At a Glance - Nail clubbing versus pincer nails

Contributed by Dr Jean Watkins, a sessional GP in Hampshire.

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.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

BMA mourns 'dark death toll' as UK passes 100,000 COVID-19 deaths

BMA mourns 'dark death toll' as UK passes 100,000 COVID-19 deaths

More than 100,000 people have now died from COVID-19 in the UK, five times the death...

UK COVID-19 vaccination programme tracker

UK COVID-19 vaccination programme tracker

GPs across the UK are playing a leading role in the largest-ever NHS vaccination...

Viewpoint: End-of-life care in care homes goes well beyond COVID-19

Viewpoint: End-of-life care in care homes goes well beyond COVID-19

Best practice standards for GPs and teams caring for older people in care homes -...

Locum GPs left behind in patchy COVID-19 vaccine rollout

Locum GPs left behind in patchy COVID-19 vaccine rollout

COVID-19 vaccination for locum GPs has trailed behind the rollout to other doctors,...

Four in five over-80s have had first COVID-19 jab despite weekend slump in vaccinations

Four in five over-80s have had first COVID-19 jab despite weekend slump in vaccinations

Almost 80% of people aged over 80 in the UK have have had at least one dose of COVID-19...

Fitness to practise and revalidation to continue despite pandemic, GMC confirms

Fitness to practise and revalidation to continue despite pandemic, GMC confirms

Revalidation and ongoing fitness to practise cases will continue despite huge pressure...