The onychogryphosis It is the thickening or hypertrophy of the nail plate, which consequently produces the elongation and hypercurvature of the nail that takes on the appearance of a snail or horn shell. The nails are clearly epidermal structures that cover the distal and dorsal extremities of the fingers, both of the hands and the feet..
Its most important function is to protect the distal phalanx and its main component is called alpha keratin. This element has a large amount of the amino acids cystine and arginine, in addition to sulfur. Contrary to what is commonly said, calcium is not the element that gives nails hardness or thickness to the skin.
The average growth of fingernails is 3mm per month, while for toenails it is 1.5mm per month. Onychogryphosis or onychogryposis most frequently manifests itself in the toes, or in the large fingers of both the feet and the hands..
It is common to find this pathology in the elderly and, exceptionally, in young people, in which it may be associated with other pathologies or congenital causes.
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Nail pathologies, or onychopathies, are more common than is thought and their causes may be due to internal factors (secondary to systemic pathologies) or external factors (secondary to trauma or nail plate defects).
The mechanism by which it occurs is always due to dysfunctions of the nail matrix, which produces nail cells faster and in greater quantity than it usually would, saturates the nail plate and the nail thickens, being unable to perform a correct cell turnover.
It can occur in patients with congenital pachyonychia, a rare disorder associated with palmoplantar keratoderma (which may be painful), thickening of the nail plate and bed, and whitish oral plaques or cysts.
A dominant allele has been registered in two different families for a certain gene that determines the appearance of onychogryphosis.
Trauma to a nail plate or nail root can cause partial or total destruction or misalignment of the matrix cells, which are responsible for producing or originating the nail body..
Strong trauma is not necessary to produce onychogryphosis. With slight repetitive trauma, such as wearing inappropriate footwear, damage to the nail matrix can also occur.
These matrix cells do not have the capacity to regenerate: when they suffer some damage, they are irreversibly and permanently affected.
That is why the growth of a nail after a trauma will be abnormal, and irregular thickenings will be evidenced in the new nail, as well as a general thickening if the cells were completely affected..
Different causes have been determined that influence the abnormal growth of the nail, essentially in its thickening.
The best known pathophysiological mechanism is the decrease in blood supply to the nail matrix, which produces a dysfunction in these cells that will affect the production of new nail plate.
It is for this reason that the elderly and diabetics are the ones who most frequently suffer from onychogryphosis, since they are the age group with the highest incidence of circulatory pathologies that prevent the correct irrigation of the womb and, consequently, its optimal functioning in the production of new sheet.
Due to the fact that the nails are clearly epidermal structures, some dermatological pathologies can cause thickening of the nails, as well as they produce it in the skin.
Psoriasis is an example of these pathologies. It is an autoimmune disease that produces chronic inflammation of the skin with thickened lesions, which can initially only affect the nails and then spread to the rest of the body.
When it occurs in the nails it is known as nail psoriasis, and it differs from post-traumatic onychogryphosis in that the thickening is uniform and is seen in all the nails.
The exaggerated thickening of the nail prevents their growth in a straight line and they end up curving.
Some nail plates may be thicker in some people and thinner in others, without having any pathological connotations. To determine that the thickening is pathological, the thickness or thickness of the nail must be greater than 0.8 mm.
This thickening is asymmetrical with a deviation to one side, which gives it that horn-like appearance and according to which it receives its name.
Transverse striations are usually evident and have a blackened color, gray tending to black, and even brown and yellow in some cases. They always lose the characteristic shine of the nail and look dull.
In congenital cases it can be evidenced in all 20 nails; otherwise, it can be evidenced only in the toenails or in specific nails if it is post-traumatic. In addition, sometimes calluses and nail residues appear under the nail.
As such, there is no definitive treatment that restores the condition prior to the appearance of onychogryphosis once the nail matrix is destroyed or misaligned.
The treatment has to be carried out by a podiatrist, it is purely mechanical and basically consists of keeping the nail within normal limits, thinning it through the use of electric micromotors..
It is not recommended to perform the procedure at home with normal hygiene instruments, as the nail can break underneath and, in some cases, it will not even be possible to generate any change due to its hardness and thickness..
In some more severe cases, specialists suggest surgical removal of the nail completely. The procedure is performed under anesthesia and the nail is removed, as well as the total destruction of the matrix.
The patient may feel dejected by the aesthetic aspect, but it is the responsibility of the doctor to explain the possible complications that could be triggered by not excision, such as fungal or bacterial infections..
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