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Hi,
I have a patient who is worried about a nail that has not grown for three months..he believes it's associated with his swimming twice a week, which began apporx. 3 months ago too.

His GP suggested it may be fungal.

Attached pics of 1st nail, which is not growing, also the lesser toe nails. What may not show in the pictures is a thinning and dullness of the nail plate ( pt. says nails have always looked like this)



He is 65 yrs old, on blood pressure medication (ramipril) and is fairly fit but on the overweight side.
Fingernails not dull, and look very healthy.

Anyone have any ideas?

 

Is the contralateral 1st nail of similar appearance?

Doesn`t look particulalry mycotic and doubt very much that chlorine would be responsible for the mild onychorrhexis, which is common in later years. Also, if you consider that the average growth rate in a`healthy`young adult is 1.62mm per month, then the growth of a traumatised and older nail plate will be significantly reduced. I have patients who report `no nail growth`, yet still require regular nail care, albeit approx every 4-5 months instead of every 2 months.

Differential dx includes Lichen planus, but that usually manifests with other symptoms....http://dermnetnz.org/scaly/lichen-planus.html

 

Thanks Blinda,
I thought lichen planus, or perhaps an autoimmune disorder. Other nail is normal.
This patient came in off the street worried, I have him booked in for 6 weeks time, and I'll see what's happening, but he seems over anxious to sort it out.
Cheers again

 

Have you checked footwear? He has callus on apex of 2nd digit which may indicate shoes too short and toe box may not be high enough. Worth a check on all footwear. Any new ones in last 12 months too?

 

Hi Sally
Seen him once only, he dropped in, hot day in sandals, did ask about footwear, he wears trainers most of the time, but it didn't get to see them.
Will have a discussion next topi me he visits..
Thanks for the suggestion

 

Hey , it looks just like mine do when I have to follow my 3 year old around the pool, it's abrasion from scraping the nail in shallow water on the rough bottom.

Cheers

Joe

 

Thank you, I'll discuss the possibility with my patient