat properly (the predominance of fruit and vegetable, protein diets, products containing gelatin), exclude contact with household chemicals, nail polishes. Sanatorium-resort treatment is shown. The prognosis is relatively favorable, taking into account the aesthetic component of the process, which violates the quality of life of the patient.