Plummer’s nail, also known as Plummer’s nail deformity or Plummer’s nail dystrophy, is a medical condition that affects the toenails and is characterized by thickening and discoloration of the nails. This condition is often accompanied by a loss of the normal curvature of the nail, which can result in the nail becoming more convex or having an irregular shape.
Plummer-Vinson syndrome, also known as Paterson-Brown-Kelly syndrome, is a rare condition that affects the throat and esophagus. It is characterized by a triad of symptoms: dysphagia (difficulty swallowing), iron-deficiency anemia, and atrophic glossitis (smooth, thin tongue). Plummer-Vinson syndrome is most commonly diagnosed in middle-aged women who are suffering from long-term iron-deficiency anemia.
There are several types of Plummer’s nail, including:
- Idiopathic Onycholysis: This type of Plummer’s nail is caused by an unknown underlying medical condition, and is characterized by the separation of the nail from the nail bed.
- Psoriatic Onycholysis: This type of Plummer’s nail is caused by psoriasis, a skin condition that results in the buildup of scaly, red patches on the skin.
- Traumatic Onycholysis: This type of Plummer’s nail is caused by trauma to the nail, such as repeated blows to the nail or wearing tight-fitting shoes that squeeze the toes.
- Fungal Onycholysis: This type of Plummer’s nail is caused by a fungal infection, such as onychomycosis, which can cause the nail to become thick and discolored.
- Bacterial Onycholysis: This type of Plummer’s nail is caused by a bacterial infection, such as paronychia, which can cause the skin around the nail to become red and swollen.
There are many causes of Plummer’s nail, including:
- Fungal infections: The most common cause of Plummer’s nail is a fungal infection. Fungi thrive in warm, moist environments, such as the inside of a shoe, and can easily infect the toenails. Fungal infections can be difficult to treat and often require a combination of antifungal medications, topical treatments, and lifestyle changes to resolve.
- Trauma: Injuries to the toenail, such as stubbing the toe or dropping a heavy object on it, can cause Plummer’s nail. In some cases, the nail may become discolored, thick, or brittle as a result of the injury.
- Chronic diseases: Certain medical conditions, such as diabetes and circulation problems, can increase the risk of Plummer’s nail. These conditions can weaken the immune system and make it more difficult for the body to fight off fungal infections.
- Poor hygiene: Not keeping the feet clean and dry can increase the risk of Plummer’s nail. Fungi thrive in warm, moist environments, so it is important to keep the feet clean and dry, especially after activities such as swimming or sweating.
- Tight shoes: Wearing tight, closed-toe shoes can increase the risk of Plummer’s nail by creating a warm, moist environment for fungi to thrive. It is important to wear shoes that fit well and allow the feet to breathe.
- Nail injuries: Injuries to the toenail, such as cuts or punctures, can increase the risk of Plummer’s nail. These injuries can allow fungi to enter the nail and cause an infection.
- Aging: As people age, their toenails can become thicker and more brittle, making them more susceptible to Plummer’s nail. Older adults are also more likely to have medical conditions that increase the risk of Plummer’s nail.
- Family history: A family history of Plummer’s nail can increase the risk of developing the condition. This may be due to genetics or shared lifestyle habits and risk factors.
- Certain medications: Certain medications, such as antibiotics, can weaken the immune system and increase the risk of Plummer’s nail. Additionally, some medications can cause changes to the toenail that make it more susceptible to fungal infections.
- Exposure to damp environments: Spending a lot of time in damp environments, such as public showers or locker rooms, can increase the risk of Plummer’s nail. Fungi thrive in warm, moist environments, so it is important to keep the feet clean and dry in these environments.
Some common risk factors for Plummer’s nail include:
- Age: Plummer’s nail is more common in older adults, as the nails become less elastic and more brittle with age.
- Medical conditions: Certain medical conditions, such as diabetes, peripheral neuropathy, and psoriasis, can increase the risk of developing Plummer’s nail.
- Trauma: Trauma to the nail, such as repeated blows to the nail or wearing tight-fitting shoes that squeeze the toes, can increase the risk of developing Plummer’s nail.
- Lifestyle factors: Lifestyle factors, such as frequent exposure to water and chemicals, can increase the risk of developing Plummer’s nail.
The main symptoms of Plummer-Vinson syndrome include:
- Dysphagia: This is the most common and prominent symptom of Plummer-Vinson syndrome. Patients experience difficulty swallowing both solids and liquids, and may feel as if food is getting stuck in their throat. This can cause discomfort, pain, and even fear of eating.
- Iron-deficiency anemia: This condition is characterized by low levels of hemoglobin in the blood, which is responsible for carrying oxygen to the body’s tissues. Iron-deficiency anemia can lead to fatigue, weakness, and shortness of breath.
- Atrophic glossitis: This is a condition in which the tongue becomes smooth, thin, and shiny. It may also appear red and inflamed. Atrophic glossitis can cause discomfort, burning, and loss of taste sensations.
- Webbed or narrowed esophagus: In Plummer-Vinson syndrome, the esophagus may become narrowed or obstructed by webs of tissue, making it difficult for food to pass through. This can cause food to get stuck in the esophagus, leading to chest pain, coughing, and choking.
- Fatigue: Plummer-Vinson syndrome can lead to fatigue and weakness, due to the body’s inability to properly absorb iron from food. This can also lead to decreased energy levels and decreased ability to perform daily activities.
- Shortness of breath: Iron-deficiency anemia can lead to decreased oxygen levels in the body, causing shortness of breath and fatigue.
- Weight loss: Patients with Plummer-Vinson syndrome may experience weight loss due to difficulty swallowing and a decreased appetite.
- Dental problems: Plummer-Vinson syndrome can also cause dental problems, such as gingivitis (inflammation of the gums) and tooth decay.
- Increased risk of infections: Plummer-Vinson syndrome can increase the risk of infections, due to decreased immunity and decreased oxygen levels in the body.
- Vitamin deficiencies: Plummer-Vinson syndrome can also lead to deficiencies in vitamins and minerals, such as folic acid, vitamin B12, and calcium.
There are several diagnostic tests that can be used to determine the cause of Plummer’s nail.
- Physical examination: The first step in diagnosing Plummer’s nail is a physical examination of the affected nail. The physician will examine the nail for signs of separation, discoloration, and thickening. They may also look for other signs of infection, such as redness and swelling.
- Nail clippings: A sample of the affected nail can be taken for examination under a microscope. This can help to determine if a fungal infection is present. The sample can also be used for a culture test, which can help to identify the specific type of fungus that is causing the infection.
- Blood tests: Blood tests can be used to check for underlying medical conditions that may be contributing to the development of Plummer’s nail. For example, a thyroid function test can be used to check for an overactive or underactive thyroid gland, which can cause onycholysis.
- Skin scrapings: A skin scraping from the affected area can be taken and examined under a microscope. This can help to determine if a fungal infection is present.
- Biopsy: In some cases, a biopsy of the affected nail may be necessary to make a definitive diagnosis. During a biopsy, a small sample of the affected nail is removed and examined under a microscope. This can help to determine the exact cause of the onycholysis, such as a fungal infection, psoriasis, or a thyroid disorder.
- X-rays: X-rays may be used to check for any underlying bone or joint problems that may be contributing to the development of Plummer’s nail.
- Dermatophyte test medium (DTM) culture: This test is used to culture fungi that may be causing the onycholysis. The sample is placed on a special medium that encourages the growth of fungi. The results of the culture test can help to determine the specific type of fungus that is causing the infection.
- Polymerase chain reaction (PCR) test: The PCR test is a highly sensitive test that can be used to detect the DNA of fungi that may be causing the onycholysis. This test is particularly useful in cases where the fungal infection is difficult to culture.
In addition to these diagnostic tests, the physician may also ask the patient about their medical history and any medications they are currently taking. This information can help to determine if any underlying medical conditions or medications may be contributing to the development of Plummer’s nail.
Here is a list of the main treatments for Plummer’s nail:
- Antifungal medications: Antifungal medications are the most common treatment for Plummer’s nail. These medications can be taken orally or applied topically to the affected nail. Oral antifungal medications include terbinafine (Lamisil) and itraconazole (Sporanox). Topical antifungal medications include ciclopirox (Penlac) and amorolfine (Loceryl).
- Topical ointments and creams: Topical ointments and creams can also be used to treat Plummer’s nail. These products contain antifungal agents that penetrate the nail and help to kill the fungus. Some of the most popular topical ointments and creams include terbinafine (Lamisil) and clotrimazole (Lotrimin).
- Medicated nail polish: Medicated nail polish is another option for treating Plummer’s nail. This type of nail polish contains antifungal agents and is applied directly to the affected nail. Examples of medicated nail polishes include ciclopirox (Penlac) and amorolfine (Loceryl).
- Laser treatment: Laser treatment is a newer form of treatment for Plummer’s nail. This treatment uses a laser to kill the fungus that is causing the infection. Laser treatment is usually done in a doctor’s office and is relatively painless.
- Debridement: Debridement is a procedure in which the affected nail is trimmed and the infected part of the nail is removed. This procedure is often done in conjunction with other treatments, such as antifungal medications or laser treatment. Debridement can help to reduce the thickness and discoloration of the affected nail and allow antifungal medications to penetrate the nail more effectively.
- Home remedies: There are also several home remedies that can be used to treat Plummer’s nail. These remedies include using vinegar, tea tree oil, and baking soda. These remedies are not scientifically proven to be effective, but some people find them helpful.
It is important to note that Plummer’s nail can be a stubborn condition to treat, and it may take several months for the infected nail to completely clear. It is also important to follow proper nail care, such as keeping the nails clean and dry and wearing shoes that allow for good air circulation, in order to prevent reinfection.
Before starting any treatment for Plummer’s nail, it is important to see a doctor or podiatrist to confirm the diagnosis and rule out any underlying medical conditions. The doctor will also be able to recommend the most appropriate treatment based on the severity of the infection and any other underlying health conditions.