Claw Diseases in Dogs and Cats

WORLD SMALL ANIMAL VETERINARY ASSOCIATION WORLD CONGRESS PROCEEDINGS, 2004

Didier-Noel Carlotti, Doct.-Vét., DECVD
Cabinet de Dermatologie Vétérinaire, Heliopolis B 3
Bordeaux-Mérignac, France (EU)

Nail disorders are relatively rare in companion animals, particularly in comparison

with nail disorders in man1-6,which are numerous and related to various causes7.
Anatomy of the canine claw unit has been well described1,8,9,10.

CLINICAL SIGNS1-4

Onyxis is by definition the disease of the abnormal looking nail. It can be proximal,
distal or it may involve all the nail. It may affect only one nail or be multiple
depending on the cause. Perionyxis is the inflammation of the nail
fold. Onychoschisis means fissuration (splitting) of the nail. Onychorrhexis is the
breaking of a nail which has become brittle. Onychogryphosis is a deformation of
the claw. It appears to be elongated and distorted. Onychomadesis is the sloughing
process of nails. Onychoclasis is the fracture of the claw. Trachyonychia is a nail
disorder in humans characterized by lusterless, longitudinally ridged and
rough-surfaced nail plates. Pruritus is rarely observed in nail diseases. Pain is more
common. However neither pruritus nor pain will be noticeable in many cases such
as onychogryphosis.

DIAGNOSTIC APPROACH

This shall be based on history, physical examination and complementary diagnostic

aids, including biopsy by amputation or without onychectomy11.

CONSIDERATION OF PARTICULAR DISEASES1-4,9

Traumatic onyxis is a very common disease in the dog. It usually affects only one
nail, in particular the thumbnails (digit 1) on the hind legs. The nail is more or less
distally broken and pain is usually observed. Diagnosis is clinically obvious. Therapy
consists in promptly removing the distal part of the nail with forceps. A bandage is
then applied for a few hours. If this is done a few days after the fracture, systemic
antibiotics should be used for a week to prevent secondary bacterial infection.

Bacterial onyxis exists in the dog but is much rarer in the cat. In the latter, it is
usually associated with an immunodeficient state (FeLV and/or FIV infection,
diabetes mellitus etc.). In the dog it may be idiopathic or secondary to an underlying
disease (such as hypothyroidism, or even Cushing's disease). Perionyxis,
onychoschisis, onychorrhexis and onychomadesis are usually seen on several nails,
with pain as the primary complaint. Diagnosis is made by cytology--which reveals a
bacterial pus (degenerated neutrophils, phagocytosis), bacteriology and the
response to therapy. Treatment must be based on the removal of broken nails,
topical antibacterial therapy and long term systemic antibiotic therapy (based on
bacterial cultures and sensitivity testing, Staphylococcus sp. and Gram negative
rods often being cultured). Months of careful therapy are needed, until the distal
abnormal part of the nail has disappeared. In all cases, and particularly in chronically
relapsing ones, an underlying disease should be suspected and, if found, treated.
Bacterial pododermatitis, whatever the cause, often leads to bacterial onyxis. Good
examples are interdigital pyodermas due to demodicosis and allergic skin diseases.
Perionyxis is a prominent feature in such cases. Therapy appropriate to the causal
pododermatitis will cure the nail problem if carried out for long enough.

Dermatophytic onyxis is a rare cause of onyxis and perionyxis in the dog, usually
with one or a few digits being affected. In Aquitaine, Microsporum
gypseum and Microsporum canis have been found to be the dermatophytes which
most frequently cause fungal onyxis. Alopecia of the corresponding digit is often
observed. Diagnosis is made by Wood's light examination which may reveal the
fluorescence of the hair of the digit involved, direct examination and fungal culture of
this hair, and histopathology of the nail itself. Skin biopsy and the removal of the
third phalanx are unnecessary. PAS staining of the nail is mandatory and reveals the
invasion of the nail keratine by the fungal hyphae. Long-term antifungal therapy
(griseofulvine, ketoconazole, itraconazole) is necessary until the abnormal part of the
nail disappears distally. This may take several months. Other cutaneous lesions
should be topically treated simultaneously. Dermatophytic onyxis appears to be
extremely rare in the cat. The author has never made such a diagnosis in a feline.

Malassezia perionyxis can be seen in atopic dogs, with a brownish staining of the

claw, a greasy exudate in the claw folds and persistent pruritus12. Malassezia
pachydermatis and Candida albicans can be isolated from claws of Bull Terriers
affected with lethal acrodermatitis13.

Onychogryphosis is a classic symptom of canine leishmaniasis. In the enzootic

area such a complaint justifies serology and/or a parasitological examination (skin
and/or bone marrow cytology). Comprehensive therapy (Lomidine®, Glucantime®,
amphotericin B, allopurinol) and a strict follow-up are mandatory.

Onychorrhexis and onychomadesis can be seen in chronic cases of

pododermatitis caused by ankylostomiasis. Diagnosis is made by cutaneous
histopathology and coproscopy.

An inflammatory skin disease of the digits (pododermatitis) is observed clinically in

canine atopic dermatitis and food allergy or intolerance. Onychogryphosis is
frequent, often associated with perionyxis and redness of the hair on the digits. The
nails may appear reddish in dogs whose nails are normally white but this may be
due to secondary Malassezia infection. A diagnosis is obviously reached by
evaluating all the symptoms observed in these diseases, by skin-testing, serology
and elimination diets. Therapy includes allergen eviction, hyposensitization and
symptomatic treatment (systemic glucocorticoids, antihistamines, essential fatty
acids, topical antipruritic agents etc.).

Autoimmune (and immune-mediated) dermatoses usually affect several digits.

Discoid lupus erythematosus is a not so uncommon cause of onyxis in the

dog3,9,14. In fact, as the disease is symmetrical, as focal thickening and smudging of
the basement membrane zone are not seen and as direct immunofluorescence
testing is negative, Danny SCOTT named this disease "Symmetrical Lupoid
Onychodystrophy" in 199515. It is a real interface onychitis. Onychorrhexis and
onychogryphosis are the main features of the disease. Other lesions may be seen in
other areas of the body, but this is not always the case. Perionyxis is not always
pronounced and skin biopsies of the nail bed area may be unrewarding. Amputation
of the third phalanx is often the only way to reveal the typical hydropic and lichenoid
interface dermatitis. Alternatively, a 8mm punch biopsy of the nail fold can be
performed. This technique is applicable mainly to interface onychitis (it seems that in
other conditions the resistance of tissues is higher). Essential fatty acids
(omega-3/omega-6 commercial compound), tetracycline or doxycycline and
niacinamide, pentoxifylline and azathioprine have been reported to be effective in
some cases. Immuno-suppressive doses of glucorticoids (prednisolone) eventually
associated with azathioprine may control the disease.3,15,16,17.

Nails and nail beds may be affected in pemphigus vulgaris18. Onychogryphosis

and onychomadesis can be observed. Severe perionyxis is also present, with
erosions around the nail bed which are a source of pain. Diagnosis is made by
histopathology either by skin biopsies around the claw or alternatively by amputation
of the third phalanx. Biopsies of lesions in other body areas may be diagnostic. Only
a guarded prognosis should be made. Immunosuppressive therapy should be
carried out (glucocorticoids, azathioprine).

Onychogryphosis and perionyxis can be observed in canine pemphigus

foliaceus, particularly in severe forms of the disease. A unique case of pemphigus
foliaceus restricted to the claws has been diagnosed by E. Guaguère and J.P.
Magnol9. When pemphigus foliaceus is exclusively confined to the footpads,
onychorrhexis is often observed. The author has seen 2 cases of pemphigus
erythematosus confined exclusively to the footpads, with onychorrhexis. Diagnosis
can be made by histopathology. In the extensive forms of the disease (pemphigus
foliaceus), biopsy of the skin lesions may be diagnostic. In the localized forms,
biopsy of the footpads and/or an amputation of the third phalanx may be diagnostic.
Immunosuppressive therapy is necessary.

In the cat, pemphigus foliaceus is a possible cause of severe perionyxis. A thick

pus is discovered in the nail bed. Diagnosis is usually made by skin biopsy of the
other skin lesions. Glucocorticoid immunosuppressive therapy is helpful.
 Severe multiple onychomadesis and/or severe onychogryphosis with ulcerative
perionyxis may be seen in the bullous pemphigoid group skin disease (a group of
autoimmune disorders with subepidermal clefting as a common feature). They may
even be the prominent features of this disease, making it a most painful one.
Diagnosis is made by biopsy of the skin lesions, particularly of the digits, if there is
ulceration around the nail bed. Alternatively, amputation of the third phalanx of an
affected digit may be the only way to diagnose such a condition if only nail disease
is present. In one case, the author had the luck to establish a diagnosis of bullous
pemphigoid by removing nails from a dog with onychomadesis; a small amount of
skin tissue still attached to the claw displayed the typical lesions of
dermal-epidermal clefting. Therapy is not easy. Glucorticoid immunosuppression is
not always helpful.

Systemic lupus erythematosus, cold agglutinin disease, drug eruption and

vasculitis may affect the claws3,4.

Trachyonychia has been seen in a dog with alopecia areata19. A cat affected

with pseudopelade had onychomadesis20.

In Man, Raynaud's disease is due to a spasm of digital arteries due to cold, which
may be either secondary (e.g., to SLE) or idiopathic. It is a cyanotic/hyperhaemic
and painful disease. Three female dogs (2 Boxers of 3 and 4 years of age and a 5
year-old mongrel) were suspected by the author to have a Raynaud-like disease9.
The patients were in severe pain from several digits which from time to time looked
cyanotic. Onychogryphosis was prominent. Skin biopsies were performed in 2 dogs
around the claws and showed non-specific superficial dermatitis and a
few Malassezia in the stratum corneum in one dog. Direct immunofluorescence
testing was negative for IgG and C3. ANA test was negative in the 3 dogs. Long
term therapy with isoxsuprine, a vasodilatator, at the dose of 1mg/kg/day, was very
helpful.

Idiopathic onychomadesis has been described in dogs11,21,22 although some of these

cases could be undiagnosed cases of interface onychitis, particularly when biopsies
were not done.

Keratinization diseases: the author has seen severe multiple onychogryphosis in

cases of canine ichthyosis. However, generalized skin lesions were prominent and
histopathology of the lesions confirmed the diagnosis9. Many cases responded
partially to retinoid therapy.

Some cases of zinc responsive dermatosis observed in Nordic dogs involve

several digits. Two cases restricted to the digits, with a prominent perionyxis and
above all onychorrhexis were observed by the author in Malamutes (of 10 and 12
months of age respectively)9. Diagnosis was made by histopathology, with biopsies
taken around the nail bed. There was a dramatic response to zinc sulfate
supplementation (15 mg/kg BID) whereas zinc methionine had not been very helpful.
 Several cases of idiopathic nosodigital hyperkeratosis in the older dog may be
associated with mild multiple onychogryphosis.

GENODERMATOSES

Ichthyosis is a hereditary keratinization disorder. Onychogryphosis can be seen

in canine dermatomyositis (Collies, Shetlands, Beaucerons) and epidermolysis
bullosa (Beaucerons)23. Glucorticoids, vitamin E and pentoxifylline are helpful. A
similar hereditary condition could exist in the cat, with onychomadesis24.

A case of congenital linear epidermal nevus ending in the paw of a hind leg was
diagnosed by the author in a 3-year-old Pyrenean shepherd, with a prominent
onychogryphosis on 2 digits (and a secondary demodectic pododermatitis as well).
The nevus responded well to retinoid therapy (etretinate 1 mg/kg/day during 18
months followed by acitretin, at the same dosage, during 8 months).

Idiopathic onychogryphosis is observed in dogs. It usually affects one digit.

Diagnosis is made by the elimination of other possible causes. Regular removal of
the nail affected is advisable. The author has seen multiple inverted papillomas in a
7-year-old mixed French Spaniel associated with a severe onychogryphosis of only
one digit. Papillomas can cause the development of cutaneous horns and potentially
this claw alteration was linked to the skin disease.

Neoplasia of the nail fold is a common cause of onyxis and onychomadesis in the
old dog. Squamous cell carcinoma (which is often misleading since it looks like a
non-healing wound), melanoma, and mast cell tumour are relatively frequent.
However nail bed epithelial inclusion cyst, keratoacanthoma, inverted papilloma, and
eccrine adenocarcinoma may also be observed3,25. These tumours affect only one
digit usually, and necessitate aggressive excision therapy. Melanoma and mast cell
tumour may metastasize, although squamous cell carcinoma has a better prognosis
than usually believed if excision is carried out at an early stage. Swelling is often
prominent and pain is acute. Diagnosis is made by histopathology of the removed
tumour and radiographs of the digits often reveal bone lysis. Multiple squamous cell
carcinomas are seen in black dogs, affecting several digits, with a slow growth rate
and rare metastasis3,26. Excision therapy is mandatory. Nail bed tumours are rarer in
old cats. Those that do occur are squamous cell carcinoma, hemangiosarcomas,
and metastasis of primary lung carcinomas4,25.

CONCLUSION

Claw diseases in dogs and cats are often diagnostic and therapeutic challenges. A
detailed case history, a thorough physical examination and appropriate
complementary examinations are required to establish a diagnosis. The latter include
cytology, bacteriology, mycology, histopathology (skin biopsy around the nail bed or
even third phalanx amputation, sometimes very helpful) and immunological tests
such as skin-testing and elimination diets. Therapy must be specific. In all cases
appropriate follow-up is most important.