Nail dystrophy refers to degenerative growth changes on one, several, or all of the fingernails or toenails. Nail dystrophies can have numerous local or systemic causes and are by no means limited to fungal infections. Damage that is temporary manifests as punctate lesions or lesions that are transverse to the nail, whereas longitudinal grooves or runes develop in persistent causes.
What is nail dystrophy?
Nail dystrophies are caused by growth disorders of the fingernails or toenails. The growth disorders may be temporary or persistent, resulting in different symptoms. Typically, transient disorders form punctate lesions or transverse grooves visible to the naked eye. Persistent growth disorders develop highly visible longitudinal grooves in the nails that gradually extend from the nail bed to the upper free edge of the nail. The possible extent of nail dystrophy, like its causes, covers a wide spectrum and ranges from harmless, only faintly visible symptoms to complete destruction of the nails. The appearance of nail dystrophy usually provides an experienced physician and dermatologist with the first clues to possible causes of the disease. In many cases, the appearing lesions on the nails are symptomatic of the presence of a certain disease syndrome, which also affects other organs. If the disorder is brief and occurs only once, the localized change in the nail can be followed up for about three months, because up to three months are needed to “push through” the localized lesion from the nail root to the upper free edge.
Causes
Nail dystrophy can be caused by a variety of causes that can be grouped into a few cause complexes. Main cause complexes include mycoses or bacterial inflammations, skin diseases, and certain types of tumors. However, metabolic diseases with systemic effects, side effects of medications as well as injuries and some rare hereditary diseases can also promote nail dystrophy. Malnutrition and local circulatory disorders can also cause symptomatic nail dystrophies. In the case of infection with a nail fungus from the family of shoot fungi or filamentous fungi, there are usually conditions such as a weakened or suppressed immune system or systemic metabolic disorders that “allow” the almost ubiquitous and rather harmless fungus to become pathogenic. Skin diseases that favor the development of nail dystrophy include eczema, psoriasis, various forms of non-contagious nodular lichen (lichen ruber planus), and several other skin diseases. Chronic diseases of the lungs, bronchial tubes or heart, which lead to constant undersupply of oxygen, favor the formation of so-called clock glass nails. They are large and roundishly curved and usually associated with widened terminal phalanges of the fingers. Among the drugs that can cause nail dystrophies as undesirable side effects are ACE inhibitors for arterial blood pressure lowering, anticoagulants to prevent blood clots, special antibiotics and some other drugs. Mechanical injury to the nail bed from bruising or blows with blunt objects (hammer blows) usually results in a visible blue-black hematoma (blue nail) below the nail blade. The blue-black spot under the nail is partially resorbed and gradually moves to the nail edge. In more severe injuries to the nail bed or more severe infections, the nail may detach completely, which is called onycholysis.
Diseases with this symptom
- Skin diseases
- Metabolic disorder
- Eczema
- Psoriasis
- Bruises
- Nail fungus
- Malnutrition
- Lichen ruber planus
- Mycosis
- Hypoxia
- Nail bed inflammation
- Tumor
- Circulatory disorders
- Hereditary diseases
- Lung diseases
Diagnosis and course
In most cases, a diagnosis can already be made on the basis of the appearance of nail dystrophy. In many cases, the symptoms are not quite clear, so that by clarification of other parameters, the diagnosis made must be confirmed or even rejected.The clarifying examinations refer to blood tests or other laboratory tests. Particular caution is required when brownish longitudinal stripes appear, which may indicate a malignant tumor, for example a malignant melanoma under the nail bed. The reliable interpretation of the manifold manifestations of nail dystrophy up to onycholysis, a detachment of the nail, requires expert knowledge and as much experience as possible. The courses of the disease are very different depending on the cause growth disorders of the nail. They range from self-healing to severe, especially when the nail abnormalities are due to serious metabolic diseases. In less severe cases, the nail bed and nail regenerate on their own once the cause of the impaired nail growth is identified and corrected.
Complications
Nail dystrophy, or degenerative change of a nail, can have various causes and corresponding complications. In the worst cases, it can lead to complete destruction of the nail, which may eventually detach and fall off. The wound that results may become infected and inflammation may develop. This inflammation can spread systemically, leading to sepsis. Sepsis is often fatal and requires immediate medical attention. A fungal disease on the nail can also spread systemically, especially if the body is immunocompromised. The nail fungus can also spread to other nails if left untreated and is therefore highly infectious. If the infestation is severe, it can interfere with walking due to severe pain. In the context of systemic scleroderma, the nail can also be destroyed. This autoimmune disease can affect other organs in addition to the nails, leading to heart failure or kidney or lung failure, for example. Due to the severe involvement of the muscle and bone, patients can be severely impaired in their movement. In addition, the disease can cause circulatory disorders, so that the corresponding tissues can form ulcers or even die. This occurs mainly in the area at the fingertips (Raynaud’s syndrome) and rather less frequently in the arms and legs in the context of pAVK.
When should you see a doctor?
In the case of nail formation disorders such as nail dystrophy, a doctor should always be consulted. Medical clarification is necessary at the latest when the dystrophy is accompanied by injuries or inflammation of the nails. As soon as pain occurs or the brittle nails affect the general condition, this must be clarified by a doctor. In general, changes in the nails that are not due to a specific cause must be examined and treated if necessary. Nail dystrophy can be the result of serious diseases such as acrogeria, Darier’s disease or poikiloderma and therefore always requires medical clarification. Longitudinal nail changes must be examined immediately, as they indicate a chronic disorder that may have already developed complications. Nail dystrophies in children and adolescents should be discussed with the pediatrician. In most cases, the complaints are based on simple deficiency symptoms that can be reliably remedied by administering the appropriate vitamins or minerals. If a serious illness is the cause, prompt treatment significantly improves the chances of recovery.
Treatment and therapy
Efficient treatment of nail dystrophy depends on the causative factors. Often it becomes necessary not to treat primarily the disturbed nail growth, but to aim only at remedying the causes. In simple cases, for example, when a deficiency of vital substances necessary for the synthesis of nails is detected, it is enough to supply the body with the necessary substances. In many cases, nail problems are due to improper treatment of nails by nail polish, nail polish remover or frequent contact with household chemicals and aggressive detergents. This kind of problems can be solved by a more proper treatment of the nails. In case of detected mycoses or other infections, the therapy may be limited to local treatment and combating the infectious agents. Sometimes it is combined with systemically effective treatment. The therapy is much more challenging if the nail changes are associated with eczema or psoriasis.In these cases, therapy is primarily aimed at the underlying disease. Therapy is also problematic in the presence of genetic metabolic disorders, which in some cases are severe, so that therapy must be aimed at mitigating the effects caused by the metabolic disorder.
Outlook and prognosis
In most cases, nail dystrophy causes various deformities and disorders of the fingers and nails. The causes of nail dystrophy vary widely, which is why a delayed diagnosis of the disease usually occurs. In the worst case, the patient may suffer from severe or complete detachment and destruction of the nail. This results not only in pain, but also in visual discomfort, so that many of those affected suffer from inferiority complexes and sometimes even depressive moods. If nail dystrophy is triggered by a fungal disease, this disease can spread over the body and possibly affect other regions of the body. It can also damage the muscles, causing disturbances in blood flow to the extremities. If nail dystrophy occurs due to the lack of vitamins and other nutrients, the affected person must follow a strict diet. Likewise, nail polishes and other cosmetic items must often be avoided. Antibiotics are used for infections and inflammations. In most cases, nail dystrophy has a positive course of the disease. It does not affect life expectancy.
Prevention
One of the most important measures to prevent nail dystrophy is to eat a healthy, varied diet that promotes an intact immune system and protects against mycoses and bacterial infections to the greatest extent possible. Avoiding improper treatment of nails and protecting them from aggressive household chemicals by using alternative cleaning agents or wearing household gloves also helps prevent nail dystrophy.
What you can do yourself
Nail dystrophy is easy to treat yourself with a number of home remedies and measures. Depending on the cause, it is often possible to correct the problems by treating the nails gently. Nail dystrophy resulting from malnutrition can be alleviated by supplying the necessary vitamins and minerals. If the symptoms are due to an infection or eczema, a doctor should always be consulted. In addition, the nails must be protected. Nail protection products from the pharmacy can be used in consultation with the attending physician, as can various home remedies. Vinegar or tea tree oil, for example, help to disinfect the damaged nail and supply it with important nutrients. In case of fluorine deficiency, the affected nails can be treated with toothpaste. In case of infection, alcohol can be used for disinfection. Nail dystrophy in the early stages can be treated with the patient’s own urine or preparations containing urea. Later, sparing and avoiding damaging influences such as nicotine or environmental toxins are the means of choice. In addition, a medical record should be kept so that the physician can quickly clarify the causes of nail dystrophy.