Hi everyone Today`s topic is Onychogryphosis (Nail Condition). So Onychogryphosis is going to be a nail condition. So it's a disorder involving abnormal growth of the nail plate so it is an acquired condition although there are congenital forms of this condition where all males are affected at an early age we're not going to talk about the congenital form we're only going to talk about the acquired form of this condition so Onychogryphosis involves a thickened and discolored nail and it is often caused by repetitive minor trauma.
We'll talk a bit more about this
when we talk about the causes of Onychogryphosis, in the next slide now the
pathophysiology behind why Onychogryphosis occurs is because of hypertrophy of
the nail plate so the nail itself, this is the nail plate and it becomes hypertrophic
and this leads to abnormally thickened nails now this condition occurs most commonly
in older adults we see it as patients get older, especially above the age of 60
and 65 and in fact, some studies have found that the prevalence may be anywhere
from 11 to 18% of the elderly population that is affected with Onychogryphosis.
Now let's talk about the causes of Onychogryphosis,
so one of them is going to be increasing age as mentioned as the patient gets
older they're more likely to have this condition and it may be due to some associated
factors of increasing age we're going to talk about here in a moment another
important risk factor and cause of Onychogryphosis is the trauma we mentioned that
many cases of this condition are due to repetitive and minor trauma so this can
be anything from dropping something heavy on your toe-nail to running in very
tight shoes so having your toe-nails hitting against a tight shoe or tight
sneaker repeatedly can lead to Onychogryphosis and any injury to the foot or
damage to the foot can also cause this condition as well along with the
repetitive trauma that we talked about before tight fitting footwear is also
another important risk factor and cause of Onychogryphosis.
Again these tie in with what we just mentioned if a patient is wearing very tight shoes or footwear the nails can repeatedly hit up against the edge of the footwear and this can cause and lead to hypertrophy of the nail plate and eventual Onychogryphosis. Another important risk factor for getting Onychogryphosis is poor self-care so not cleaning nails or feet routinely and not cutting nails routinely can all tie in with poor self-care and can tie with our previous risk factor being increasing age. Another important risk factor of getting Onychogryphosis is poor circulation so anything that can cause poor circulation so if there are varicose veins or if there's a peripheral vascular disease can all increase the risk of getting Onychogryphosis and again this ties in with an increasing age certain dermatological conditions can also increase the risk of Onychogryphosis and some of the dermatological conditions that are associated with Onychogryphosis, include pemphigus Vulgaris, ichthyosis Vulgaris, and psoriasis and infectious diseases can also increase the risk of Onychogryphosis.
One of them is going to be Onychogryphosis
which is an infection of the nail by a fungus a fungal infection of the nail
can increase the risk of this condition but we can also see it with other
infections like syphilis so some infectious diseases can increase the risk of Onychogryphosis,
so what we're going to see most commonly in Onychogryphosis is that the helix
or the big toe is going to be most commonly affected, so we can see the toe-nails
growing and look like this so they can often be described as curved and what
we can often see is that they can be very thickened and they can grow and often
will curve in toward the other nails so if it's the big toe it can often curve
in toward the other toe-nails it can be described as claw-like and it can often
be described as a ram's horn so it can look like a ram's horn there can be the elongation of the nail.
The nail can become very long it can
be very difficult for patients to deal with and to clip or cut these nails and
it can become very thickened so it can become hyperkeratosis again it can be
curved or claw-like can become elongated and thickened and other important
characteristics of these nails include the fact that they are opaque so you
can't see through the nail like a normal nail you could see underneath the nail
plate but with onechogryphotic nails, you can't they are opaque and they become
discolored they become yellow to brown in coloration so they look like this
they have this particular color to them we can also see pain and discomfort occurring
if they are left untreated.
You can imagine trying to walk
around with these onechogryphotic nails can be very difficult for patients. There can be certain complications if patients have these nails for too long. One of them can be parinica so there can be an infection of the tissue
surrounding the nail there can be an increased risk of onechocryptosis which is an
ingrown toenail and there can be secondary onychomycosis. Onychomycosis is a
fungal infection of the nail where the nail becomes yellow in coloration but
becomes more brittle as the fungi digest the pin.
So let's talk about how clinicians diagnose
and treat Onychogryphosis this is going to be a clinical diagnosis simply by
looking at the nail seeing the thickening of the nail the elongation and the
claw-like or curved appearance of the nail along with the discoloration of the
nail is often enough to make the diagnosis and if there is some question as to
whether or not the nail is Onychogryphosis or onechomycosis a KOH prep can be
used to rule out onychomycosis that fungal infection of the nail. So this is
what onychomycosis can look like there are certain similarities between the two
conditions including the nail being opaque and discolored usually yellow to brown
as well but the big difference is that it's not going to be a hyper carotid nail
it's not going to be thickened and it's going to be often brittle as that fungi
digest the nail so it's not going to have those other characteristics we talked
about before including that elongation of the nail thickening of the nail and
curve-like nature to the nail once this condition has been diagnosed how is it
treated so it's important to limit the pressure on the nail bed this is going
to be key in preventing further growth of the nail and further issues with the
nail itself.
So some of these ways of limiting
the pressure include either changing the way the patient exercises or changing
their footwear and many times it can be by finding better fitting footwear
meaning that they don't have tight-fitting footwear anymore and improving
self-care and clipping the nails can also be important in Onychogryphosis and
preventing it from occurring in the future other ways to treat this condition
include mechanical debridement. So the nails can be so thick that it can be
important to actually have a mechanical procedure to debride the nail, nail
avulsion can also be performed in some patients as well to actually rid them of
the nail, and then in some cases, a matricectomy can be performed and this is
where the matrix of the nail is removed if you want.
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