Horn like nail

A 36-year-old man presented with opaque, yellow-brown thickening with elongation of his right ring fingernail abnormality for the past 3 years. The curvature of the nail plate was markedly increased and showed transverse striations [Figure 1]. The proximal nail fold was hyperpigmented and thickened. Nail change was preceded by local trauma to the nail apparatus. X-ray of the right ring finger showed no evidence of any underlying tumor. The patient denied consent for invasive procedures, including nail matrix biopsy. Based on the clinical findings, a diagnosis of onychogryphosis was made. He was advised to trim his nail and apply 40% urea once daily for 2 weeks. The patient lost to follow-up.

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Figure 1:

Thickening with elongation and increased curvature of the fingernail.

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Onychogryphosis, also known as Ram’s horn nails, is characterized by hyperkeratosis and excessive nail curving. It may result from trauma, peripheral vascular diseases, wearing ill-fitted shoes, lack of self-care, etc. Treatment options include shortening the nail using an electric drill and burrs, nail destruction by 40% urea, and nail avulsion followed by ablative or excisional matricectomy.^[1]