4.2.4 Nail Dystrophies

Grading & Level of Importance: B

Review:

2026

W. Burgdorf, Munich; C. Ellis, A. Salam, J. McGrath, London,
Revised by V. del Marmol, Brussels; J. White, Brussels

Overview:

ICD-11
Synonyms
Definition
Epidemiology
Aetiology & Pathogenesis
Signs & Symptoms
Localisation
Classification
Laboratory & other workups
Dermatopathology
Course
Complications
Diagnosis
Differential Diagnosis
Prevention & Therapy
Special

ICD-11

EE10.5

Synonyms

Onychodystrophy

Definition

Disturbances in nail growth (proliferation, differentiation and maturation).

Epidemiology

Very common disorder. Incidence and prevalence are unknown, it depends on the pathogenetic background (trauma, mycosis, autoimmune disorder, vascular diseases, scleroderma, internal diseases).

Aetiology & Pathogenesis

Often idiopathic, may reflect manifestations of other diseases e.g. psoriasis, lichen planus, alopecia areata, GVHD, genetic disorders including twenty nail syndrome, different types of eczemas, metabolic disorders, toxic damage, infections, medications (e.g. chemotherapy). May also be due to mechanical irritation including nail manicure.

Signs & Symptoms

Changes in colour, structure and growth pattern of nails.

The nail changes are often asymptomatic, apart from the changes in colour, structure and growth pattern of nails. Occasionally functional problems are encountered, such as pain on movement or putting on shoes.

Localisation

Finger- or toe-nails. Examine skin and hair for further signs.

Finger- or toe-nails. The skin, hair and teeth (in children) should otherwise be examined for further signs.

Classification

Onychoschisis, onychorrhexis, onycholysis, onychomadesis.

Laboratory & other workups

Microbiological specimen to exclude onychomycosis, pseudomonas aeruginosa etc.

Consider taking clippings for microscopy and culture to exclude dermatophyte, yeast or a pseudomonas infection. Sometimes blood tests are required if a vitamin or mineral deficiency is suspected.

Dermatopathology

Not usually required.

Course

Varies according to underlying cause. Often chronic.

Complications

Secondary fungal infections possible.

Diagnosis

Clinical findings in context of associated findings.

Differential Diagnosis

Wide. Consider infections, psoriasis, atopic dermatitis, allergic or irritant contact dermatitis, lichen planus, hereditary causes etc.

Prevention & Therapy

Treatment of underlying disease. Podiatry review for severe toenail involvement impinging on walking.

Avoid prolonged wetting of the hands and finger nails to prevent mycotic infections. Certain nail polishes and the use of artificial nails can adversely affect the nail surface and lead to nail plate defects and infections. The use of a protective, uncoloured nail lacquer should be considered.

Active treatment is predominantly of the underlying disease. Podiatry review may be required for severe toenail involvement impinging on walking.