Unraveling Onychophosis: Causes, Symptoms, and Treatment Options Impacting Nail Health and Well-Being

What is onychophosis? Onychophosis is a condition affecting the nails and is characterized by various abnormalities such as thickening, colour change and pain. Read this article to find out more about the condition, the possible causes and prevalence of onychophosis. Onychophosis can occur as a result of a number of factors. These include: Trauma to the nail plate resulting from, for example, a finger being knocked, or due to repetitive actions on the nail plate, such as trimming or cutting the nails. Fungal infections by a type of fungus that grows under the nail or in the tissue behind the nail plate. The signs and symptoms of fungal infections of the nail include hyper-pigmentation, thickening of the nail plate, and changes to the nail surface including scaling and elevation of the nail plate. Dermatological conditions, such as psoriasis or eczema that develop around the nail plate and lead to changes in the nail plate itself. These conditions can cause morphological changes in the nail plate. Reference: Gupta A, Tristano C, Patel V. Onychophosis. [Updated 2020 Jun 12]. In: StatPearls [Internet]. Bethesda (MD): National Center for Biotechnology Information (NCBI). Available from: https://www.ncbi.nlm.nih.gov/books/NBK536863/ Leung A, Yim JWM, Lio P. Eczema. [Updated 2020 Mar 15]. In: StatPearls [Internet]. Bethesda (MD): National Center for Biotechnology Information (NCBI). Available from: https://www.ncbi.nlm.nih.gov/books/NBK513250/

Fact is Onychophosis is not an uncommon condition. In other words it is not rare. Any one of any age can suffer from onychophosis but, rather like Onychomycosis it has a predilection for particular groups of people. Tradesman, for example, are likely to get onychophosis as they have to do a great amount of work with their hands and indeed often on their feet as well. People with a poor immunity may also get it. Similarly people having any skin condition are prone to having onychophosis as well.

Onychophosis symptoms can vary widely from person to person and from one toe to another. Thickened nails are one of the more common manifestations of the condition and can cause difficulty in cutting the nail down to size. This difficulty in nail trimming can further lead to discomfort and irritation. Discoloration can also be present, where the plate becomes yellow, brown, or even black. Pain is also reported when the plate becomes uneven and is further irritated by inflammation in the skin surrounding the nail plate. Severely, the nail can separate from the nail bed; and this too can cause pain, as well as considerable psychological distress (Piraccini & Alessandrini, 2015; Westerberg & Voyack, 2013).

While nail conditions may seem like a trivial issue, the impact on the quality of life can be more than one realises. Onychophosis is more than a cosmetic concern. Having a nail condition that can easily be seen can cause emotional trauma and self-consciousness to a degree that affects the person’s personal and professional life. Individuals with highly visible nail changes like those present in onychophosis may tend to keep their hands hidden in order to avoid embarrassing remarks and advance feelings of shame and embarrassment. Thus, a vicious cycle of social withdrawal leading to increased depression and/or anxiety can be initiated. In extreme cases, the emotional burden of living with severe pain from a condition like onychophosis, in addition to the distress caused by unsightly nails, may progress into a clinical psychiatric condition such as clinical depression and/or anxiety disorder (Zaraa et al., 2024).

It is very important to know about onychophosis in order to realise its impact on the physical beauty, health and on mental wellbeing. The best way to manage onychophosis is to find out the causes and effects of the condition and get cured by applying suitable remedies if the symptoms are detected at the initial stages itself. There are several methods by which onychophosis can be cured and the method adopted varies depending on the intensity of the symptoms. While some common methods of medication that have to be taken orally may have to be administered in cases of moderate to severe onychophosis (Gupta et al., 2017; Falotico & Lipner, 2022), topical medication that forms the cream or solution for applying on the nails have to be taken in mild cases of onychophosis (Gupta et al., 2018; Geizhals & Lipner, 2019).

Besides medications, the education of the patients is also very important. They need to learn how to manage the cause and manifestations of their nail disorders to improve their quality of life. In fact, appropriate nail care measures would play a pivotal role. Basic hygiene practices such as appropriate nail trimming, keeping the nails and paronisha dry as well as avoiding tight shoe wear can aid in alleviating the condition (Pasch, 2016).

Fungal infections of the nail can also be treated by controlling the fungal infection by changing the patients’ lifestyle. This can start with something simple such as wearing new socks made of dry material to help reduce the moisture between the toes as high levels of moisture on the skin and feet act as a conducive environment for fungal infections. Improving the general health of the individual by taking adequate amounts of nutrients is also important in order to fight-off the infections. Once the treatment is done for curing fungal infections, the nail health is also said to improve largely and this therefore has a great effect on the health of the individual.

Emotional health is an important part of treating onychophosis. Having nail problems can cause high levels of stress and anxiety. Patients may also feel embarrassed and depressed, which could negatively impact their quality of life. Treating only the physical symptoms of onychophosis and ignoring the emotional effects that accompany it is not optimal (Leung et al., 2020; Gupta et al., 2018). Psychologists or joining a support group may be helpful.

Treating onychophosis requires a holistic approach. It is therefore important to combine a treatment with medications, as well as educational, behavioral and psychological elements. This approach can not only improve the condition of the nails, but also the quality of life of the affected patient. Although the treatments with drugs can improve the condition of the nails, a non-medical approach is necessary to build up a good base in order to prevent future nail problems.

Citations:

Gupta, A.K., Stec, N., Summerbell, R.C., Shear, N.H., Piguet, V., Tosti, A. and Piraccini, B.M., 2020. Onychomycosis: a review. Journal of the European Academy of Dermatology and Venereology, 34(9), pp.1972-1990. https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.16394

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

Piraccini, B.M. and Alessandrini, A., 2015. Onychomycosis: a review. Journal of Fungi, 1(1), pp.30-43. https://www.mdpi.com/2309-608x/1/1/30

Westerberg, D.P. and Voyack, M.J., 2013. Onychomycosis: current trends in diagnosis and treatment. American family physician, 88(11), pp.762-770. https://www.aafp.org/pubs/afp/issues/2013/1201/p762.html

Zaraa, I., Dehavay, F. and Richert, B., 2024. Onychomycosis. Hand Surgery and Rehabilitation, 43, p.101638. https://www.sciencedirect.com/science/article/pii/S2468122924000070

Gupta, A.K., Versteeg, S.G. and Shear, N.H., 2017. Onychomycosis in the 21st century: an update on diagnosis, epidemiology, and treatment. Journal of cutaneous medicine and surgery, 21(6), pp.525-539. https://journals.sagepub.com/doi/abs/10.1177/1203475417716362

Falotico, J.M. and Lipner, S.R., 2022. Updated perspectives on the diagnosis and management of onychomycosis. Clinical, Cosmetic and Investigational Dermatology, pp.1933-1957. https://www.tandfonline.com/doi/abs/10.2147/CCID.S362635

Gupta, A.K., Mays, R.R., Versteeg, S.G., Shear, N.H. and Piguet, V., 2018. Update on current approaches to diagnosis and treatment of onychomycosis. Expert Review of Anti-Infective Therapy, 16(12), pp.929-938. https://www.tandfonline.com/doi/abs/10.1080/14787210.2018.1544891

Geizhals, S. and Lipner, S.R., 2019. Review of onychocryptosis: epidemiology, pathogenesis, risk factors, diagnosis and treatment. Dermatology online journal, 25(9). https://escholarship.org/uc/item/9985w2n0

Pasch, M.C., 2016. Nail psoriasis: a review of treatment options. Drugs, 76(6), pp.675-705. https://link.springer.com/article/10.1007/s40265-016-0564-5