Clock glass nails on fingers or toes are the symptom of hypoxia in the connective tissue of the nail bed. Thus, the nail changes are causally related primarily to heart and lung diseases. With the treatment of the primary disease, the symptom of clock glass nails also improves in this context.
What are watch glass nails?
Hypertrophies correspond to an increase in the size of certain tissues or organs while the number of cells remains the same. So-called clock glass nails are present when there is hypertrophy of connective tissue in the nail bed. It is a form of pathologically altered fingernails. More rarely, toenails are affected. In most cases, clock glass nails are associated with drumstick fingernails, which cause the nails to become distended by thickening the finger end links into a cob shape. A watch glass nail is larger, usually roundish in shape, and more outwardly curved than a normal fingernail. In all cases, the nail anomalies are the symptom of a superordinate disease. Symptomatically, the anomalies are associated mainly with such diseases that are accompanied by cyanosis, oxygen deficiency and thus the bluish discoloration of skin or mucous membranes. Affected finger or toe nails are strongly curved in longitudinal and transverse directions. All fingers and toes or a single finger or toe limb may be affected by the pathological changes of the nail bed.
Causes
Clock glass nails should be understood as a symptom of superordinate diseases. The diseases associated with the abnormality usually cause hypoxia in specific tissues. Tissue hypoxia provides the breeding ground for clock glass nails. There is an increased production of growth factors that cause the connective tissue within the nail bed to hypertrophy. Connective tissue is located in the nail bed between the bone and the nail matrix. Hypoxic-induced new formation of vessels such as capillaries is thought to be a causative factor for the increased production of growth factors. This new formation of capillaries mainly affects the finger end links. When clock glass nails occur together with drumstick fingers, this is usually due to cardiac or pulmonary disease. These diseases often cause local or systemic tissue hypoxia leading to oxygen deficiency. Capillary blood carries oxygen. Since tissues depend on a supply of oxygen for survival, the formation of new capillaries occurs as a compensatory effect to the lack of oxygen. Thus, clock glass nails are usually the result of chronic lung or heart diseases such as emphysema, pulmonary fibrosis, or right-to-left shunt. When clock glass nails occur singly, local vascular changes, such as aneurysm or arteriovenous fistulae, often underlie the phenomenon.
Diseases with this symptom
- Hypertrophy
- Pulmonary fibrosis
- COPD
- Cyanosis
- Pulmonary emphysema
- Lung cancer
- Hypoxia
- Pulmonary disease
- Smoker’s leg
Diagnosis and course
In patients with clock glass nails, individual or all finger or toe nails are pathologically changed. In most cases, patients also suffer from drumstick fingers in the form of a conspicuous rounded distension of finger end links associated with soft tissue thickening. In this case, the patients’ watch glass nails are distended by the thickening of the finger end links into a piston shape. The shape of the nails is also abnormal. Affected nails appear abnormally large, roundish in shape and, most importantly, curved outward. Depending on the primary cause, clock glass nails are associated with other symptoms. Since the primary cause is usually cardiopulmonary disease, circulatory disturbances are often present, which manifest themselves in a bluish discoloration of various tissues. This so-called cyanosis is due to a slight oxygen saturation of the blood, which is characteristic of many cardiopulmonary diseases. In addition, there are local heart or lung symptoms such as shortness of breath or cardiac arrhythmias. Clock glass nails are detected by visual diagnosis. The symptom is attributed to a primary disease during the diagnostic process, which requires extensive examination of the heart and lungs. In most cases, the symptom is recognized and the physician is moved by it to investigate the cause.Less frequently, a diagnosis of cardiopulmonary disease is already present prior to the detection of clock glass nails, to which the symptom that has occurred is attributable. For example, acute damage to lung tissue may have been diagnosed, which causes clock glass nails to develop 14 days later. The prognosis for patients with clock glass nails depends on the cause of the primary hypoxia and its treatability.
Complications
Clock glass nails develop as a result of various lung diseases, such as hyperinflation of the lungs (emphysema). The alveoli may burst as they progress, allowing air to escape into the pleural space. This can lead to collapse of the lung (pneumothorax). Coupled with chronic bronchitis, which is often caused by smoking, this is referred to as COPD (chronic obstructive pulmonary disease), which greatly reduces life expectancy. Hyperinflation also leads to an increase in blood pressure in the area of the pulmonary arteries. The right heart, which pumps blood into the pulmonary circulation, becomes overloaded as a result, and heart failure can develop. This heart failure can cause cardiac arrhythmias (arrhythmias). Atrial fibrillation carries the risk of pulmonary embolism or stroke, while ventricular fibrillation can lead directly to cardiac death. Asthma can also cause watch glass nails. A feared complication of asthma is status asthmaticus, a condition that cannot be treated with medication but requires intensive care. This can progress to unconsciousness. Hepatitis, if chronic, can progress to cirrhosis of the liver, which can eventually progress to liver cancer (liver carcinoma). In cirrhosis of the liver, edema and water retention in the abdomen (ascites) are common. In addition, the affected person has clotting disorders. Not infrequently, there is also an enlargement of the spleen and thus additional pain.
When should one go to the doctor?
Clock glass nails often occur in association with piston-like fingertips called drumstick fingers. If the piston-like fingers are congenital and do not show a drastic change, there is no need to see a doctor. As soon as a change occurs in the form that the fingernails bulge like a watch glass, it should be taken as a signal. Clock glass nails in most cases indicate a disease of internal organs. Therefore, consulting a doctor is advisable as soon as shortness of breath or cough are added or the patient’s performance decreases. They indicate functional disorders of the gastrointestinal tract or the liver. Likewise, clock glass nails can be a sign that oxygen deficiency has occurred due to lung or heart disease. Lung cancer is the most common cause of clock glass nails. However, it can also be an indication of pulmonary tuberculosis or other lung disease. Chronic heart failure or cirrhosis of the liver are also possible causes of clock glass nails. The physician performs a chest examination after taking the patient’s medical history. Furthermore, a differential blood count is used to look for evidence of oxygen deficiency. The ratio of kidney, liver, and thyroid levels in the blood is also examined. A bronchoscopy or an ultrasound examination of the heart also help to track down the disease underlying the clock nails.
Treatment and therapy
Clock glass nails are not usually treated symptomatically. Symptomatic treatment makes no sense if only because the nail changes do not in themselves pose a health risk. However, the primary cause of the changes may be associated with a more or less serious health risk. Therefore, causative treatment for clock glass nails is paramount. A causative arteriovenous fistula is removed as much as possible. Causative aneurysms are brought to resolution with medication, if possible. These measures restore the permeability of the vessels. The oxygen supply in the tissue normalizes and the clock glass nails regress. If heart or lung diseases are present, these diseases are brought to an improvement by means of invasive surgical and medicinal treatments. As soon as the oxygen supply improves in a consequence, the hypoxia symptom of the clock glass nails also decreases. More severe lung and heart diseases can only be cured causally by transplantation.In these cases, the abnormal nails therefore remain until the patient receives a donor organ. This is especially the case with major tissue damage in the lung and heart areas.
Outlook and prognosis
In most cases, clock glass nails indicate severe chronic disease. If they do occur, it is imperative that a physician be consulted. The clock glass nails themselves can cause severe pain in the patient. These can be contained with painkillers, but painkillers should not be taken for a long period of time. The change in the nail itself is not a dangerous condition to the body and therefore is not treated directly. Clock glass nails recede on their own once the triggering symptom has been treated. For many people, clock glass nails are considered unattractive and unaesthetic. Therefore, they may result in lowered self-esteem and psychological problems. If the clock glass nails occur at the same time as heart disease or lung disease, surgical intervention is usually necessary. The success of this operation depends largely on the patient’s condition and the operation itself. If the clock glass nails are extremely pronounced, the nail on the finger can be completely removed. This will grow back again. However, in any case, the underlying symptom for the clock glass nails must be treated. For this reason, it is not possible to make a general prediction about the course of this symptom.
Prevention
Clock glass nails can be prevented only to the extent that hypoxia of the nail bed connective tissue can be prevented. Circulation-enhancing measures can be widely understood as preventive measures. Similarly, prophylactic steps to avoid cardiac and pulmonary diseases can be broadly understood as preventive measures, such as exercise, a balanced diet, and abstinence from nicotine use.
Here’s what you can do yourself
With clock glass nails should in any case first go to the family doctor. Depending on the cause, medical treatment can be supported by some self-help tips and remedies from household and nature. If the complaints are based on a heart or lung disease, for example, sports and dietary measures are suitable. In consultation with the doctor, physiotherapy and yoga can be started. Avoiding harmful foods and stimulants should also be discussed with the patient’s doctor or a nutritionist in order to avoid complications. Cosmetic measures such as colorless nail polish can restore the original color of the nails. Home remedies such as olive oil or lemon juice can at least curb clock glass nails – but not permanently. The causal treatment of the symptoms always has priority and should quite automatically lead to the decline of the clock glass nails. It is recommended to maintain a healthy lifestyle even after surgical intervention. In this way, nail health can be preserved permanently. Damaged nails can be repaired using various remedies such as tea tree oil, molasses or apple cider vinegar. Foods containing vitamin E and biotin further contribute to nail health.
