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HEALTH} under the microscope Onychogryphosis Onychogryphosis refers to nails that have thickened and developed a deep curve. The symptoms of onychogryphosis, also called "ram's horn," include thickening, curving, discoloration, and debris beneath the nail. The curve of a nail damaged by onychogryphosis may appear at the free edge, wrapping around and under the finger, or it may start under, or at, the cuticle of the nail, causing the nail to jut out to the right or left at a severe angle. Onychogryphosis is more common in toenails than in fingernails, and when it does appear on the fingernails, it often affects only one nail. What is it? Onychogryphosis is often caused by trauma or repetitive micro-trauma to the nail or matrix. In toenails, this can be caused by something as common as ill-fitting shoes. In extraordinary cases, damage to the ulnar and median nerves is the initial cause. Those nerves supply impulses to the fingers and without the proper nerve supply, the nails worsen, especially with extended neglect. How do you get it? The pain and pressure of onychogryphosis can be similar to those of a fungal infection of the nails, so it may be necessary for a doctor to take a culture to confirm the absence or presence of fungus. Onychogryphosis is rarely cured, but more commonly it is controlled. Treatment of the condition depends on the cause. For example, direct trauma to an isolated nail or matrix can be permanent, and patients may opt to have the nail permanently removed. However, if the condition is caused by repetitive micro-trauma, such as from shoes or sports cleats, then avoiding the pressure can sometimes improve the condition. Apart from avoiding pressure and trauma to the nails, the best way to manage the nails is to keep them cut short and filed down. In addition, topical medications that contain urea are sometimes prescribed to remove the thickness of the nail and to soften the surrounding tissue. How is it treated? If a client comes in with an existing condition, be cautious. It's possible to think you are thinning out a thick nail, when in reality you are causing small abrasions to damaged tissue. Additionally, the nail bed below may be compromised. Techs should insist upon a release from a dermatologist or other medical professional before manicuring the nails. While any enhancement may improve the look of the hands or feet, there are inherent risks in applying product. Instead, once the client has provided a release from a doctor, work with conservative measures to keep the nail trimmed and smooth. What can a tech do? It is possible for the thickened, rough nail to lacerate the nail bed. When the nail bed is damaged, ulcerations or sores can develop, creating an environment where infection can grow. This is especially true in patients with loss of feeling in their feet. This compounds the problem and increases the danger to the client. What else? Carly Robbins, D.P.M., and Nuzhatun Nia, M.D., contributed to this article 132 | NAILS MAGAZINE | JUNE 2013 For more information about onychogryphosis, log on to www.nailsmag.com/encyclopedia.