Clubbing nails
Idiopathic or primary clubbing is rare, while the occurrence of secondary clubbing depends on the underlying disease.
Primary digital clubbing has been reported to occur in 89% of patients diagnosed with pachydermoperiostosis. This syndrome most often occurs in young males.
Of patients with idiopathic pulmonary fibrosis, 65% have clinical digital clubbing. In these patients, an increased occurrence has been shown in patients with higher grades of smooth muscle proliferation in the lungs.
Clubbing has been reported in 29% of patients with lung cancer and is observed more commonly in patients with non-small cell lung carcinoma (35%) than in patients with small cell lung carcinoma (4%).
Digital clubbing was reported in 38% of patients with Crohn disease, 15% of patients with ulcerative colitis, and 8% of patients with proctitis. Clubbing was observed in up to one third of Ugandan patients with pulmonary tuberculosis. It was not associated with stage of HIV infection, extensive disease, or hypoalbuminemia.
Treatment
Medical Care
No specific treatment for clubbing is available. 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. Treatment for related problems, such as pain, is symptomatic.
Surgical Care
No specific surgical procedures are performed for clubbing. Appropriate surgical treatment of underlying disease, such as tumor removal in patients with lung cancer, may improve or reverse clubbing, provided that permanent morphologic changes have not occurred.
Consultations
Clubbing is a clinical sign of many pathological processes; therefore, consultation with specialists may be necessary to diagnose the underlying disease. Patients with primary hypertrophic osteoarthropathy should be evaluated for associated findings, possibly including myelofibrosis.
Medication
Definitive medical therapy is tailored to the underlying disease process and may include symptomatic treatment of the sequelae of clubbing.