Clubbing of the Nails Follow-up

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 25, 2011
 

Further Inpatient Care

Further inpatient care should be guided by the specific primary disease, which is the cause of the clubbing. This should be evaluated on a case-by-case basis.

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Further Outpatient Care

Further outpatient care should be guided by the specific primary disease, which is the cause of the clubbing. This should be evaluated on a case-by-case basis.

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Inpatient & Outpatient Medications

Definitive medical therapy is tailored to the underlying disease process and may include symptomatic treatment of the sequelae of clubbing.

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Complications

Since clubbing is a clinical finding, no direct complications occur, except for cosmetic concerns. The complications of the underlying disease resulting in clubbing may be numerous considering the wide spectrum of diseases that are associated with clubbing. The discussion of these is beyond the scope of this article.

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Prognosis

Treatment of the underlying pathological condition may decrease the clubbing or, potentially, reverse it if performed early enough. Once substantial chronic tissue changes, including increased collagen deposition, have occurred, reversal is unlikely. Prognosis of the underlying disease should be determined on an individual basis.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Gregory M Richards, MD  Clinical Assistant Professor, Department of Human Oncology, University of Wisconsin School of Medicine and Public Health

Gregory M Richards, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Medical Association, American Roentgen Ray Society, American Society of Clinical Oncology, American Society of Therapeutic Radiation Oncology, and Radiological Society of North America

Disclosure: Nothing to disclose.

Supriya Goyal, MD  Consulting Dermatologist

Supriya Goyal, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard K Scher, MD  Professor of Dermatology, University of North Carolina

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. Goyal S, Griffiths AD, Omarouayache S, Mohammedi R. An improved method of studying fingernail morphometry: application to the early detection of fingernail clubbing. J Am Acad Dermatol. Oct 1998;39(4 Pt 1):640-2. [Medline].

  2. Castori M, Sinibaldi L, Mingarelli R, Lachman RS, Rimoin DL, Dallapiccola B. Pachydermoperiostosis: an update. Clin Genet. Dec 2005;68(6):477-86. [Medline].

  3. Tariq M, Azeem Z, Ali G, Chishti MS, Ahmad W. Mutation in the HPGD gene encoding NAD+ dependent 15-hydroxyprostaglandin dehydrogenase underlies isolated congenital nail clubbing (ICNC). J Med Genet. Jan 2009;46(1):14-20. [Medline].

  4. Dickinson CJ, Martin JF. Megakaryocytes and platelet clumps as the cause of finger clubbing. Lancet. Dec 19 1987;2(8573):1434-5. [Medline].

  5. Ddungu H, Johnson JL, Smieja M, Mayanja-Kizza H. Digital clubbing in tuberculosis--relationship to HIV infection, extent of disease and hypoalbuminemia. BMC Infect Dis. Mar 10 2006;6:45. [Medline].

  6. Saigal R, Kansal A, Mittal M, Singh Y, Ram H. Pachydermoperiostosis with myelofibrosis and empty sella. J Assoc Physicians India. Apr 2010;58:253-5. [Medline].

  7. Ozdemir B, Senturk T, Kaderli AA, et al. Postoperative regression of clubbing at an unexpected rate in a patient with aortic and mitral valve replacement due to infective endocarditis. Ir J Med Sci. Oct 9 2008;[Medline].

  8. Moralidis E, Gerasimou G, Theodoridou A, Hilidis I, Mylonaki E, Gotzamani-Psarrakou A. Hypertrophic osteoarthropathy manifested with isolated calcaneal periostitis in bone scintigraphy. Ann Nucl Med. Feb 2 2010;[Medline].

  9. Pallarés-Sanmartín A, Leiro-Fernández V, Cebreiro TL, Botana-Rial M, Fernández-Villar A. Validity and reliability of the Schamroth sign for the diagnosis of clubbing. JAMA. Jul 14 2010;304(2):159-61. [Medline].

  10. Hugosson C, Bahabri S, Rifai A, al-Dalaan A. Hypertrophic osteoarthropathy caused by lipoid pneumonia. Pediatr Radiol. 1995;25(6):482-3. [Medline].

  11. Shneerson JM. Digital clubbing and hypertrophic osteoarthropathy: The underlying mechanisms. Br J Dis Chest. Apr 1981;75(2):113-31. [Medline].

  12. Fawcett RS, Linford S, Stulberg DL. Nail abnormalities: clues to systemic disease. Am Fam Physician. Mar 15 2004;69(6):1417-24. [Medline].

  13. Sridhar KS, Lobo CF, Altman RD. Digital clubbing and lung cancer. Chest. Dec 1998;114(6):1535-7. [Medline].

  14. Grathwohl KW, Thompson JW, Riordan KK, Roth BJ, Dillard TA. Digital clubbing associated with polymyositis and interstitial lung disease. Chest. Dec 1995;108(6):1751-2. [Medline].

  15. Kanematsu T, Kitaichi M, Nishimura K, Nagai S, Izumi T. Clubbing of the fingers and smooth-muscle proliferation in fibrotic changes in the lung in patients with idiopathic pulmonary fibrosis. Chest. Feb 1994;105(2):339-42. [Medline].

  16. West SG, Gilbreath RE, Lawless OJ. Painful clubbing and sarcoidosis. JAMA. Sep 18 1981;246(12):1338-9. [Medline].

  17. Loredo JS, Fedullo PF, Piovella F, Moser KM. Digital clubbing associated with pulmonary artery sarcoma. Chest. Jun 1996;109(6):1651-3. [Medline].

  18. Smahi M, Lakranbi M, Choumi I, Elbiaz M, Amara B, Benjelloun MC. [Nail clubbing and lung hydatid cysts]. Rev Mal Respir. 2010;27(1):99-101. [Medline].

  19. Pineda CJ, Guerra J Jr, Weisman MH, Resnick D, Martinez-Lavin M. The skeletal manifestations of clubbing: a study in patients with cyanotic congenital heart disease and hypertrophic osteoarthropathy. Semin Arthritis Rheum. May 1985;14(4):263-73. [Medline].

  20. Kitis G, Thompson H, Allan RN. Finger clubbing in inflammatory bowel disease: its prevalence and pathogenesis. Br Med J. Oct 6 1979;2(6194):825-8. [Medline].

  21. Barraud-Klenovsek MM, Lübbe J, Burg G. Primary digital clubbing associated with palmoplantar keratoderma. Dermatology. 1997;194(3):302-5. [Medline].

  22. Mullins GM, Lenhard RE Jr. Digital clubbing in Hodgkin's disease. Johns Hopkins Med J. Mar 1971;128(3):153-7. [Medline].

  23. Dispenzieri A, Gertz MA. Treatment options for POEMS syndrome. Expert Opin Pharmacother. Jun 2005;6(6):945-53. [Medline].

  24. Grekas D, Avdelidou A. Digital clubbing as an unusual complication associated with severe secondary hyperparathyroidism: report of two cases. Hemodial Int. Apr 2007;11(2):193-7. [Medline].

  25. Schuller A, Cottin V, Hot A, Cordier JF. Finger clubbing and altered carbon monoxide transfer capacity in cannabis smokers. Eur Respir J. Feb 2008;31(2):473-4. [Medline].

  26. Thompson MA, Warner NB, Hwu WJ. Hypertrophic osteoarthropathy associated with metastatic melanoma. Melanoma Res. Dec 2005;15(6):559-61. [Medline].

  27. Salem A, Al Mokadem S, Attwa E, Abd El Raoof S, Ebrahim HM, Faheem KT. Nail changes in chronic renal failure patients under haemodialysis. J Eur Acad Dermatol Venereol. Nov 2008;22(11):1326-31. [Medline].

  28. Rush PJ, Giorshev C, Shore A, Levinson H. The use of thermography in clubbing. Respir Med. May 1992;86(3):257-9. [Medline].

  29. Ward RW, Chin R Jr, Keyes JW Jr, Haponik EF. Digital clubbing. Demonstration with positron emission tomography. Chest. Apr 1995;107(4):1172-3. [Medline].

  30. Kumar U, Bhatt SP, Misra A. Unusual associations of pachydermoperiostosis: a case report. Indian J Med Sci. Feb 2008;62(2):65-8. [Medline].

  31. Saghafi M, Azarian A, Nohesara N. Primary hypertrophic osteoarthropathy with myelofibrosis. Rheumatol Int. Apr 2008;28(6):597-600. [Medline].

  32. Arivazhagan A, Pandey P, Anandh B, et al. An unusual etiology of recurrent cerebral abscesses-a report of 3 cases. Surg Neurol. Feb 2009;71(2):241-4; discussion 245. [Medline].

  33. Bigler FC. The morphology of clubbing. Am J Pathol. Mar-Apr 1958;34(2):237-61. [Medline].

  34. Collins KP, Burkhart CG. Clubbing of the fingers. Int J Dermatol. Jun 1985;24(5):296-7. [Medline].

  35. Harding G, Janday B, Armstrong R. The topographic distribution of the magnetic P100M to full- and half-field stimulation. Doc Ophthalmol. 1992;80(1):63-73. [Medline].

  36. Karte K, Bocker T, Wollina U. Acquired clubbing of the great toenail. Digital mucoid cyst (pseudocyst). Arch Dermatol. Feb 1996;132(2):225, 228. [Medline].

  37. Kundu AK. Digital index--a new way of numerical assessment of clubbing. J Assoc Physicians India. Apr 1999;47(4):462. [Medline].

  38. Leb DE, Sharma JK. Clubbing secondary to an arteriovenous fistula used for hemodialysis. JAMA. Jul 14 1978;240(2):142-3. [Medline].

  39. Lo Monaco A, Govoni M, Trotta F. Digital clubbing or digital "pseudoclubbing" in systemic sclerosis. J Clin Rheumatol. Apr 2006;12(2):97. [Medline].

  40. Malmquist J, Ericsson B, Hulten-Nosslin MB, Jeppsson JO, Ljungberg O. Finger clubbing and aspartylglucosamine excretion in a laxative-abusing patient. Postgrad Med J. Dec 1980;56(662):862-4. [Medline].

  41. Oikarinen A, Palatsi R, Kylmaniemi M, Keski-Oja J, Risteli J, Kallioinen M. Pachydermoperiostosis: analysis of the connective tissue abnormality in one family. J Am Acad Dermatol. Dec 1994;31(6):947-53. [Medline].

  42. Siragusa M, Schepis C, Cosentino FI, Spada RS, Toscano G, Ferri R. Nail pathology in patients with hemiplegia. Br J Dermatol. Mar 2001;144(3):557-60. [Medline].

  43. Spicknall KE, Zirwas MJ, English JC 3rd. Clubbing: an update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance. J Am Acad Dermatol. Jun 2005;52(6):1020-8. [Medline].

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