From the Research
Onychauxis is a condition that requires a multifaceted approach to management, focusing on reducing nail thickness, addressing underlying causes, and preventing complications, with the most recent and highest quality study suggesting that oral terbinafine is the treatment of choice for onychomycosis, a common underlying cause of onychauxis 1.
Diagnosis and Treatment
Onychauxis is characterized by abnormal thickening of the nail plate, most commonly affecting toenails. The condition can be caused by various factors, including fungal infections, psoriasis, trauma, repeated microtrauma, aging, poor circulation, or systemic conditions.
- Treatment typically involves regular trimming and filing of the affected nails to reduce thickness.
- For mild cases, over-the-counter urea-based creams (20-40% concentration) can be applied daily to soften the nail, making it easier to thin with a file.
- Professional podiatric care is recommended for severe cases, where mechanical debridement using specialized tools can safely reduce nail thickness.
- Prescription-strength topical medications containing urea (40%) or salicylic acid may be prescribed for ongoing management.
- Underlying causes such as fungal infections, psoriasis, or trauma should be addressed simultaneously.
Fungal Involvement
For fungal involvement, oral antifungals like terbinafine (250mg daily for 12 weeks) or topical solutions like ciclopirox may be necessary 2. However, it is essential to note that terbinafine can exacerbate psoriasis, and its use should be cautious in patients with this condition 3.
Prevention of Complications
Without proper management, the thickened nails can cause pain, difficulty wearing shoes, and potentially lead to ingrown nails or secondary infections. Therefore, it is crucial to address onychauxis promptly and effectively to prevent these complications.
Recent Guidelines
Recent studies suggest that oral antifungal therapies are effective but may have significant adverse effects, while topical antifungal therapies have minimal adverse events but are less effective due to poor nail penetration 1, 4. Therefore, the choice of treatment should be individualized based on the severity of the condition, underlying causes, and patient factors.