Onychauxis is a disease that affects the nails of fingers and toes. The name of the disease is derived from the Greek language, where it comes from the terms ‘onyx’ for fingernail and ‘auxano’ for proliferation. Onychauxis is present in affected individuals either from birth or is acquired during the rest of life due to various influences.
What is onychauxis?
Onychauxis refers to a pathological abnormality in the growth and appearance of the nails of fingers and toes. The condition exists in some patients from birth. In other cases, onychauxis develops later in life, with certain risk factors favoring the development of onychauxis. Typical for onychauxis is that the finger and toe nails are more or less clearly thickened. However, the nails are not deformed, but grow predominantly in the same shape as healthy nails. The medical scientific literature uses the disease term rather rarely. Instead, there are more case descriptions of onychogryphosis and onychogrypose. In both cases the nails of toes and fingers are affected not only by a considerable thickening but also by a deformation. Onychauxis occurs, for example, in people suffering from so-called acromegaly or psoriasis. Wearing shoes that are too tight or too small for a long period of time also increases the risk for affected individuals to develop acquired onychauxis. In addition, onychauxis sometimes occurs in connection with certain disease syndromes. Pachyonychia congenita, for example, is an autosomal recessive inherited dysplasia of the nails. In this case, genetic mutations are present on the gene FZD6.
Causes
Diverse factors favor the pathogenesis of onychauxis. The acquired form of the disease occurs, for example, as a result of traumatic impact on the nails of the fingers and toes. This is the case, for example, with injuries to the nail. Also the permanent, excessive impact of pressure on the nail increases the risk of developing onychauxis. In addition, frostbite of the fingers or toes is capable of triggering onychauxis. Especially often the thickening of the nails results as a result of too small shoes that press on the toenails. In addition, onychauxis often occurs in association with certain diseases and syndromes. Thus, onychauxis is more often than average associated with Darier’s disease, pityriasis rubra pilaris, acromegaly and psoriasis. In principle, acquired onychauxis develops in numerous cases only on individual nails of the fingers or toes, depending on where the traumatic impact took place.
Symptoms, complaints and signs
Onychauxis is manifested by characteristic complaints and signs. The affected nails on toes and fingers are noticeably thickened. In addition, they often have a yellowish coloration. Onychauxis is often confused with onychomycosis and psoriasis. Although the diseased nail thickens significantly and thus increases in height and volume, the stability does not always increase to the same extent. When cutting the nails affected by onychauxis, they often tear, break or crumble. In some cases, the surface of the nail appears pitted and porous. In other cases, it is almost impossible to cut the diseased nails because the thickening is too severe or the consistency is too firm.
Diagnosis and course of the disease
If persons show the typical signs and symptoms of onychauxis, a doctor should be informed about the complaints. The general practitioner is initially a suitable contact person, who will take an initial medical history with the patient and perform minor visual examinations. After a preliminary assessment of the diseased nails on toes and fingers, the doctor may refer the person to a podiatrist. Sometimes, however, the general practitioner himself initiates the further treatment steps. The diagnosis of the Onychauxis begins with a detailed patient interview. In addition to the individually present complaints, the doctor attaches importance to learning as much as possible about the background and possible factors of the development of the thickening of the nail. In the case of acquired onychauxis, traumatic effects on the nail such as injuries are particularly relevant.Permanent stress such as wearing shoes that are too small also indicate onychauxis. In the congenital form of onychauxis, certain disease syndromes give clues to the disease, for example Darier’s disease. If a person suffers from certain chronic and congenital diseases, he is predisposed to the development of onychauxis.
Complications
Causal treatment of onychauxis is not always possible. In these cases, the patient must be prepared to permanently rely on the help of a trained podiatrist, who usually flattens the thickened nails using special tools. This treatment must be repeated at regular intervals. Acquired onychauxis may also require a number of behavioral adjustments for the patient. In most cases, tight or pointed shoes may no longer be worn, as they constantly press on the nail and cause or at least encourage the thickening caused by the disease. Some patients are no longer allowed to wear standard shoes at all, but have to get used to special orthopedic shoes. Those affected must also reckon with additional complications if the thickened nails are particularly strong or highly porous. If the stability develops in proportion to the thickness of the nail, they often can no longer be cut or filed with standard pedicure instruments. Those affected are then dependent on the help of trained pedicurists. If particularly strong nails grow in, this is extremely painful for the patient. If the nails become particularly porous, there is a risk that the affected person will slip off while cutting the nails and injure the nail bed or the surrounding tissue. The cut wounds can be very painful and become infected.
When should you go to the doctor?
Changes or abnormalities in the nails should be observed. If the irregularities grow out independently and there is subsequently freedom from symptoms, a doctor is not normally needed. If the problems persist or spread, a check-up with a doctor is necessary. Discoloration of the nails on the hands or toes is considered unusual and should be medically clarified. If there is instability of the nails, rapid injuries or damage to the nail structure, the indications should be discussed with a doctor. These are often warning signs of the organism for existing diseases that need to be clarified. Thickening or brittle nails are other signs of an existing irregularity. They should be examined so that a diagnosis can be made. If the affected person suffers from psychological problems due to the optical changes, a doctor is also needed. If there is a depressive mood, mood swings or withdrawal from social life, there is cause for concern. Strong feelings of shame or disgust should be discussed with a doctor. Nail biting indicates an internal imbalance in many people. Often, mental stress or emotional irregularities contribute to a worsening of the overall condition. In addition, the risk of secondary diseases or further complaints is increased.
Treatment and therapy
Causative treatment of onychauxis is often impractical. Instead, the cosmetic therapy of the thickened nails is in the foreground. Such treatment-related measures are usually undertaken by a trained podiatrist. The plate of the diseased nail is flattened with the help of special files. Sometimes special shoe shapes are recommended so that the pressure load on the nail is reduced.
Outlook and prognosis
Onychauxis offers a good prognosis. The condition can be treated well and does not result in any health discomfort for the patient. If the condition is treated early, the individual complaints can be reliably alleviated. Life expectancy is not reduced by onychauxis. However, the well-being can sometimes be severely limited, especially during physical exercise. In addition, in chronic diseases, a malposition often develops concomitantly. This can result in psychological and physical complaints that place a heavy burden on the patient. Particularly problematic are secondary diseases such as joint wear or circulatory disorders, as they occur especially in advanced onychauxis.The prognosis of onychauxis is usually made by the podiatrist in charge. For this, the severity of the disease must be assessed, taking into account a number of factors such as the type and degree of deformity and the causative disease. The prognosis can usually be made after only a few treatment appointments and does not need to be changed if the course of the disease is expected. An onychauxis can form again and again, insofar as the triggers for the condition are not remedied.
Prevention
Prevention of onychauxis is possible only in the acquired form of the disease. Individuals avoid wearing shoes that are too tight for long periods of time, as well as trauma to the nails from injuries. However, prevention is not always successful due to unforeseen accidents.
Aftercare
In most cases, only limited measures of an aftercare are available to the affected person in case of Onychauxis, since it is a rare disease. If the disease has been present since birth, it usually cannot be completely cured. Therefore, if the affected person wishes to have children, he or she should undergo genetic testing and counseling to prevent the recurrence of the disease. As a rule, the disease cannot be cured on its own. Most patients with this disease are dependent on various cosmetic procedures that can alleviate and limit the symptoms. These may have to be repeated more often, so that a complete limitation of the disease is not possible. Likewise, in the case of onychauxis, contact with other patients of the disease can be very useful, as this leads to an exchange of information, which can facilitate the everyday life of the affected person. Likewise, the nails of the affected person should not be stressed too much, so as not to aggravate the symptoms. Further measures of an aftercare are not available to the affected person with this disease and are usually not necessary. Onychauxis does not reduce the life expectancy of the affected person.
What you can do yourself
Onychauxis can occur in connection with various diseases and injuries. Accordingly, the methods of treatment are also varied. In general, a deformation of the toenail does not need to be treated, provided that it does not cause pain, discomfort or other discomfort. In most cases, it is sufficient to wear suitable footwear and to check the affected area regularly for changes. If swelling appears or another problem occurs, a visit to the doctor is recommended. Before that, an attempt can be made to correct the change in the toenail by foot baths or massages. If these measures show no effect, the family doctor should be consulted. Onychauxis can be corrected by having a podiatrist abrade the nail plate. With the help of the appropriate foot care products, those affected can often do this themselves. However, proper podiatric training should be available to prevent injury. Lastly, onychauxis must be seen as a warning sign. It is important to determine the trigger and avoid a recurrence. A small onychauxis usually does not cause any discomfort and does not need to be treated. If the thickened nail cannot be cut itself because it is too hard, a podiatrist or professional chiropodist should be consulted.