Causes and risk factors
Improper nail care along with failure to trim the nail is one of the major contributing factors for onychogryphosis. Repeated trauma and pressure or compression of nails due to ill-fitting shoes also seem to contribute equally. Onychogryphosis is particularly seen secondary to certain nerve injuries, especially of the ulnar and the median nerve. Like many other nail disorders, onychogryphosis is caused due to a variety of skin conditions and systemic diseases. Poor blood supply, diabetes mellitus, psoriasis, syphilis, and fungal infections are some of the most common causes. Although rare, onychogryphosis can be congenital, caused due to certain genetic factors.
Clinical presentation:
More commonly, the toenails are affected. The patient often comes up with complaints of excessive curving of nails. This curving is more commonly seen at the free edges. However, the curving of nail can begin at the cuticle; this can lead to lifting of the nail. The nails grow long and a faster rate of growth is seen. The excess growth and curvature gives a claw-like appearance to the nails. There occurs accumulation of dead debris under the nail bed resulting in yellowish brown discoloration. The nails become brittle and break off easily. Compression and pressure on nails can initiate pain and discomfort. It can make walking a little difficult. Apart from these complaints, the dull and ugly appearance of the nails can be a matter of worry from a cosmetic point of view. Laceration of nail bed and secondary bacterial infections are the common complications seen in such cases.
Investigations
The diagnosis is done on the basis of the symptoms narrated by the patient and physical examination carried out by the dermatologist. Dermoscopic examination is usually sufficient for diagnosis.
Treatment
The treatment plan consists of administration of medication in cases where an infection is present. Avulsion of nail plate is the choice of treatment in this condition. In severe cases where the matrix is damaged, permanent nail removal is recommended.
Other modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the disease. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints.
