Acquired Nail Disorder in an Older Person
Am Fam Physician. 2017 Apr 15;95(8):519-520.
A 78-year-old man who had not seen a physician in many years had pain in his feet, but no history of trauma. He wore sneakers and was able to walk well without a cane or walker. He had not cut his toenails for an extended period and had poor hygiene. He was independent in activities of daily living. He had no relevant medical history and was not taking medications.
On physical examination, his lower extremities were cool with thin, dry, and scaly skin. Bilateral thick, elongated, and curved toenails 5 to 8 cm long were digging into the skin (Figure 1). Keratin debris was noted over the toes and interdigital spaces, and there was trace pitting edema on both legs. Dorsalis pedis pulses were diminished bilaterally. Sensation was grossly decreased to light touch.
Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?
REFERENCESshow all references
1. Mumoli N. Ram's horn nails. Med J Aust. 2011;195(4):202....
2. Goldsmith LA, Fitzpatrick TB, eds. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, NY: McGraw-Hill Medical; 2012.
3. Usatine R, ed. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009.
4. Singh G, Haneef NS, Uday A. Nail changes and disorders among the elderly. Indian J Dermatol Venereol Leprol. 2005;71(6):386–392.
5. Fowler AW. Excision of the germinal matrix: a unified treatment for embedded toe-nail and onychogryphosis. Br J Surg. 1958;45(192):382–387.
6. Kaplan I, Labandter H. Onychogryphosis treated with the CO2 surgical laser. Br J Surg. 1976;29(1):102–103.
7. Andrew T, Wallace WA. Nail bed ablation—excise or cauterise? A controlled study. Br Med J. 1979;1(6177):1539.
This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.
A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz.
Previously published Photo Quizzes are now featured in a mobile app. Get more information at https://www.aafp.org/afp/apps.
The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to email@example.com.
Copyright © 2017 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions