Nail Clubbing
Clinical features
- Most often associated with disease, eg lung cancer, TB, abscess, cyanotic congenital heart disease, chronic hypoxia, bacterial endocarditis, Crohn's, ulcerative colitis, malabsorption, cirrhosis, hyperthyroidism.
- Familial.
- Affects finger and toe nails.
- Gradual onset of loss of the normal angle between the nail bed and the nail fold.
- Nail fold and nail show increased convexity.
- Thickening of the soft tissue alone or all of the terminal phalanges of the digit so it appears like a drumstick.
- Skin and nail appear shiny.
- Painless.
Management
- Seek a cause by taking a history and examining the patient.
- Reversal of the changes may occur if the underlying condition is treated.
Pincer (involuted nails)
Clinical features
- May be of congenital origin and present at birth.
- Occasionally family history of the condition.
- May develop later in life due to tightly fitting footwear with pressure on the nail plate.
- Malnutrition may be a risk factor.
- Most commonly affects the big toe.
- Inward curving of the nail toward the nail bed at the medial and/or the lateral margins.
- Causes reduction in circulation to the nail and matrix.
- May cut into the sulcus leading to painful ulceration and the risk of infection.
Management
- Careful manicure of nails and reduction of thickening of the incurved edges is sufficient in minor cases.
- Footwear advice.
- A nail brace to lift the nail and reduce pressure may help to ease minor problems.
- In more severe cases, partial nail avulsion may be required.
- In very severe cases, total avulsion of the nail and destruction of the matrix may be necessary.
- Newer approaches aim to restore the shape of the nail with dermal grafts.
