special nails problems

diopathic or primary clubbing is rare, while the occurrence of secondary clubbing depends on the underlying disease.

Primary digital clubbing has been reported to occur in 89% of patients diagnosed with pachydermoperiostosis. This syndrome most often occurs in young males.

Of patients with idiopathic pulmonary fibrosis, 65% have clinical digital clubbing. In these patients, an increased occurrence has been shown in patients with higher grades of smooth muscle proliferation in the lungs.

Clubbing has been reported in 29% of patients with lung cancer and is observed more commonly in patients with non-small cell lung carcinoma (35%) than in patients with small cell lung carcinoma (4%).

Digital clubbing was reported in 38% of patients with Crohn disease, 15% of patients with ulcerative colitis, and 8% of patients with proctitis. Clubbing was observed in up to one third of Ugandan patients with pulmonary tuberculosis. It was not associated with stage of HIV infection, extensive disease, or hypoalbuminemia.

Medical Care
No specific treatment for clubbing is available. Treatment of the underlying pathological condition may decrease the clubbing or, potentially, reverse it if performed early enough. Once substantial chronic tissue changes, including increased collagen deposition, have occurred, reversal is unlikely. Treatment for related problems, such as pain, is symptomatic.

Surgical Care
No specific surgical procedures are performed for clubbing. Appropriate surgical treatment of underlying disease, such as tumor removal in patients with lung cancer, may improve or reverse clubbing, provided that permanent morphologic changes have not occurred.

Clubbing is a clinical sign of many pathological processes; therefore, consultation with specialists may be necessary to diagnose the underlying disease. Patients with primary hypertrophic osteoarthropathy should be evaluated for associated findings, possibly including myelofibrosis.


Definitive medical therapy is tailored to the underlying disease process and may include symptomatic treatment of the sequelae of clubbing.

Yellow Nail Syndrome

Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis). Yellow nail syndrome is most commonly associated with lung disorders, and with lymphedema.

If you have not heard of Yellow Nail Syndrome (YNS), well it is all right because this disorder is very rare. Yellow Nail syndrome is a combination of lymphedema or swelling of the lower extremities, bronchiectasis, recurrent pneumonia, and nails turning yellow. In most of the patients it is manifested as the disease of the lower lobes of the lungs. It might be caused by infection of the lungs or some kind of obstruction. Bronchiectasis is a disorder in which one or more of the bronchi get enlarged irreversibly. It occurs because of the damage to the muscular and elastic supporting tissues.

Symptoms and effects of Yellow Nail Syndrome

Yellow Nail syndrome generally remains under diagnosed and is thought to be
caused due to hereditary or para-neoplastic or congenital causes. It generally affects the nails and the lymphatic tissue. Generally YNS is related to lung diseases but it is thought to be caused by congenital abnormalities in the lymphatic system.

Yellow nail Syndrome is marked with yellow nails with lack of cuticle. Nails grow slowly and are loose and detached. One or more nails might show the signs of onycholysis. Other symptoms include lymphoedema, pleural effusion, and bronchiectasis.

Diagnosing Yellow Nail Syndrome (YNS)

Yellow Nail Syndrome is far more common in toenails than in the fingernails. The patients suffering from YNS shows upper and lower respiratory tract infections that are believed to be caused by some antibody deficiency that occurs after the symptoms of YNS manifest. These symptoms include swelling of the lymph system in many parts but more commonly in hands and feet.

From 1994, a whole lot of symptoms got attached to YNS. These include chronic rhino-sinusitis, recurrent pneumonia, chronic sinusitis, pleural effusion, pericardial effusion, lymphoedema, bronchiectasis or ankle oedema. In some cases even Diabetes has been diagnosed.

Treatment of Yellow Nail Syndrome (YNS)

Unfortunately the treatment of Yellow nail Syndrome is not that much effective and patients are recommended cough suppressants or sleeping pills. They are told to avoid smoking and other respiratory irritants. Treatment could consist of physical therapy like clapping or vibration and postural drainage. Oral antibiotics, vitamin A and E, Zn sulfate, itraconazole and nutritional supplements could also be prescribed.

The best news is that Yellow Nail Syndrome sees about thirty percent spontaneous healing. And you can defend yourself pretty well by proper foot hygiene. Try to wear shoes which have some space at the front, preferably about the width of your thumb. That would prevent your toes from getting damaged. It is advisable to walk barefoot whenever it is possible if you are under medical treatment more so after applying antimicrobial solutions.

You should use cream treatments and liquids topically. Always remember to wear clean socks and also to rotate shoes more frequently. Your doctor would most probably prescribe oral medications or natural remedies to take care of any side effects. And you can always hide it with nail polish.

And yes, one more thing. Slowing down of growth of nails, cause its discoloration. And this slowing down of growth could be of various other reasons. The best thing to do is to consult a physician if you find something like this happening.

Onychocryptosis is also called Unguis incarnates, but is much better known as an ingrown toenail. This extremely painful condition results when a toenail begins growing into the skin of the toe, and can reduce mobility when the toenail is severely ingrown. While many cases of onychocryptosis can be treated at home, extremely ingrown toenails may require corrective surgery.

Ingrown toenails commonly affect the largest toe on the foot. They occur when the toenail begins to grow in a sideways fashion instead of growing from the base to the tip of the toe as is normal. This sideways growth can cause the growing nail to begin embedding itself into the skin beside the nail bed. Symptoms of onychocryptosis of the nail include pain, swelling, and redness of the affective area. A yellow or clear fluid may drain from the nail bed of the toe. Ingrown toenails are also more susceptible to infection in cases where the skin is broken.

Certain people are at increased risk of developing an ingrown toenail. At-risk people include those who wear poorly-fitting shoes, have suffered a traumatic foot injury, have a congenital foot injury, have an infection or fungal disease of the nail, or have short toenails or long toes. People with diabetes and other circulatory disorders are at increased risk of infection and other complications if a toenail becomes ingrown.

An uncomplicated case of onychocryptosis can be treated effectively at home. The recommended treatment is to soak the affected foot two to three times daily in warm water. Epsom salts or white vinegar can be added to the water to help healing and prevent infection. When not soaking, the foot and leg should be kept elevated as much as possible. If the toenail does not improve after five to ten days of this treatment, or if symptoms worsen at any time, medical advice should be sought as soon as possible.

People with diabetes or who are at risk of complications for other reasons should not attempt to treat an ingrown toenail at home. The increased risk of complications means that it’s important to seek medical advice for even a mild case of onychocryptosis. A doctor or podiatrist may recommend antibiotics to prevent infection, or may perform a minor procedure to help prevent the nail from embedding more deeply within the nail bed.

Possible surgical treatments for an ingrown toenail include partial or complete removal of the affected nail. Both of these procedures can be carried out by a podiatrist. Following the procedure, careful monitoring of the nail is required as it grows back over the course of several months. An ingrown toenail may recur even in cases where the entire nail is removed, so it is important to ensure that the nail grows back correctly.


A fungal or yeast infection which results in Onychomycosis can invade through a tear in the proximal and lateral nail folds as well as the eponychium. This type of infection is characterized by onycholysis (nail plate separation) with evident debris under the nail plate. It normally appears white or yellowish in color, and may also change the texture and shape of the nail. The fungus digests the keratin protein of which the nail plate is comprised. As the infection progresses, organic debris accumulates under the nail plate, often discoloring it. Other infectious organisms may be involved, and if left untreated, the nail plate may separate from the nail bed and crumble off.

Medical Care

Treatment of onychomycosis depends on the clinical type of the onychomycosis, the number of affected nails, and the severity of nail involvement. A systemic treatment is always required in proximal subungual onychomycosis and in distal lateral subungual onychomycosis involving the lunula region. White superficial onychomycosis and distal lateral subungual onychomycosis limited to the distal nail can be treated with a topical agent. A combination of systemic and topical treatment increases the cure rate. Because the rate of recurrence remains high, even with newer agents, the decision to treat should be made with a clear understanding of the cost and risks involved, as well as the risk of recurrence. Photodynamic therapy and lasers may represent future treatment options.

Topical antifungals

The use of topical agents should be limited to cases involving less than half of the distal nail plate or for patients unable to tolerate systemic treatment. Agents include amorolfine (approved in other countries), ciclopirox olamine 8% nail lacquer solution, and bifonazole/urea (available outside the United States).

Topical treatments alone are generally unable to cure onychomycosis because of insufficient nail plate penetration. Ciclopirox and amorolfine solutions have been reported to penetrate through all nail layers but have low efficacy when used as monotherapy.15 They may be useful as adjunctive therapy in combination with oral therapy or as prophylaxis to prevent recurrence in patients cured with systemic agents.

Oral therapy

The newer generation of oral antifungal agents (itraconazole and terbinafine) has replaced older therapies in the treatment of onychomycosis.16,17,18 They offer shorter treatment regimens, higher cure rates, and fewer adverse effects. Fluconazole (not approved by the US Food and Drug Administration [FDA] for treatment of onychomycosis) offers an alternative to itraconazole and terbinafine. Derivatives of fluconazole may also be available soon. The efficacy of the newer antifungal agents lies in their ability to penetrate the nail plate within days of starting therapy. Evidence shows better efficacy with terbinafine than with other oral agents.

To decrease the adverse effects and duration of oral therapy, topical treatments and nail avulsion may be combined with oral antifungal management.20

Surgical Care

Surgical approaches to onychomycosis treatment include mechanical, chemical, or surgical nail avulsion.
Chemical removal by using a 40-50% urea compound is painless and useful in patients with very thick nails
Removal of the nail plate should be considered an adjunctive treatment in patients undergoing oral therapy.
A combination of oral, topical, and surgical therapy can increase efficacy and reduce cost.


Activity does not need to be limited during treatment, but patients should be educated about avoiding direct contact with high-risk areas in public places.


The goals of pharmacotherapy for onychomycosis are to reduce morbidity and to prevent complications.


The goals of pharmacotherapy for onychomycosis are to reduce morbidity and to prevent complications..