Nail conditions

Nail conditions Mrs Sue Paterson MA VetMB DVD DipECVD RCVS and European Specialist in Veterinary Dermatology Rutland House Veterinary Hospital, St Helens, UK Structure of the canine claw courtesy of Patel, Forsythe Nail terms Onychoclasis breaking of the claw Onychocryptosis ingrown nail Onychodystrophy abnormal claw formation

Onychogryphosis hypertrophy and abnormal curvature of the claw Onychomedesis sloughing of the claw Onychomalacia softening of the claw Onychomycosis fungal infection of the claw Onychorrhexis longitudinal striations associated with brittleness and breaking of the claw Onychoschizia - splitting or lamination of the claw Paronychia inflammation or infection of the claw fold

Paronychial disease involves the nail fold Nail disease involves the nail Important to differentiate between diseases of the nails beds and

those of the nails Investigation and therapy of each disease is different Disease of the nail bed Dogs Bacterial paronychia secondary to allergy, endocrine disease, demodex Malassezia paronychia secondary to allergy or

endocrine disease Demodectic paronychia Leishmaniasis Neoplastic Immune mediated S.L.E. Pemphigus foliaceus Bullous pemphigoid Drug eruption

Disease of the nails Dogs Congenital disease DEB, Ichthyosis Traumatic injury RTA Onychomycosis Vasculitis Dermatomyositis Leishmaniasis Idiopathic lupoid onychodystropy

Disease of the nail bed Cats Bacterial paronychia secondary to allergy or FIV, FeLV Malassezia paronychia secondary to allergy or endocrine disease Viral paronychia calici, herpes, pox Demodectic paronychia

S.L.E. Pemphigus foliaceus Bullous pemphigoid Drug eruption Neoplastic met bronchial carcinoma Disease of the nails Cats

Traumatic RTA Onychomycosis Vasculitis Idiopathic onychodystrophy Investigation of nail disease History Physical examination Dermatological examination

Examination of nail Examination of the nail / nail bed is important to establish which structure is affected In some case paronychial disease and nail disease is present concurrently Investigation of nail disease Diagnostic tests

Samples from nail beds skin scrapes, hair plucks, cytology Nail trimmings for dermatophytes culture Removal of nail for histopathology ? BIOPSY TECHNIQUES Symmetrical lupoid

onychodystrophy Approach to a nail case History breed, age, life style Physical examination signs of systemic ill health Dermatological examination evidence of involvement of other areas, e.g. face, other mc junctions

Symmetrical lupoid onychodystrophy Aetiology Uncommon to rare immune mediated claw loss Usually young adult - middle aged dogs esp. GSD Initial signs are of loss of 1 2 nails but disease is progressive and over weeks to months all claws will slough Replacement claws are usually misshapen, soft, brittle, friable and will slough again without therapy Feet usually painful and dog may be lame

This is a diagnosis of exclusion Initial diagnostic tests Cytology of any exudate Bacterial culture of exudate when appropriate Fungal culture of claw clippings Bloods if systemic disease is suspected Biopsy of skin if generalised disease is a

potential differential diagnosis Histopathology of P3 Initial diagnostic tests Diagnostic histopathology of P3 Hydropic degeneration, apoptosis of individual keratinocytes in basal

cell layer, pigentary incontinence, lichenoid interface dermatitis Symmetrical lupoid onychodystrophy Differential diagnosis Dermatophytosis Trauma Autoimmune disease e.g. pemphigus foliaceus

Immune mediated disease vasculitis, dermatomyositis Further investigation A diagnosis of onychodystrophy is made by exclusion of other causes Removal of all nails by traction should be undertaken Dog anaesthetised with full analgesia. The feet are clipped and prepared surgically

Each nail is grasped in turn with a pair of artery forceps and is twisted and pulled to remove it Cultures taken from nail bed and nail submitted for fungal culture Post operatively Dog feet are dressed & hospitalised for 48 hrs Antibiotics given usually Cephalexin 25mg/kg

bid plus analgesia Tramadol 2 5 mg / kg bid After 24 hours dressings removed, feet gently cleaned under GA if necessary. No further dressing are applied Dog sent home initially with more antibiotics, pain relief and a large buster collar 10 day recheck ongoing tx At 10 days analgesia and

antibiotics can be discontinued Ongoing treatment Immune modulators Nutritional supplements 10 day recheck ongoing tx Immune modulators Tetracycline or Doxycycline and Niacinamide

Glucocorticoids Azathioprine Ciclosporine Pentoxyphylline 10 day recheck ongoing tx Nutritional supplements Omega 6 and /or omega 3 EFAs

Biotin Tetracycline/doxycycline + niacinamide Dogs < 15kg Tetracycline 250mg with Niacinamide 250mg tid Dogs > 15kg Tetracycline 500mg with Niacinamide 500mg tid Alternative to tetracycline - Doxycycline 10mg/kg sid Precise mechanism unknown.

Tetracycline and Doxycycline both have anti-inflammatory and immune modulating activity Niacinamide shown to have range of anti-inflammatory effects Combination useful in DLE and pemphigus as well as lupoid onycodystrophy Glucocorticoids Have been shown to be useful in many case,

only start once any bacterial or fungal infection has been resolved Dose rate is very variable Low dose therapy Prednisolone 0.5mg/kg sid/eod po High dose therapy Prednisolone 2.0mg/kg sid/eod po Gastric protectants useful if using the higher

dose rate Azathioprine / Cyclosporine Both drugs can be used with or to replace steroids Azathioprine 2mg/kg po sid up to 3 months until remission is seen then eod. Dogs must be monitored for changes in liver function and bone marrow Cyclosporine 5m/kg po sid up to 3 months until

remission and then taper to eod or biw Monitoring not necessary in a healthy dog, but cost may be prohibitive Omega 6 and /or omega 3 EFAs Essential fatty acids increasing the suppleness of thin,

brittle nails. Important in dogs when exercising and when nails are cut Dose 300mg EPA / 10kg daily or 200mg GLA / 10kg daily Pentoxiphylline 10-24

mg/kg bid/tid Immunodulatory drug in man useful for treatment of peripheral vascular disease and vasculitis Been shown to be useful for similar conditions in dogs

Biotin - Human studies Biotin supplementation increases nail thickness by 25 percent in 63% of a group of patients with brittle nails. (Floersheim GL 1989). Patients taking biotin daily for 3-6 mths had reduced brittleness & splitting (Hochman LG et al 1993). Increased nail thickness as

identified by scanning EM was recorded after biotin supplementation. (Colombo VE et al 1990). Typical combination therapy Essential fatty acids GLA 200mg/10kg sid po or 300mg/10kg sid po Biotin 2.5- 3mg daily/ dog

Prednisolone 0.5mg/kg eod po Pentoxyphylline 10mg/kg tid po Continue therapy for 6 weeks then reassess If dog making progress consider with drawing Pentoxyphylline, continue with other drugs long term Failure to respond to therapy Switch to a different immune modulator Azathioprine

Ciclosporine Tetracycline / doxycycline with niacinamide Surgical intervention to amputate all of the claws.

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