Onychauxis is the thickening of one or more nails, resulting in a nail change known as onychauxis affecting the finger or toe nails. The thickening may be uniform or ragged, and this change may concern you, and also be a sign of a systemic condition. Thickened nails can occur on finger or toenails.
Onychauxis can occur due to various causes. The main cause is genetic. However, besides that, mechanical trauma is one of the many possible causes of onychauxis. When the nail is injured or struck many times, this condition arises. Moreover, underlying conditions can also be responsible. One such condition is onychomycosis (Leung et al., 2020). This is a fungal infection of the nail that affects its thickness.
It’s quite easy to determine the onychauxis symptoms. The thickness of the nail is the primary cause of these symptoms. This thickening tends to become more pronounced as time progresses and can also lead to the appearance of a discoloration. The nails can become either pale or yellow and dull in color. This condition can also cause slight pain. In fact, due to their thickness, the nails tend to be pressed against the skin on the finger tips. This causes quite a bit of pain especially when one has to wear shoes or performs other activities which put pressure on the fingers. (Singh & Haneef, 2005)
Onychauxis can cause a series of changes and lesions that can affect nail health and the quality of life of the patient. Thickened nails can cause a feeling of discomfort that can worry the patient, causing aesthetic concern and low self-esteem. In addition, this discomfort can also interfere in the daily life of the patient. Activities such as typing or buttoning buttons can become annoying and unbearable. Thus, they can hinder the performance of daily tasks and may affect the functionality of some activities that are essential to the life of the patient (Ricardo et al., 2025).
Luckily there are many ways to prevent onychauxis. Good nail care, avoiding trauma to the nails and the right footwear can help prevent onychauxis. Cutting, shaping and cleaning the nails will help to prevent thickening and excess growth of the nails. Furthermore, preventing trauma to the nails, such as through poorly fitting footwear for the toes, good hygiene and adequate treatment of fungal infections can all contribute to nail health (Baboun et al., 2024). Depending on the extent of the onychauxis and its cause, the options for treatment are many. For example, if the thickening of the nails is caused by a fungal infection, the mild form of onychauxis can be treated with a topical antifungal cream or lotion. For more severe cases of onychauxis, the oral antifungal medication may be the best option. In addition, in the case of more severe forms of onychauxis, mechanical debridement may be necessary. Debridement is a process of removing thickened parts of the nail, in order to alleviate the discomfort and to enhance the effects of the treatment (Piraccini, 2019).
Onychauxis, the condition of having very thick nails, has various psychological and social implications. Over time, people that have overgrown nails or discolored nails feel very embarrassed because they look unproportionate in relation to the finger, which can cause an drop in self-esteem and therefore it leads to social withdrawal. Many people feel self-conscious about their bodies as they have already learned to admire or criticize themselves, and it is no different when it comes to fingernails as they are in plain sight. Consequently, nail disorders such as onychauxis result in people fearing to come into social situations where their hands need to be exposed, which therefore interferes with their living experience (Albucker et al., 2024).
Early diagnosis and appropriate treatment is important to manage onychauxis optimally. An early diagnosis of the condition allows the most appropriate management strategy to be implemented in order to prevent progression of nail changes. It is recommended that management is undertaken by a dermatologist and/or podiatrist in order to deliver appropriate care. It is also important to look for other contributing conditions that may include fungal infections and/or dermatological conditions (Frowen et al., 2010).
Onychauxis can be managed by the primary healthcare providers by treating the condition and educating the patients on the nail care. The patients need to be instructed regarding correct nail trimming technique, hygiene of nails and avoidance of any harsh substance that can harm the nail plate. The prime intention of educating a patient regarding the nail care is to increase awareness of nail health (Gupta et al., 2017). The knowledge of risk factors and appropriate measures that needs to be adopted for the prevention of onychauxis recurrence can be enhanced (Roy & Lipner, 2021).
All things considered, we should encourage people to pay more attention to nail health as well as realise how much some nail conditions like onychauxis can affect people’s lifestyle. We believe that prevention is the key and if more people recognised the importance of early detection as well as proper nail care techniques, the impact of conditions such as onychauxis would be vastly diminished. If we all did more to protect our nail health, our overall health would also improve (Pham & Pham, 2025).
Citations:
Leung, A.K., Lam, J.M., Leong, K.F., Hon, K.L., Barankin, B., Leung, A.A. and Wong, A.H., 2020. Onychomycosis: an updated review. Recent patents on inflammation & allergy drug discovery, 14(1), pp.32-45. https://www.benthamdirect.com/content/journals/iad/10.2174/1872213X13666191026090713
Singh, G. and Haneef, N.S., 2005. Nail changes and disorders among the elderly. Indian Journal of Dermatology, Venereology and Leprology, 71, p.386. https://ijdvl.com/nail-changes-and-disorders-among-the-elderly/
Ricardo, J.W., Dominguez-Cherit, J., Haneke, E., Rana, J., Richert, B., Tosti, A., Vlahovic, T.C. and Lipner, S.R., 2025. Evaluation and management of mechanical and structural nail disorders: A clinical review. Journal of the American Academy of Dermatology. https://www.sciencedirect.com/science/article/pii/S0190962225032232
Baboun, D., Yaghi, M., Keri, J.E. and Morrison, B.W., 2024. Natural Treatment Options for Nail Disorders. Skin appendage disorders, 10(2), pp.83-91. https://karger.com/sad/article/10/2/83/870533
Albucker, S.J., Conway, J. and Lipner, S.R., 2024. Nails in older adults. Annals of Medicine, 56(1), p.2336989. https://www.tandfonline.com/doi/abs/10.1080/07853890.2024.2336989
Frowen, P., O’Donnell, M. and Burrow, J.G., 2010. Neale’s Disorders of the Foot. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=wM3WT4RCzmUC&oi=fnd&pg=PP1&dq=Onychauxis+treatment+causes+symptoms+overview&ots=CrM5CieZXY&sig=VW4WW41meTFTqBNSwEWCqAGHyAk
Piraccini, B.M., 2019. Drug‐induced nail disorders. Baran & Dawber’s Diseases of the Nails and their Management, pp.574-603. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119323396.ch16
Roy, B. and Lipner, S.R., 2021. A review of nail changes in acrokeratosis paraneoplastica (Bazex syndrome). Skin Appendage Disorders, 7(3), pp.163-172. https://karger.com/sad/article-abstract/7/3/163/295176
Damasco, F.M., Geskin, L.J. and Akilov, O.E., 2019. Nail changes in Sezary syndrome: a single-center study and review of the literature. Journal of Cutaneous Medicine and Surgery, 23(4), pp.380-387. https://journals.sagepub.com/doi/abs/10.1177/1203475419839937
Pham, G.M. and Pham, R.N., 2025. Dermoscopy-aided diagnosis of uncommon onychauxis in a 21-year-old: A case report and review of the literature. IDCases, 41, p.e02306. https://www.sciencedirect.com/science/article/pii/S2214250925001623
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