onychogryphosis

What happened to the nails on this 69-year-old's toes?

David L. Kaplan, MD-Series Editor
University of Missouri Kansas City, University of Kansas

Dr Kaplan is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine.  He practices adult and pediatric dermatology in Overland Park, Kansas. 

Volume 52 - Issue 4 - April 2012

onychogryphosis

A 69-year-old man is disturbed by the condition of the nails on both great toes.

What does this look like to you?

A. Onychomadesis.

B. Onycholysis.

C. Onychogryphosis.

D. Trachyonychia.

E. Onychoschizia.

(Answer on next page.)
 

onychogryphosis

Answer: Onychogryphosis

This condition is onychogryphosis, C, hypertrophy of the nails that leads to curved growth and a claw-like configuration. Onychogryphosis usually affects the nail of the great toe; it can be caused by trauma, hallux valgus, chronic venous insufficiency, and epidermal dysplasias. Filing the nail and applications of urea paste may ease the condition; nail removal or matrixectomy may be necessary in resistant cases.

Onychomadesis is nail shedding; onycholysis is separation of the nail plate from the nail bed. Rough, brittle nails characterize trachyonychia; lamellar splitting of the distal nail plate is onychoschizia.