Pachyonihia of the nail

In dermatology there is a little-known term "pachyonichia", which means a violation of the structure, density and shape of the nail plate. Such a condition can accompany various diseases, or arise independently - for example, with a hereditary variant of pathology.

In dermatology there is a little-known term "pachyonichia", which means a violation of the structure, density and shape of the nail plate. Such a condition can accompany various diseases, or arise independently - for example, with a hereditary variant of pathology.

[1], [2]

Epidemiology

Pachyonihia is more often found in men and boys. The approximate ratio of sick men to women is 7: 4.

Pachyonihia, as an independent pathology, is relatively rare. More often this symptom accompanies other diseases - dermatological or endocrinological etiology.

[3], [4], [5], [6], [7], [8]

Causes of the pachyonihia

The main reason for the appearance of such a pathology as pachyonichia is a disorder of trophic or nail structuring. Outwardly, such a violation manifests itself in the form of a change in the thickness, shape of the nail plate.

If pahionichia is not congenital, its cause can be candidiasis, chemical effects, inflammatory processes at the base of the nail.

A special role in the formation of pachyonichia is played by such risk factors:

• psoriasis;
• bladder dermatosis;
• red flat lichen;
• ichthyosis;
• alopecia;
• pyoderma;
• eczema.

In the elderly, pachyonichia can be a consequence of worsening capillary circulation of blood and lymph, which can cause a violation of the process of forming the nail in its bed.

In young people, disruption of capillary circulation can be caused by diabetes, metabolic and endocrine disorders.

If they speak of the congenital form of the disease, they usually refer to the Yadasson-Lewandowski syndrome. This is a genetic pathology with several patterns of inheritance, which occurs with a change in the formation of the stratum corneum and nails. In this situation, pachyonihia is the main symptom caused by the incorrect formation of collagen and a violation of the absorption of certain vitamin substances.

[9], [10]

Pathogenesis

Pachyonihia is considered a variety of onychodystrophic diseases. It can be acquired or inherent in nature, associated with certain genetic changes.

Hereditary form of pachyonichia was discovered by doctors-dermatologists Yadasson and Levandovsky one hundred years ago. Acquired pachyonichia occurs much more often and can accompany various dermatological diseases.

Sometimes pachyonihia is found as an age-related feature in patients of senile age.

Since pachyonihia in the vast majority of cases is associated with other diseases or with age-related changes in tissues, many specialists do not single out it in a separate pathology, treating as just a symptom or a painful symptom.

[11], [12], [13], [14], [15], [16], [17]

Symptoms of the pachyonihia

The main distinguishing feature of pachyonihia is coarsening and thickening of the nail. It is not necessary to defeat all nails - one and two nails can be affected. In addition, there are possible phenomena of hyperkeratosis of the skin at the base of the nail plate, a violation of its shape and a change in the color shade.

If the pachyonchia of the nail is one of the symptoms of dermatological diseases, then there may be other signs - for example, a rash, scales on the skin, papules, vesicles, plaques. As a rule, the defeat extends to the base of the nail, and then passes into a full-fledged pachyonihia.

If the disease is caused by a chronic effect on the skin and appendages of chemicals based on alkali, then this state is manifested by the looseness of the structure of the nail, and over time and its thickening. The development of the nail can be disturbed and as a result of the inflammatory reaction, which is a consequence of professional regular adverse effects.

The age-old pachyonihy develops over the growing, over the years. The first signs of age-related damage are turbidity and a change in the color shade of the nail. If a person smokes for many years, the nail can change its color towards yellow and even brown.

Congenital pachyonihia is characterized by the most pronounced clinical picture. Due to the genetic nature of the disease, experts divided it into the following types:

• Jadasson-Lewandowski syndrome (there is an obvious thickening of the nails on the limbs, pain in the feet, there are signs of hyperkeratosis on the inside of the hands and feet);
• Jackson-Lawler syndrome (except thickening of the nails, early appearance of teeth, backwardness in mental development, focal alopecia).

Stages

Congenital pachyonichia can proceed in different ways, depending on the stage and the presence of individual symptom-complexes:

1. Pachyonihia, which is characterized by a symmetrical arrangement of keratoderma and follicular hyperkeratosis.
2. Pachyonihia with symmetric keratoderma, hyperkeratosis and leukokeratosis of mucous tissues.
3. Pachyonihia with keratoderma, hyperkeratosis, leukokeratosis of mucous tissues and cornea.
4. Pachyonihia with keratoderma, hyperkeratosis and pachidermy, against the background of birth defects of the mesoderm (for example, osteopathy).

[18], [19]

Complications and consequences

Pachyonihia refers to diseases that almost do not lend itself to complete cure. It is characterized by periodically exacerbating current, with frequent relapses.

Pahionichia does not pose a threat to the life of the patient, but this condition can negatively affect the self-perception and socialization of a person. Therefore, sometimes such indirect complications as neuroses, depression, alcohol dependence are observed.

In cases of the congenital nature of pachyonichia, a complete loss of the affected nails is possible in the future.

Diagnostics of the pachyonihia

It is not difficult to correctly diagnose pachyonihia for an experienced doctor. Even during the preliminary inspection, he will pay attention to the change of nail plates. However, in order to prescribe the most optimal treatment, it is often necessary to conduct a number of additional diagnostic procedures - first of all, in order to determine the initial cause of the disease.

Inspection allows you to detect such pathologies as eczema, psoriasis, and lichen. And for diagnostics of other diseases that can cause pachyonihia, other diagnostic procedures are almost always required - this concerns, for example, diabetes mellitus or other endocrine and microcirculatory diseases.

Additional tests for pachyonichia:

• general analysis of blood and urine;
• urine analysis for hydroxyproline content;
• blood chemistry;
• a blood test for sugar;
• a blood test for the maintenance of thyroid hormones.

Instrumental diagnostics at pachyonihia:

• Ultrasound of the abdominal cavity;
• Ultrasound of the thyroid gland;
• CT scan;
• angiography.

[20], [21]

Differential diagnosis

Differential diagnosis of pachyonichia is carried out with such diseases:

• anonichia - congenital anomaly, which is accompanied by the absence of nail plates;
• gapalonichia - excessive softness of the nails, which is accompanied by their splitting, changing the shape and appearance of cracks;
• onycholysis - detachment of the nail from the nail base;
• onyorexis - change and splitting of nail plates along longitudinal lines;
• onychisis - transverse cleavage of the nails;
• trachionichia - a kind of onychodystrophic condition, in which the nail becomes dull, scaly and rough;
• dyschromia - change in the color of nails;
• Candidiasis - fungal lesions of nail plates;
• bullous dermatoses, pyococcal paronychia, psoriasis of the nail plates, nail damage with syphilis or gonorrhea.

Congenital pachyonihia or Jadasson's syndrome of Lewandowski should be distinguished from the multiform keratosis of Siemens and Schaefer's syndrome. With Siemens skin keratosis, children often have a rash near the lips, leukoplakia of mucous tissues, and also oligophrenia. With Schaefer's syndrome, cataract and follicular keratosis with atrophy is usually present.

[22], [23], [24]

Treatment of the pachyonihia

Treatment should be comprehensive: it is necessary to influence the cause of pachyonichia and all pathogenetic components, not only providing the necessary medications, but also changing the diet and lifestyle.

Necessarily with pachyonichia prescribe vitamins: retinol 100,000 ED daily for 4-6 weeks, as well as complex products with a sufficient content of iron, calcium.

With indications, thiamine, cyanocobalamin, nicotinic acid, vitamins C and E, aloe extract are prescribed.

A positive effect with pachyonichia is food gelatin:

• 1 tbsp. L. Gelatin is poured into 0.5 liters of cold water, left for 2.5 hours for swelling;
• heated to dissolution;
• drink the cooked volume throughout the day.

The course of treatment with gelatin is usually from 1 to 4 months.

It is recommended to hold hot baths with a water temperature of about 45 ° C, with the addition of baking soda, needle extract, starch, bran. The duration of the bath is from 20 to 40 minutes.

It is possible to carry out contrasting douche of hands, and also to rub molten wax.

Physiotherapeutic treatment of pachyonichia involves the application of paraffin or ozocerite, the use of therapeutic mud. Recommended procedures such as paravertebral diathermy on the affected area, hypodermic oxygen insufflation, massage of the extremities.

According to reviews, with pachyonichia, phonophoresis with Aevit is especially effective (with Fukortsin's pre-treatment of the nail zone). It is also useful to use ointments containing gelatin, vitamin A and / or ichthyol. Phonophoresis is conducted by a course of 12-15 sessions, 15 minutes daily. The mode of phonophoresis is continuous, with an intensity of 0.8 to 1 W per cm². After three months, the course of phonophoresis can be repeated.

Medicines for pachyonchia

	Dosing and Administration	Side effects	Special instructions
Aloe extract	Assign in the form of intramuscular injections, 1 amp. Once a day or every other day.	Rarely, dyspepsia, pain in the zone of drug administration is observed.	The drug can not be used in pregnancy and in children under 12 years.
Calcemin	Take 1 tablet 2 times a day.	Sometimes there may be allergies, bloating, vomiting.	The drug is not prescribed in the presence of kidney stones.
Mertz	Take 1 tablet twice a day.	Possible allergies to the drug.	Do not exceed the dosage of the drug, as this can harm the body.
Aevit	Take 1 capsule daily.	Sometimes there is an allergy.	The drug is not prescribed for children under 14 years.

Alternative treatment

• Once or twice a week, repeat the baths on the basis of warmed vegetable oil, with the addition of an oil solution of vitamin A and lemon juice.
• In a tray with vegetable oil, it is useful to add a little homemade apple cider vinegar.
• With pachyonichia, lotions from a mixture of 5 g of alum, 25 g of glycerin and 70 g of warm water are well helped. Gadgets are applied every night for two weeks.
• Prepare salt baths, using sea salt (without dyes and flavors). Use 1 tbsp. L. Salt per 1 liter of water. The duration of the procedure is 20 minutes.
• Lubricate the affected nails before going to sleep with sea-buckthorn or peach oil. Over put on cotton gloves, which are removed only in the morning.

As an integrated approach, also use herbal treatment: the herbs are taken orally, or used to prepare the trays.

[25], [26], [27]

Herbal Treatment

• At night recommend compressing with infusion of chamomile or sage.
• Regularly you need to rub in the nail plates strong infusions yarrow, St. John's wort, the leaves of the grapes.
• A good remedy is a compress based on aloe or golden mustache. The cut of the plant is applied to the affected nail and pribintovyvayut, leaving for the night.
• Rub oil into the nails of tea tree.

It is equally useful to add celandine or garlic juice to a normal baby cream, as well as a small amount of honey. This cream is rubbed into the affected nails 3-4 times a day, daily.

Homeopathy

Among the homeopathic remedies, only a few drugs are very popular with pachyonichia. To select them it is necessary so: within two weeks there should be an improvement, but if it is not present, it is necessary to try other means.

After the improvement of the condition, you should stop taking the chosen drug, and you can resume it only when the symptoms of pachyonichia resume.

• Silicon (Silica) 6X - 2 granules three times a day;
• Calcarea Carbonica - 2 tablets 2-3 times a day;
• Natrium muratikum - at the beginning of treatment take every 3 hours, then - 2-3 times a day;
• Graphite 12 - 3 granules per night, daily.

When choosing a homeopathic remedy, it is necessary to take into account a specific disorder within the body that led to pachyonichia. There are no direct contraindications to the use of homeopathic remedies.

Surgery

Surgical intervention in many cases is not as effective as expected at first. The appearance of the nail plate after surgical treatment can practically not change. As a rule, the deformation of the nail remains after the operation.

Experts recommend more attention to care for the affected fingers, apply strengthening drugs and external means. An experienced dermatologist will individually explain the peculiarities of caring for altered and thickened nails.

Prevention

Preventative measures consist in qualitative timely treatment of any skin and inflammatory diseases.

In addition, it is important to protect the hands and nails from the negative impact of the environment:

• use protective agents while working with chemicals;
• use properly selected makeup for feet and hands;
• choose high-quality and light shoes that will not deform the foot and nails.

Periodically, you should take complex preparations containing the necessary vitamins and minerals. It is also important to eat right, not allowing the lack of certain substances inside the body.

[28], [29], [30]

Forecast

The prognostic data for pachyonichia is not completely determined: they depend on the underlying cause of the pathology. If the therapy prescribed for pachyonichia is effective, the deformed nail can gradually acquire the appearance of a normal nail plate.

In the congenital variant of pachyonichia, in most cases the prognosis is unfavorable: the majority of patients lose their nails, and also acquire other disorders in the body.

[31], [32], [33]