What Is Nail Clubbing?

Overview

Do you know some health conditions can alter how your fingers and toes look? This article talks about one such alteration taking place in your fingers and toes, nail clubbing. 

Nail clubbing means the swelling of soft tissues at the end of the fingers that results in the flattening of the angle between the nail bed and the nail¹ (Lovibond angle). Clubbing can be associated with dermatological conditions, heart diseases, lung diseases, and other underlying causes. Also, this can occur alone as well.

In this article, we are going to explore the causes of nail clubbing, and management options. At the end of the article in the FAQ section, you will find answers to some of the commonly searched questions about clubbing.

Stages of nail clubbing

Nail clubbing is not an acute condition that occurs overnight. It takes time to develop, usually years and seems to develop in stages.^2,3

• Firstly, you can feel the softness of the base of the nail (nail bed) with reddened skin (erythema) around the nail
• Next, you will see an increased angle between the nail bed and the skin just below the cuticle (nail fold) that results in the curving of your nail than usual³
• Then you will find shiny nails with ridges along the full length of the nail and the skin around your nails will also look shiny
• Finally, the ends of your fingers look larger than it was and gives a clubbed appearance to your finger

Hypertrophic Pulmonary Osteoarthropathy (HPOA)

In some people at the later stages of clubbing, additional areas of bone might form on joints; finger joints, wrist joints, and ankles. This condition occurs in some people with lung cancer and is commonly mistaken for arthritis.

Causes of nail clubbing

Nail clubbing can be a sign of several underlying diseases involving multiple systems. However, sometimes this can occur alone without any underlying condition as well. In this section, we will explore other conditions that cause finger clubbing and causes for primary finger clubbing (clubbing without any other associated conditions).

Primary finger clubbing

• Familial clubbing  comes down from family along with genetics
• Primary hypertrophic osteoarthropathy⁴

Secondary clubbing or clubbing caused by other diseases

Multiple conditions affecting the lungs, heart, digestive system, and some malignancies can result in clubbing. However, not all the people who have these conditions manifest clubbing. Only a proportion of people who have the following conditions show finger clubbing.⁴

Lung diseases

• Lung cancer
• Tuberculosis
• Bronchiectasis, the collapse of the airways
• Cystic fibrosis
• Lung abscess
• Interstitial lung disease
• Idiopathic pulmonary fibrosis
• Sarcoidosis is a rare condition where small patches called granulomas are developed in the organs
• Empyema, pus inside the lung
• Pleural mesothelioma
• Pulmonary metastases, the spreading of cancer originating from other organs into lung tissues

Cardiovascular diseases

• Cyanotic congenital heart disease
• Bacterial endocarditis

Gastrointestinal system (Digestive system) related conditions

• Ulcerative colitis
• Crohn's disease
• Primary biliary cirrhosis
• Cirrhosis of the liver
• Achalasia

Malignancies

• Thyroid cancer
• Thymus cancer
• Hodgkin's lymphoma

Management and treatment for nail clubbing

As nail clubbing occurs as a manifestation of another underlying disease process, treating the underlying condition is the management option that is available for nail clubbing.

Upon detection of nail clubbing, your health care practitioner will take necessary steps to exclude associated underlying causes one by one. If none of the causes can be found the diagnosis of primary finger clubbing will be made.

If the underlying condition is diagnosed early and treated well nail clubbing can be reversible. However, after a certain stage, these changes become irreversible.

FAQs

How can I prevent nail clubbing

There is no specific practice to prevent finger clubbing as this occurs as a manifestation of another underlying disease. However, meeting your healthcare provider and helping to diagnose other diseases earlier by taking health advice immediately when you have symptoms of those underlying conditions may prevent the development of clubbing in the first place.

What are the early stages of nail clubbing

Clubbing is not an acute condition that occurs overnight. It develops usually over the years, but this can be varied with the aggressiveness of your underlying condition. There are a few stages of clubbing before it is developed into the final stage.

• Firstly, you can feel the softness of the base of the nail (nail bed) with reddened skin (erythema) around the nail
• Next, you will see an increased angle between the nail bed and the skin just below the cuticle (nail fold) that results in the curving of your nail than usual³
• Then you will find shiny nails with ridges along the full length of the nail and the skin around your nails will also look shiny
• Finally, the ends of your fingers look larger than it was and gives a clubbed appearance to your finger

Is nail clubbing harmful

Nail clubbing itself is not harmful. However, nail clubbing is mostly associated with underlying conditions which are harmful if not treated promptly. Therefore, if you notice clubbing meet your doctor immediately to exclude underlying causes which manifest clubbing.

When should I see a doctor

If you notice finger clubbing, meet your doctor immediately as all the conditions which give rise to clubbing should be excluded promptly.

Summary

Nail clubbing means the swelling of soft tissues at the end of the fingers that results in the flattening of the angle between the nail bed and the nail (Lovibond angle). Clubbing can be associated with dermatological conditions, heart diseases, lung diseases, and other underlying causes. Also, this can occur alone as well.

There is no specific treatment for nail clubbing rather than treating the underlying condition which causes clubbing. If you notice nail clubbing it is better to meet your doctor to exclude underlying conditions that manifest as clubbing.