Onychauxis

Onychauxis is a medical term used to describe thickening of the nails, also known as hypertrophy of the nails. This condition is characterized by an increase in the width and/or length of the nails, which can become abnormally thick and difficult to cut or trim. Onychauxis can affect any of the nails on the fingers or toes, and can be a result of a variety of underlying causes, including fungal infections, metabolic disorders, and underlying medical conditions.

The nails are composed of a protein called keratin, which is produced by the nail matrix, the area located at the base of the nail. The nails protect the fingertips and toes, and also play a role in sensory perception. The nails are made up of several layers of keratin, and the thickness of the nails is determined by the amount of keratin produced by the nail matrix. In normal nails, the thickness of the nails is regulated by a delicate balance between the production and shedding of keratin.

Causes

Onychauxis refers to the thickening of the nails, which can occur due to a variety of reasons. Here are some of the main causes of onychauxis:

  1. Fungal infections: One of the most common causes of onychauxis is fungal infections, such as onychomycosis. These infections cause the nails to thicken and become discolored, leading to a brittle, crumbly texture. Fungal infections can be caused by a variety of fungi, including dermatophytes, yeasts, and molds, and can be spread through contact with contaminated surfaces or through direct skin-to-skin contact.
  2. Aging: As people age, their nails naturally become thicker and more brittle, due to changes in the structure of the nails and the skin surrounding them. This can lead to onychauxis, which can make it more difficult to perform everyday tasks like typing or buttoning clothes.
  3. Nutritional deficiencies: Nutritional deficiencies, such as a lack of biotin, vitamins B and C, and iron, can also lead to onychauxis. This is because these nutrients play a crucial role in the health and growth of the nails, and a lack of them can cause the nails to become brittle, discolored, and thick.
  4. Medical conditions: Certain medical conditions, such as psoriasis and lichen planus, can also cause onychauxis. These conditions can cause the nails to become thick and discolored, and can make them more susceptible to fungal infections.
  5. Trauma: Physical trauma to the nails, such as from repeated injury or exposure to harsh chemicals, can also lead to onychauxis. This is because the nails are designed to protect the underlying skin and bones, and repeated trauma can cause them to thicken in response.
  6. Nail polish: Regular use of nail polish and other cosmetic products can also cause onychauxis. This is because these products can contain harsh chemicals that can damage the nails and cause them to thicken and become discolored.
  7. Psoriasis: Psoriasis is a chronic skin condition that can cause the nails to become thick and discolored, and can make them more susceptible to fungal infections. This is because psoriasis causes the skin to become inflamed and overgrown, which can cause the nails to thicken and become brittle.
  8. Lichen planus: Lichen planus is a skin condition that can cause the nails to become thick and discolored, and can make them more susceptible to fungal infections. This is because lichen planus causes the skin to become inflamed and overgrown, which can cause the nails to thicken and become brittle.
  9. Eczema: Eczema is a skin condition that can cause the nails to become thick and discolored, and can make them more susceptible to fungal infections. This is because eczema causes the skin to become inflamed and overgrown, which can cause the nails to thicken and become brittle.
  10. Thyroid disease: Thyroid disease, such as hypothyroidism, can also cause onychauxis. This is because the thyroid gland plays a crucial role in the metabolism and growth of the nails, and a lack of thyroid hormones can cause the nails to become thick and brittle.

Symptoms

Onychauxis, also known as nail thickening, is a common nail condition that can affect both fingernails and toenails. This condition is characterized by an increase in the thickness of the nail plate, which can make the nails appear more opaque, yellowish, and brittle. There are several symptoms that are associated with onychauxis, including:

  1. Increased thickness of the nail plate: This is the most prominent symptom of onychauxis and is usually the first sign that a person may have this condition. The nails may appear to be more opaque and may have a yellowish tint to them.
  2. Brittle nails: Nails affected by onychauxis are often brittle and prone to breaking, cracking, or splitting. This can make it difficult to maintain the natural shape of the nails and may also cause discomfort when the nails are touched.
  3. Rough texture: Onychauxis can also cause the nails to have a rough texture, which can be uncomfortable and make it difficult to maintain the natural appearance of the nails.
  4. Discoloration: Nails that are affected by onychauxis may also have a yellowish tint to them. This discoloration can be due to a buildup of keratin, which is a protein that makes up the nail plate.
  5. Fungal infections: Onychauxis can also make the nails more susceptible to fungal infections, which can cause further thickening and discoloration of the nails. Fungal infections can also cause the nails to have a foul odor and may make the nails more difficult to cut.
  6. Pain: In severe cases, onychauxis can cause pain in the nails and surrounding area. This pain may be due to pressure on the nail bed caused by the thickening of the nail plate.
  7. Difficulty with nail care: Onychauxis can make it difficult to maintain the natural shape and appearance of the nails. This can be due to the increased thickness of the nail plate, which can make it difficult to cut the nails, and the increased susceptibility to fungal infections, which can cause further thickening and discoloration of the nails.
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There are several factors that can contribute to the development of onychauxis, including:

  1. Age: Onychauxis is more common in older individuals, and it is estimated that up to 50% of people over the age of 60 may be affected by this condition.
  2. Medical conditions: Certain medical conditions, such as psoriasis, lichen planus, and eczema, can increase the risk of developing onychauxis.
  3. Trauma: Injuries to the nails, such as repeatedly stubbing a toe, can increase the risk of developing onychauxis.
  4. Fungal infections: Fungal infections, such as onychomycosis, can cause the nails to thicken and become discolored, leading to onychauxis.
  5. Medications: Certain medications, such as chemotherapy drugs, can increase the risk of developing onychauxis.
  6. Poor nutrition: A lack of essential vitamins and minerals, such as biotin, can contribute to the development of onychauxis.
  7. Genetics: Onychauxis can also be hereditary, and individuals with a family history of this condition may be more likely to develop it themselves.

Diagnosis

In order to diagnose onychauxis, a number of diagnostic tests may be performed. In this article, we will discuss the main diagnostic tests for onychauxis.

  1. Physical Examination: The first step in diagnosing onychauxis is a physical examination of the nails. This includes a close examination of the thickness, shape, and appearance of the nails. The doctor will also look for any signs of infection, such as redness, swelling, or discharge. They may also press on the nail to check for any pain or tenderness. This examination can help determine the cause of the thickening and determine the best course of treatment.
  2. Nail Clipping: A nail clipping test is a simple and quick way to diagnose onychauxis. A small piece of the nail is clipped and examined under a microscope to look for any signs of fungal infection. If a fungal infection is present, the doctor may prescribe antifungal medication.
  3. KOH Preparation: A KOH (potassium hydroxide) preparation is a test that is used to diagnose fungal infections of the nails. A small piece of the nail is mixed with a drop of KOH on a slide, and the slide is examined under a microscope. If a fungal infection is present, the KOH will dissolve the fungal cells and cause them to become visible under the microscope.
  4. Culture Test: A culture test is a more definitive way to diagnose a fungal infection of the nails. A sample of the infected nail is taken and placed in a culture medium to allow the fungal cells to grow. The culture is then examined under a microscope to identify the type of fungus causing the infection.
  5. Biopsy: In some cases, a biopsy of the nail may be necessary to diagnose onychauxis. A small piece of the nail is removed and examined under a microscope to determine the cause of the thickening. This may be necessary if the cause of the thickening is not obvious or if the doctor suspects that a more serious underlying condition is present.
  6. Blood Tests: In some cases, blood tests may be performed to help diagnose the cause of onychauxis. For example, if the doctor suspects that an underlying medical condition, such as diabetes or a thyroid disorder, is causing the thickening, they may order blood tests to check for these conditions.
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In conclusion, onychauxis is a condition in which the nails become thickened and deformed. There are a number of diagnostic tests that can be performed to diagnose onychauxis, including physical examination, nail clipping, KOH preparation, culture test, biopsy, and blood tests.

Treatment

The treatment of onychauxis depends on the underlying cause and may involve both medical and lifestyle changes.

  1. Topical treatments: Topical treatments for onychauxis include antifungal creams and ointments, topical corticosteroids, and urea-based creams. Antifungal agents such as terbinafine, itraconazole, and clotrimazole are effective in treating fungal infections of the nails, which can cause onychauxis. Topical corticosteroids can help reduce inflammation and itching in cases of onychauxis caused by psoriasis and lichen planus. Urea-based creams can help soften thickened nails, making them easier to cut.
  2. Oral medications: In cases of fungal infections, oral antifungal medications such as terbinafine, itraconazole, and fluconazole may be prescribed. For severe cases of psoriasis and lichen planus, oral corticosteroids or immunosuppressive drugs may be recommended.
  3. Lifestyle changes: Making certain lifestyle changes can also help in the treatment of onychauxis. Keeping the nails dry and clean, wearing gloves while doing household chores and wet work, and avoiding prolonged exposure to water can help prevent fungal infections of the nails. Wearing shoes with proper support and avoiding repetitive trauma to the nails can also help prevent onychauxis.
  4. Debridement: Debridement, or the removal of the thickened portion of the nails, can be performed by a healthcare provider. This may be done using a scalpel or a chemical agent such as urea or salicylic acid. Debridement can help improve the appearance of the nails and make them easier to maintain.
  5. Surgery: In severe cases of onychauxis, surgical removal of the nails may be necessary. This is typically done as a last resort, when other treatments have failed.
  6. Nail care: Proper nail care can help prevent the thickening of the nails and improve their appearance. This includes regularly trimming the nails, using moisturizing creams, and avoiding harsh chemicals.
  7. Supportive therapy: Supportive therapies such as physical therapy and occupational therapy can help improve circulation and reduce the risk of repetitive trauma to the nails.
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It is important to note that the treatment of onychauxis may take several months to show improvement and may require ongoing maintenance. In addition, it is important to address any underlying medical conditions that may be contributing to the thickening of the nails.

In conclusion, onychauxis is a condition that can have a significant impact on the appearance and function of the nails. Treatment options for onychauxis include topical treatments, oral medications, lifestyle changes, debridement, surgery, nail care, and supportive therapy. The most effective treatment plan will depend on the underlying cause of the condition and may involve a combination of these approaches. It is important to work closely with a healthcare provider to develop a personalized treatment plan that addresses your specific needs and goals.

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