DERMATOLOGY

Claw disease in dogs:

Part 1 anatomy and
diagnostic approach
Claw and claw fold diseases are relatively rare in the dog but can be frustrating conditions
to diagnose and treat. They may also be debilitating for affected animals and result in severe
pain and lameness. A rigorous, methodical diagnostic approach is required in order to narrow
down a large differential diagnoses list. Diagnostic tests, including bacterial and fungal culture
and impression smear cytology, can be helpful but histopathological examination of a whole
claw biopsy may be required in order to help achieve a definitive diagnosis.
10.12968/coan.2013.18.4.165
Sarah Warren BVetMed MSc (Clin. Onc.) CertVD MRCVS
Regional Veterinary Dermatologist, CVS Southern Region, Mildmay Veterinary Centre, Winchester, Hampshire
Key words: Claw | Claw fold | Onychopathy | Onychosis | Paronychia

2013 MA Healthcare Ltd

he claw is a complex and specialised structure that

is a direct continuation of the skin (dermis and
epidermis). It is formed of a highly keratinised horny
layer derived from the basal layer of the epidermis,
which overlies the dermis (or quick) that covers the distal phalanx
(or P3) (see Figure 1). The basal layer of the epidermis is most
active in the coronary band, and this is where most of the claws
growth is generated, resulting in a curved formation of the claw.
The coronary band is surrounded and hidden by the claw fold,
which is free of hair on its inner surface.
A dermalepidermal interface with a basal layer can be seen
histologically. The dermis extends from the periosteum of the
phalanx and is contiguous with it in the area of the ungual crest;
therefore, the claw may not be removed without amputation of
the third phalanx. The dermis underneath the claw contains the
blood vessels and nerves, and overlays the periosteum of the third
phalanx. The constant production of claw tissue and its highly
specialised structure and function may also make it a sensitive
indicator of nutritional status.
The claws of animals are resilient structures that are both
durable and able to withstand a host of environmental forces.
They have important functions as prehensile, locomotor and
offensive and defensive organs. A dogs claws should be kept
properly trimmed for good foot health and normal mobility.
Abnormal claws predispose the feet to trauma, strains and
pododermatitis. Because of the long growth cycle (a normal
claw grows, on average, 1.9 mm per week), any correction of
abnormality may necessitate 6 to 8 months of treatment.
Companion animal | June 2013, Volume 18 No 4

Epidermis

Ungual
crest

Coronary
band

Claw fold

Basal layer
(dorsal epidermis)

Second
phalanx
(P2)

Dermis
Distal
phalanx
(P3)

Coronary
Digital pad band

Ungual
crest

Ungual
process

Claw
fold

Ventral
sole
Lateral wall
(claw plate)
Ventral
epidermis

Figure 1: Structure of the canine claw courtesy of Patel, Forsythe;

Copyright Elsevier; Permission granted.

Claw disorders are defined by certain clinical terms which

have been extrapolated from the human literature. Table 1 lists
the most commonly used terms to describe claw disorders in
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DERMATOLOGY

Table 1. Terms used to describe claw abnormalities

Table 2. Differential diagnoses for claw

diseases

Term

Definition

Environmental

Onychopathy/
Onychosis

Disease/abnormality of the claws

Paronychia

Inflammation or infection of the claw fold

Caustic agents

Onychitis

Inflammation somewhere in the claw unit

Maceration (prolonged immersion/wetting)

Anonychia

Absence of claws (usually congenital)

Leukonychia

Whitening of the claw

Infectious

Micronychia

Abnormally small claws

Viral

Distemper

Macronychia

Abnormally large/overgrown claws

Bacterial

Onychodystrophy

Malformation of the claw

Usually secondary to inflammation/systemic

disease/trauma

Onycholysis

Separation of the claw from the claw bed

Fungal

Onychomadesis

Sloughing of the claw

Dermatophytes (T. mentagrophytes; M. canis

[Figure 8]; M. gypseum)

Onychalgia

Claw pain

Onychogryphosis

Deformed, elongated and abnormal curvature of the nails

Onychomycosis

Fungal infection of the claws

Onychorrhexis

Longitudinal striations associated with brittleness/

breaking

Protozoal

Leishmania spp

Onychomalacia

Softening of the claws

Helminth

Ancylostoma spp

Onychophagia

Ingestion/biting of the claws

Onychoschizia

Splitting and/or lamination of claws

Onychocryptosis

Ingrown claws

Trauma (racing, hunting, management) (Figure 2)

Burn

Drying (prolonged exposure to a dry environment)

Malassezia spp (e.g. secondary to allergic

dermatitis) (Figure 3)
Candida spp (e.g. secondary to diabetes mellitus)
Blastomycoses; Cryptococcosis; Geotrychosis

Uncinaria spp
Arthropods Demodex spp
Neotrombicula autumnalis larvae

Immune-mediated

Differential diagnoses for claw diseases

Hypersensitivities

In some instances, the establishment of a diagnosis may

be achieved on the basis of a thorough history and physical
examination. Cytological evaluation or bacterial or fungal
culture of material taken from within the claw fold or the claw
itself, and assessing the response to trial therapy may also
prove helpful. If these initial steps do not yield a diagnosis,
further investigation of claw diseases may necessitate a whole
claw biopsy.

Autoimmune

166

Pemphigus foliaceus; Pemphigus vulgaris

Bullous pemphigoid
Discoid lupus erythematosus
Systemic lupus erythematosus
Epidermolysis bullosa
Vasculitis
Cold agglutinin disease
Drug eruption

Metabolic
Endocrine

Hyperadrenocorticism
Hypothyroidism
Diabetes mellitus
Acromegaly

Other

Metabolic epidermal necrosis/hepatocutaneous

syndrome
Zinc-responsive dermatosis
Serious internal disease compromising nutrition
or immunity

History
As in any other dermatological condition, a good history may
give crucial clues as to the underlying aetiology, and is a very
important step in the diagnostic approach. Age of onset, breed,

Adverse cutaneous food reaction

Drug reaction

Diseases affecting exclusively the claws are relatively rare.

However, certain skin disorders and systemic diseases involve claws
in conjunction with the rest of the skin and other body regions.
Diseases affecting the footpads and interdigital skin may lead to
damage to the claw fold and claw bed. See Table 2 for a list of
differential diagnoses for claw diseases.

Diagnostic approach to claw diseases

Atopic dermatitis

Neoplastic
Squamous cell carcinoma (Figure 4)
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the dog. At this time, these descriptive terms are non-specific

for underlying aetiologies, and many of these abnormalities may
be seen together in the same claw or in different claws of the
same animal.

DERMATOLOGY

other lesions that may be part of a broader disease

spectrum. The lymph nodes should be palpated; special attention
should be taken to mucous membranes, mucocutaneous junctions,
nasal planum, pinnae and footpads, the involvement of which may
suggest the presence of immune-mediated disease, for example.

Table 2. Continued
Squamous papilloma
Melanoma
Osteosarcoma
Mast cell tumour
Metastatic neoplasia affecting multiple digits
Keratoacanthoma
Eccrine adenocarcinoma
Neurofibrosarcoma
Haemangiopericytoma

Idiopathic
Symmetrical lupoid onychodystrophy (Figures 5 and 7)

Congenital
Anonychia

Dermatological examination
All claws should be thoroughly examined and the following noted:
how many claws are affected; whether the lesions are symmetrical
(multiple claws on multiple feet) or asymmetrical (one or multiple
claws on one foot); and whether pain or pruritus is present.
Symmetrical disease is more likely to be associated with metabolic,
immune-mediated, nutritional or congenital aetiologiesalthough
leishmaniasis, multicentric neoplasia and idiopathic disease should
also be considered. Asymmetrical disease strongly suggests trauma,
infectious disease or neoplasia. Figures 2 to 9 illustrate possible
presentations of the more common claw diseases in dogs.

Onychogryphosis

Diagnostic procedures

Dermatomyositis (Figure 6)

Because of the numerous aetiologies of claw disease, a wide variety

of diagnostic tests may be indicated to narrow down the large
differential diagnoses list.
Biopsy of the claw, claw fold or of nodular disease may
be the only way of confirming a specific diagnosis for certain
onychopathies in the dog, such as lupoid onychodystrophy and
neoplasia. The submission of an avulsed or sloughed claw is rarely
helpful as it does not usually contain the claw bed that is frequently
required to establish a diagnosis. The claw bed is visualised when
the third (distal) phalanx is removed with the intact claw and the
sample decalcified, sectioned longitudinally, and submitted for
histopathology. Amputation of an affected dew claw, if present, will
minimise any post-surgical complications. A biopsy technique that
avoids amputation of the distal phalanx, but provides enough claw
matrix epithelium to be of diagnostic value, has been described

Ichthyosis

Neuropathy/self-mutilation
Acral mutilation syndrome (Figure 9)

lifestyle and environment, nutritional status, travel history, recent

vaccination, evidence of contagion, progression of disease (acute
vs. chronic), seasonality and response to prior therapy may all
give relevant information and help narrow down a large list of
differential diagnoses.

Clinical examination
A full clinical examination of the entire patient is important
in order to identify any evidence of systemic disease or

Table 3. Useful diagnostic procedures to investigate claw and claw fold diseases
Procedure

Indications

Comments/material submitted/methods

Skin scrapings/hair pluckings

Demodex spp, Neotrombicula autumnalis larvae,

Helminth larvae (Uncinaria spp, Pelodera spp,
Strongyloides spp)

Microscopic examination x10, x40

Cytology (Diff Quik stained acetate strip,

impression smear, fine needle aspirate)

Bacteria, Malassezia spp, inflammatory cells,

acantholytic keratinocytes, neoplastic cells, fungal
elements, Helminth larvae

Microscopic examination x100, oil immersion

Fungal culture

Onychomycosis (dermatophytosis, Malassezia spp)

Claw fragments, shed claw/s, crust, scale

Claw fold exudates, shed claw/s

Radiography

Neoplasia, bone involvement

Food exclusion trials

Adverse cutaneous food reactions

Novel diet/hydrolysed diet

Biopsy

Neoplasia, symmetrical lupoid onychodystrophy

Tissue biopsy, amputation of the distal phalynx

(P3); punch biopsy technique (Mueller, 1999)

Blood sampling: biochemistry, haematology,

specific endocrine testing, serology, PCR

Metabolic disease (hepatocutaneous syndrome, diabetes

mellitus, hypothyroidism, hyperadrenocorticism), systemic
disease, auto-immune disease and in cases where
immunosuppressive therapy may be indicated

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Swab for aerobic/anaerobic bacterial culture If prolonged antibiotic therapy is indicated; if

and sensitivity
antibiotic resistance is suspected; if rod organisms are
seen on cytology

DERMATOLOGY

2013 MA Healthcare Ltd

Need Bigger verions

of this pics please

Figure 2: Claw avulsion in a working Pointer;

Photograph courtesy of Peter Forsythe.

Figure 5: Onychodystrophy and onychomalacia in a Greyhound with

symmetrical lupoid onychodystrophy; photograph courtesy of Peri
Lau-Gillard.

Figure 3: Malassezia paronychia;

Photograph courtesy of Pascal Prelaud.

Figure 6: Onychogryphosis, erythema, alopecia and scaling

associated with dermatomyositis in a young crossbreed dog.

Figure 4: Multiple pedal squamous cell carcinomata;

Photograph courtesy of Michele Rosenbaum.

Figure 7: Onychogryphosis, onycholysis, onychomadesis

and onychomalacia associated with symmetrical lupoid
onychodystrophy in a German Shepherd dog.

Companion animal | June 2013, Volume 18 No 4

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DERMATOLOGY

Figure 8. Onychomycosis due to Microsporum canis in a Yorkshire

Terrier; photograph courtesy of Pascal Prelaud.

Figure 9. Acral mutilation syndrome in a French Spaniel;

photograph courtesy of Pascal Prelaud.

(Mueller and Olivry, 1999) using an 8 mm biopsy punch, but

success is reported to be variable. Furthermore, practitioners
should be warned that biopsy is not always successful in revealing
the characteristic histopathological pattern (interface dermatitis)
present in the active phase of diseases such as symmetrical lupoid
onychodystrophy, and diagnosis may therefore be best achieved
by an experienced dermatologist once other differentials have
been excluded.

Further reading

Conclusions
Although rare, claw and claw fold diseases can present a
diagnostic challenge for practitioners as the list of differential
diagnoses can be numerous. A conscientious, methodical
approach should be adopted as part of a thorough investigation in
order that a specific diagnosis can be made (if possible) and an
appropriate treatment plan instituted. Regular and long-term
follow-up is necessary as treatment success may take many
months to become evident. CA

Mueller RS (1999) Diagnosis and management of canine claw diseases. Vet Clin
North Am Small Anim Pract 29(6): 135771
Mueller RS, Friend S, Shipstone MA et al (2000) Diagnosis of canine claw
disease a prospective study of 24 dogs. Vet Dermatol 11(2): 13341
Mueller RS, Olivry T (1999) Onychobiopsy without onychectomy: description of a
new biopsy technique for canine claws. Vet Dermatol 10(1): 559
Ziener ML, Bettenay SV, Mueller RS (2008) Symmetrical onychomadesis in
Norweigian Gordon and English Setters. Vet Dermatol 19(2): 88-94
Boord MJ, Griffin CE, Rosenkrantz WS (1997) Onychectomy as a therapy for
symmetric claw and claw fold disease in the dog. J Am Anim Hosp Assoc 33(2):
1318
Scott DW, Rousselle S, Miller WH Jr (1995) Symmetrical lupoid onychodystrophy
in dogs: a retrospective analysis of 18 cases (19891993) J Am Anim Hosp Assoc
31(3): 194201
Patel A, Forsythe P (2008) Saunders Solutions in Veterinary Practice: Small Animal
Dermatology. 1st edn. Saunders Elsevier, Philadelphia: 31621

Continuing Professional Development

In order to test your understanding of this article, answer these

multiple choice questions, or if you are a subscriber, go online at
www.ukvet.co.uk, and find many more multiple choice questions
to test your understanding.

Adjunctive tests
zzClaw and claw fold diseases in the dog are relatively rare

but are often very painful and debilitating conditions

zzThe claws can be affected by other dermatological

diseases, such as those affecting the footpads and

interdigital skin and systemic disease
zzA rigorous and methodical approach is key to the
successful management of claw and claw fold diseases
zzDue to the slow re-growth of claw material, any
improvement may take weeks to months to
become evident
zzAchieving a definitive diagnosis in the case of diseases
such as symmetrical lupoid onychodystrophy may be
challenging, and even whole claw biopsy may not be
diagnostic in all cases.

170

1. What is the definition of onychomadesis?

a. Malformation of the claws
b. Splitting and/or lamination of claws
c. Softening of the claws
d. Sloughing of the claws

2. What is the definition of onychogryphosis?

a. Ingrown claws
b. Separation of the claw from the claw bed
c. Claw pain
d. Deformed, elongated and abnormal curvature of the claws

3. What is the definition of onychodystrophy?

a. Sloughing of the claw
b. Malformation of the claw
c. Abnormally large claws
d. Abnormally small claws
For answers please see page 182

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KEY POINTS