Nail Dystrophy | Symptoms, Causes, Treatments, and Prevention

Have you ever seen abnormal changes in the shape, color, texture, and growth of your fingernails or toenails.? Or have you seen this occurring in other people's nails? If you are here reading this article, then you want to find out what is behind these abnormal changes.

This is due to a condition known as nail dystrophy. Yeah, nail dystrophy is commonly diagnosed when abnormal changes occur to a person’s nails.

This article will explain all there is to know about nail dystrophy; what causes it? What is its symptoms? How can it be treated? What can be done to prevent nail dystrophy? And other critical things you need to know about this condition,

Read on.

Nail Dystrophy – What is it?

Nail dystrophy is a nail condition that can develop if chronic nail-biting or injury to the nails disrupts the nail unit, which often inflames the nail matrix. The nails can grow horizontal ridging, depressions, and raised areas.¹https://www.cancer.gov/publications/dictionaries/cancer-terms/def/nail-dystrophy

Nails can become shortened permanently because the distal nail bed becomes keratinized. The cuticles are almost always damaged, disrupting nails' waterproof "seal," causing nails to thin and peel, and increasing the risk of infection. Eventually, scarring can affect the cuticles and matrix, making dystrophy irreversible.

Want to know more about the various nail disorders present including nail dystrophy? If yes, then watch the video below:

Who Gets Nail dystrophy?

Dystrophic nails are common in:

• People over age 65, are more likely to have nail fungal infections.
• People who have a skin condition that affects the nails, such as psoriasis.

Symptoms of Nail Dystrophy

If you have dystrophic nails, your nails might look thick, oddly shaped or colored yellow or brown. The nails can develop horizontal ridging, depressions, and raised areas.

The cuticles are almost always damaged, disrupting nails' waterproof "seal," causing nails to crumble, thin, and peel. There is also a presence of pigmentation on the nails ranging from dark to purple-brown color.

Dystrophic nails are cracked in multiple spots, thicker than normal, yellow, white or brown in color, and are usually pulling away from or coming off the skin under your nail.

Median nail dystrophy (median canaliform dystrophy)

Median nail dystrophy is characterized by small cracks in the nail that extend laterally and look like the branches of an evergreen tree (eg, a fir tree, such as a Christmas tree).

The cracks and ridges are similar to those seen in habit-tic nail deformity (which is dystrophy of the central nail caused by repetitive trauma to the nail matrix resulting from rubbing or picking with another finger). The cause of median nail dystrophy is unknown in some cases, but trauma is thought to play a role.²https://www.sciencedirect.com/topics/medicine-and-dentistry/nail-dystrophy

Frequent use of personal digital devices that subject the nails to repetitive striking has been implicated in several cases. Tacrolimus 0.1% at bedtime without occlusion has been successful when patients stop all activities that might lead to repetitive low-level trauma.

Twenty-nail Dystrophy

Twenty-nail dystrophy (trachyonychia) is a disorder of otherwise healthy children of school age and is characterized by yellowing, pitting, increased friability, and other dystrophic changes that progresses over 6–18 months to involve most or all of the nails giving them a roughened texture.

Although the course is variable, in many cases the dystrophy resolves without scarring over a period of several years. This disorder probably includes a number of conditions that cannot be differentiated unless other cutaneous findings appear.

Causes of Nail Dystrophy

Nail dystrophy is often caused by infection or injury to the nail. It may also be caused by certain conditions, including psoriasis, eczema, nail fungus, warts, cysts, and some tumors.

Changes in nails can also be a sign of chronic heart, lung, liver, or kidney disease. Treatment with certain drugs, including chemotherapy drugs, can also cause changes to the nails. Also called onychodystrophy.

Nail dystrophy (distortion and discoloration of normal nail-plate structure), may result from any traumatic or inflammatory process that involves the nail matrix, nail bed, or surrounding tissues.

Although onychomycosis, the result of dermatophyte fungal infection, is the most common cause of nail dystrophy in adults, it is unusual in children before puberty. Dystrophic nails occur frequently as a complication of trauma or underlying dermatoses, such as psoriasis, atopic dermatitis, and lichen planus.

Trauma to the nail may cause a subungual hematoma, which results in a brown-black discoloration. This is particularly likely following crush injuries. Usually, the diagnosis is simple, unless the trauma is subtle.

Although most hematomas resolve without treatment, large, painful collections of blood may be drained by drilling a small hole in the nail plate using a sterile, large-bore needle. This relieves pain and reduces the risk of infection.

Dark pigmentation at the base of the great toenail, caused by jamming the toe into the end of the shoe at a sudden stop, is called ‘turf toe’ and also results from subungual hemorrhage. This must be differentiated from melanoma and melanonychia.

Hemorrhage may be identified by the presence of purple-brown pigment in the distal nail and normal proximal outgrowth of the nail. In melanonychia, gray-brown streaks of pigment of varying width extend longitudinally from the proximal nail fold of one or several nails.

Although this finding is common in darkly pigmented individuals, it may occur in individuals of any race at any age. Irregular or changing pigment streaks may require a nail biopsy to confirm their innocent nature and exclude melanoma.

Nail biting, grooming, and chronic manipulation of any sort may also result in nail dystrophy. Repeated trauma to the cuticle may produce leukonychia (transverse white lines) and median nail dystrophy.

Psoriasis in the nail matrix results in scattered pits that are larger, deeper, and less numerous than those found in alopecia areata.

Psoriasis of the nail bed, especially under the distal nail, causes separation of the nail plate from the underlying skin (onycholysis) and oil-drop discoloration with heaped-up scaling.

Onycholysis alone, without pits or discoloration, may be caused by trauma, infection, nail-polish hardeners, or phototoxic reactions to drugs such as tetracycline.

How Does Nail Dystrophy Affect the Body? – Is Nail Dystrophy Dangerous?

Dystrophic nails can be painful, especially if they curve into your skin and cause ingrown toenails. You might also be bothered by how your nails look. Even if they don’t hurt, always tell your healthcare provider about any changes to your nails. You may need treatment for the underlying cause.

Is Nail Dystrophy Contagious?

Dystrophic nails can be contagious if they’re caused by toenail fungus.³https://my.clevelandclinic.org/health/diseases/22490-dystrophic-nails But if the problem is caused by trauma or psoriasis, you can’t spread it to others.

Diagnosis of Nail Dystrophy

Dystrophic nails aren't a disease. They’re a sign that something else is wrong with your nails or nail bed. Your healthcare provider will look at your nails and discuss your health history to determine the cause.

Nail dystrophy may accompany other skin disorders and help with their diagnosis. For example, alopecia areata is associated with characteristic Scotch-plaid pitting of the nails.

Your healthcare provider may identify dystrophic nails after looking at your nails. The next step is diagnosing the cause or ruling out health conditions. Tests that can help determine the cause of dystrophic nails include:

Blood tests: Your healthcare provider may test your blood to look for signs of certain health conditions like infections. They’ll collect a sample of your blood with a needle and send it to a lab for analysis.

Nail biopsy: Your healthcare provider takes a small sample of your nail. They send the sample to a lab, where a lab technician looks at it under a microscope. Your healthcare provider may perform this test to check for psoriasis or other skin conditions that affect nails.

Physical exam: During a physical exam, your healthcare provider examines you and evaluates your overall health. You’ll discuss how you feel and any health conditions you have.

Treatment of Nail Dystrophy

Treatment for dystrophic nails depends on the cause. Your treatment may include:

Antibiotics if you have a bacterial infection from an ingrown toenail or nail trauma.

Antifungal creams or pills if you have toenail fungus.

Light therapy, medications, or immunotherapy if you have psoriasis.

You might want to ask your healthcare provider or doctor the following questions when going for treatment:

• What’s the cause of my nail problem?
• What treatment do you recommend?
• What are the side effects of this treatment?
• Will my dystrophic nails go away after I complete treatment?

Prevention of Nail Dystrophy

There isn’t a guaranteed way to prevent dystrophic nails. But you can help prevent toenail fungus if you:

• Change into clean socks at least once a day and anytime your feet get wet. If your shoes get wet, change into a dry pair as soon as you can.
• Don’t share footwear, nail clippers, or towels with others.
• Clip toenails straight across. The fungus can grow under longer nails, and clipping nails in a curved shape can encourage ingrown toenails.
• Wear flip-flops or other shoes in locker rooms and public bathrooms. Don’t go barefoot in public places.

Healthsoothe’s Advice Concerning Nail Dystrophy

Dystrophic nails aren’t a disease, but some conditions that cause it, such as toenail fungus and psoriasis, require medical care. They’re a sign that something else is wrong with your nails or nail bed. Your healthcare provider will look at your nails and discuss your health history to determine the cause.

If you have diabetes, check your feet regularly for cuts and small injuries, including nail problems. Even minor foot injuries and nail problems require medical care because they can lead to infections.

Nail dystrophy may accompany other skin disorders and help with their diagnosis. For example, alopecia areata is associated with characteristic Scotch-plaid pitting of the nails.

Your healthcare provider may identify dystrophic nails after looking at your nails. The next step is diagnosing the cause or ruling out health conditions, and then after that, the recommended treatment is done.

Don’t try to treat dystrophic nails without your healthcare provider’s help. Nail problems can get worse and lead to serious infections, especially if you have diabetes or other health conditions.

If your nail was damaged by trauma, the damaged nail may take several months to grow out. See your healthcare provider so you can discuss the best way to treat your nail while it heals.

Nails are an important indicator of your overall health. If you notice changes to any of your fingernails or toenails, make an appointment with your healthcare provider. Check all of your nails regularly for:

• Changes in nail color, such as spots or streaks.
• Nail shape changes, like becoming more curved or separating from the skin underneath your nail.
• Nail texture changes, such as becoming thicker, thinner, or crumbly.
• Pain or soreness around or under your nail.

Nail dystrophy doesn't have to become a serious problem. The common causes of dystrophic nails — like toenail fungus and psoriasis — are treatable. And if you have diabetes, early treatment of foot and nail problems can prevent complications like infections. Your doctor can pinpoint the cause so you get the right treatment. In many cases, proper treatment will reveal healthy nails again.

Additional resources and citations

• 1
  https://www.cancer.gov/publications/dictionaries/cancer-terms/def/nail-dystrophy
• 2
  https://www.sciencedirect.com/topics/medicine-and-dentistry/nail-dystrophy
• 3
  https://my.clevelandclinic.org/health/diseases/22490-dystrophic-nails