How To Treat Dystrophic Nails
Iatrogenically caused onychodystrophy can arise following a biopsy of the proximal nail matrix.4 The practitioner should inform the patient during the informed consent process that this can occur. One can prevent this by procuring the biopsy from the distal nail matrix if possible.
A Closer Look At Emerging Treatment Options
Treatment of the underlying condition or infection present in onychodystrophy may be a slow and frustrating process to both the patient and practitioner. In addition to the various therapies I have outlined above, clinicians should consider other therapies and devices that will adhere to the nail plate, provide mechanical support and be easy to use.
Two of the newest medical devices available for the treatment of onychodystrophy are hydroxypropyl chitosan (Genadur™, Medimetriks) and poly-ureaurethane 16% (Nuvail™, Innocutis). These are non-drug lacquers that patients would apply topically to the nail at bedtime.
Genadur is indicated to “protect damaged nails from the effects of moisture, friction or shear” in order to relieve the symptoms of nail dystrophy.5 It is a hydrosoluble compound that patients should apply after washing and drying their nails. Studies on psoriatic nails have shown that it has an improvement in nail fragility, a reduction in splitting and a 63 percent reduction in onycholysis.6
Nuvail is a waterproof and flexible film that forms to the nail contour to provide protection from direct abrasion and optimal moisture balance to protect the nail from the effects of moisture.7 Nasir and colleagues followed 53 patients with nail dystrophy who used Nuvail nightly.8 In their clinical assessment, which evaluated color, onycholysis and subungual hyperkeratosis, the researchers noted a 60 percent improvement after six months of use.
In addition, if cosmesis is a concern for the patient, Keryflex™ (Pod-Advance) nail resin may camouflage and protect the nail unit. Physicians have used Keryflex to cover nail fungus and various other nail dystrophies whether or not the patient is receiving systemic treatment for the underlying condition. While Keryflex has many uses, physicians have used the modality following laser use for onychomycosis and in covering a nail that has become dystrophic following surgery for a paronychia.
Biotin, an oral option for brittle nails, benefits dystrophic nails approximately two to three months after patients start using the supplement.9 Although there is no protocol on optimal duration of use, biotin supplementation should continue as long as there is clinical improvement.
In review, the treatment of nail dystrophy should first involve elucidating the cause. Is it caused by an infection, an underlying systemic cause or trauma? It should be clear that not all nail dystrophies are onychomycosis. One should pursue a fungal culture/mycological staining prior to treatment to confirm the clinical diagnosis. Ultimately, one should tailor treatment to the nail disorder present. The newest treatments for onychodystrophy include application of a non-drug topical, which is meant to provide support and protect the nail from further damage.
Dr. Vlahovic is an Associate Professor and J. Stanley and Pearl Landau Fellow at the Temple University School of Podiatric Medicine.