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. 2011 Feb;57(2):173-81.

Common nail changes and disorders in older people: Diagnosis and management

Lina Abdullah  1 , Ossama Abbas
Affiliations

Common nail changes and disorders in older people: Diagnosis and management

Lina Abdullah et al. Can Fam Physician. 2011 Feb.

Abstract
in English, French

Objective To present family physicians with common nail alterations and disorders occurring in the elderly population and their management options. Quality of evidence The evidence relating to different nail conditions is mostly derived from randomized controlled trials, meta-analyses, and review articles. However, given the scarcity of evidence on some conditions, articles with weaker levels of evidence were also included in our review. Main message Given the growing elderly population and the associated demographic changes and longer lifespans, geriatric care is becoming more of a complicated and multidisciplinary effort in which the role of the family physician is increasingly important. Although common among the elderly, nail changes are often not brought to the attention of primary caregivers and are thus overlooked. These nail changes can affect various components of the nail unit and might represent normal age-related nail alterations or nail abnormalities that require immediate intervention. Knowledge and familiarity with these common nail abnormalities and their underlying causes is important for the family practitioner in order to effectively reach an accurate diagnosis and provide better care of this large and growing elderly population. Conclusion Nail changes are common in the elderly, and family physicians are best placed to diagnose and treat these common problems. It is important that family physicians also recognize less common but more serious nail problems that require immediate treatment.

Objectif: Rappeler au médecin de famille les changements et problèmes unguéaux fréquents qui surviennent chez les personnes âgées ainsi que les options de traitement.

Qualité des preuves: Les preuves concernant les diverses conditions unguéales proviennent principalement d’essais cliniques randomisés, de méta-analyses et d’articles de revue. Toutefois, vu le peu de données sur certaines conditions, nous avons inclus dans notre revue des articles basés sur des preuves plus faibles.

Principal message: Compte tenu du vieillissement de la population avec les changements démographiques et le prolongement de la longévité qui l’accompagnent, les soins gériatriques ressemblent davantage à un effort compliqué et multidisciplinaire dans lequel le rôle du médecin est de plus en plus important. Même s’ils sont fréquents chez les personnes âgées, les changements unguéaux ne sont pas toujours rapportés aux soignants de première ligne, et demeurent ainsi ignorés. Ces changements unguéaux peuvent toucher différentes composantes de l’ongle et ils pourraient représenter des modifications normales pour l’âge ou des anomalies qui exigent une intervention immédiate. Il importe que le médecin de famille ait une très bonne connaissance de ces anomalies unguéales fréquentes et de leurs causes sous-jacentes afin de pouvoir poser un diagnostic précis et de mieux traiter cette population âgée toujours plus grande.

Conclusion: Les changements unguéaux sont fréquents chez les personnes âgées, et le médecin de famille est le mieux placé pour en faire le diagnostic et le traitement. Il doit aussi être en mesure de reconnaître les problèmes unguéaux moins fréquents mais plus graves, qui exigent un traitement immédiat.

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Figures

Figure 1.
Figure 1.
Anatomy of a nail unit
Figure 2.
Figure 2.
Mild brittle nails with mild longitudinal ridging and mild distal lamellar splitting
Figure 3.
Figure 3.
Onychauxis: Localized hypertrophy of the nail plate with discoloration and loss of nail plate translucency.
Figure 4.
Figure 4.
Distal and lateral subungual onychomycosis: Onycholysis, subungual hyperkeratosis, as well as nail thickening and discoloration.
Figure 5.
Figure 5.
superficial onychomycosis: White patchy discoloration of the dorsum of the nail plate.
Figure 6.
Figure 6.
Chronic paronychia: Red and swollen nail folds, cuticle loss, and secondary nail plate changes.
Figure 7.
Figure 7.
Subungual hematomas: Red to bluish subungual discoloration.
Figure 8.
Figure 8.
Longitudinal melanonychia: A longitudinal dark band can be a manifestation of melanocytic lesions, drugs, or Bowen disease, among other causes.
Figure 9.
Figure 9.
Longitudinal erythronychia: A longitudinal red band can rarely be a manifestation of Bowen disease.
See this image and copyright information in PMC

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