Onychodystrophy is the medical term for a wide range of nail disorders that can arise from infections or other underlying conditions. When you have onychodystrophy, your nails might look or function differently than they should.
Onychodystrophy can affect any part of your nail, including the:
- matrix
- plate
- bed
- folds
Because there are so many potential causes and contributing factors, it’s important to get a proper diagnosis if you suspect you have dystrophic nails. Dystrophic toenails are a common problem, and a thorough evaluation is a must, since the changes in your nails can be caused by something as simple as a fungal infection or as serious as cancer.
Getting the correct diagnosis is critical for getting effective dystrophic nails treatment and ruling out any underlying systemic diseases or malignancies.
This article will give you a general overview of dystrophic nails, including their causes, how they’re diagnosed, and common treatment options. We’ll talk about infections, systemic conditions, trauma, and even cancer.
Anatomy and physiology of the nail unit
To really understand dystrophic nails, it helps to know how your nails work. Here’s the basic rundown.
Components of the nail unit
Your nail isn’t just one thing. It’s a whole team of parts working together. The key players are:
- The nail matrix
- The nail plate
- The nail bed
- The proximal nail fold
- The lateral nail folds
- The hyponychium
Nail growth and function
The nail matrix is where the magic happens. It’s responsible for making the nail plate. How fast your nails grow depends on which finger or toe we’re talking about, and also on your own body’s quirks.
Nails do more than just look pretty (or, in the case of dystrophic nails, not so pretty). They protect your fingertips and toes, help with delicate movements, and can even give clues about what’s going on with your overall health.
Importance in onychodystrophy
Knowing how the nail unit is supposed to work is super important for figuring out what’s wrong when you’ve got nail dystrophy. It helps doctors recognize and diagnose the different kinds of nail problems.
Infectious Causes of Nail Dystrophy
Several different types of infections can cause nail dystrophy.
Onychomycosis (Fungal Infections)
Onychomycosis, also known as a fungal nail infection, is a very common cause of nail dystrophy. In fact, fungal infections account for a large percentage of all nail disorders. Toenail onychomycosis makes up about half of all nail dystrophy cases.
Diagnosis
If your doctor thinks you have a fungal nail infection, they will likely take a sample of your nail to confirm the diagnosis. They can use several different tests, including:
- KOH examination
- PAS stain
- Fungal culture
- PCR testing
Treatment Options
Treatment for fungal nail infections can include topical or oral antifungal medications, depending on how severe the infection is. Terbinafine, an oral antifungal, has been shown to be very effective in treating toenail onychomycosis.
Other Infections
Besides fungal infections, other types of infections can also lead to nail dystrophy.
Bacterial Infections
Bacterial infections, such as paronychia (an infection of the skin around the nail), can cause nail dystrophy.
Parasitic Infections
Though rare, parasitic infections can sometimes affect the nail unit and cause dystrophy.
What can cause onychodystrophy besides infections?
There are a number of non-infectious reasons for nails to become dystrophic. Here are a few:
Skin conditions
Psoriasis
If you have psoriasis, there’s about an 80% chance that your nails will be affected. Nail psoriasis can be disabling. Nail changes from psoriasis can include, sometimes leading to onycholysis:
- Pitting
- Onycholysis (nail separation from the nail bed)
- Subungual hyperkeratosis (buildup under the nail)
- Nail plate thickening
Lichen planus
Lichen planus can cause nails to become thin or ridged. It can also cause pterygium formation, which is when the skin of the nail fold grows forward and attaches to the nail bed.
Eczema and dermatitis
Eczema, especially on the fingertips, can affect the nails. Allergic reactions can also cause nail changes. Patch testing can help identify the source of allergic reactions.
Systemic diseases
Peripheral arterial disease (PAD)
PAD reduces blood flow to the extremities, and that can cause changes in the nails.
Sarcoidosis
Sarcoidosis can affect the nails, causing them to become dystrophic.
Trauma
Acute trauma
Sudden injuries can cause subungual hematoma (blood under the nail), nail plate avulsion (nail tearing away from the nail bed), and other nail damage. “Turf toe,” which happens often to athletes, is one cause of subungual hemorrhage.
Chronic trauma
Ongoing minor injuries, like those caused by ill-fitting shoes, can make nails become thick and deformed. Orthotics or shoe modifications may help relieve the pain of trauma-related symptoms.
Drug-induced onychodystrophy
Chemotherapy
Cancer treatments like chemotherapy and targeted therapies can cause a variety of nail changes. These include onycholysis, nail plate thinning, and changes in pigmentation.
Other medications
A wide variety of drugs can cause nail changes. These can range from changes in color to nail shedding and scarring of the nail matrix (where the nail begins to grow).
Neoplastic considerations in onychodystrophy
Nail tumors
Although onychodystrophy is most often caused by injury or infection, sometimes it can be a sign of a more serious condition, such as a tumor.
Melanoma
Nail melanoma, especially amelanotic melanoma (melanoma without pigment) can look like onychodystrophy. That’s why it’s important to get a prompt diagnosis and treatment. About 20 to 33 percent of all nail melanomas are amelanotic.
If you have a history of onychodystrophy in a single nail, you should be especially aware of the potential for melanoma and see a healthcare provider for a diagnosis.
Squamous cell carcinoma
Squamous cell carcinoma, another type of skin cancer, can also affect the nail unit and cause onychodystrophy, potentially destroying the nail structure.
Other tumors
Other nail tumors, such as onychomatricoma and basal cell carcinoma, may also need to be considered as possible causes of onychodystrophy.
Diagnostic evaluation
Biopsy
A nail biopsy is essential to confirm whether a nail tumor is causing the onychodystrophy.
Imaging
Imaging studies, such as X-rays or MRI, may be needed to see how far the tumor has spread.
Specific Nail Dystrophies and Syndromes
Sometimes, a nail dystrophy can be linked to a specific syndrome or condition.
Yellow Nail Syndrome
Yellow nail syndrome is easy to spot because it involves nails that are yellow and thick. It can also be associated with lymphedema, which is swelling due to a blockage in the lymphatic system, and respiratory problems.
If you have yellow nail syndrome, your nails may grow more slowly and become thicker than they once were.
Treatments your doctor may suggest are topical vitamin E and itraconazole pulse therapy, which is an antifungal treatment.
Median Nail Dystrophy
Median nail dystrophy is a rare condition in which a split occurs down the length of the nail plate, often on the thumbs.
In one case, median nail dystrophy improved with the use of tacrolimus 0.1% ointment, which is a topical immunosuppressant.
Habit-Tic Dystrophy
Habit-tic dystrophy is the result of repetitive damage to the nail, often from picking or rubbing at the nails.
The most important management strategy is to stop the habit. Protecting the nail from further damage can also help.
Diagnosing dystrophic nails
When your nails change, it’s worth finding out what’s going on.
To diagnose the cause of nail dystrophy, doctors use several approaches.
Patient history
Doctors will want to know all about your medical history, including:
- any trauma to your nails
- any skin conditions or other dermatological issues
- any surgeries you’ve had
- any medications you take
They’ll also want to know what you do for work, what habits you have, and any other medical conditions you have.
If you have dystrophy in just one nail, your doctor will want to rule out any malignancy, especially if it’s been going on for a long time.
Clinical examination
Your doctor will examine the nails and note their color, shape, thickness, and any changes to the surface.
They may use a dermatoscope (onychoscopy) to get a closer look at your nail.
Diagnostic testing
You may need to have lab tests to confirm the diagnosis.
Your doctor may want to take a sample from your nail for microscopic examination or culture to see if an infection is involved.
In some cases, imaging studies may be necessary to look for any bone or soft tissue issues under the nail.
How to treat nail dystrophy
Treatments for nail dystrophy depend on the underlying cause. Here are a few approaches your doctor may recommend.
Treating underlying causes
Treating the underlying cause is the first step in addressing nail dystrophy. For example:
- Infections If an infection is the cause, your doctor can prescribe antimicrobial or antifungal medications to get rid of it.
- Systemic diseases If nail dystrophy is caused by a systemic illness, treating or managing the condition may help improve nail health.
Topical therapies
Your doctor may prescribe topical medications to treat nail dystrophy, such as:
- Antifungals If nail dystrophy is caused by a fungal infection, topical antifungals can help eliminate the infection and restore the nail’s appearance.
- Corticosteroids Topical corticosteroids may also be prescribed to reduce inflammation and promote nail growth.
Systemic therapies
In some cases, systemic medications may be necessary to treat nail dystrophy. For example:
- Antifungals Severe fungal infections may require oral antifungal medications, such as terbinafine, to effectively eliminate the infection.
Surgical interventions
In rare cases, surgical interventions may be necessary to treat nail dystrophy. For example:
- Nail avulsion In severe cases of nail dystrophy, nail avulsion (removal of the nail) may be necessary to diagnose the underlying cause or to treat severe nail deformities.
Remember to monitor dystrophic toenails regularly for any changes. If you notice any unusual symptoms, consult with your doctor for further evaluation and treatment.
Frequently Asked Questions
Is nail dystrophy permanent?
Whether nail dystrophy is permanent depends entirely on the underlying cause. If it’s due to a correctable issue like a fungal infection or vitamin deficiency, treatment can often restore normal nail growth. However, if the dystrophy stems from a genetic condition, injury, or chronic illness, the changes may be permanent, though management strategies can improve the nail’s appearance and comfort.
What does Vicks VapoRub do for thick toenails?
Vicks VapoRub contains ingredients like camphor and eucalyptus oil, which some people believe can soften thick toenails and potentially inhibit fungal growth. While anecdotal evidence suggests it might help, there’s limited scientific research to support its effectiveness as a primary treatment for nail dystrophy or fungal infections. It’s generally considered a complementary or temporary measure.
How do you treat nail dystrophy?
Treating nail dystrophy involves identifying and addressing the underlying cause. This might include antifungal medications (oral or topical) for fungal infections, nutritional supplements for deficiencies, or managing underlying medical conditions. Other treatments may include nail trimming and filing, topical treatments to soften the nail, or, in severe cases, surgical nail removal. It’s crucial to consult a dermatologist or podiatrist for a proper diagnosis and personalized treatment plan.
The Bottom Line
Onychodystrophy is a tricky condition because it can be caused by so many things, from infections and injuries to serious illnesses like cancer. Because of this, it’s important to work with your doctor to figure out exactly what’s causing your nail problems.
To figure out what’s going on, your doctor will need to ask you questions about your health history, examine your nails, and possibly run some tests. Getting the right diagnosis is key to getting effective treatment.
Scientists are always working on new and better ways to treat nail problems. For example, they’re exploring whether nail patches might help deliver medications more effectively. As research continues, hopefully we’ll have even more options for managing dystrophic nails in the future.