Ingrown toenail: histopathologic and immunohistochemical study

Large Lobular Capillary Hemangioma Associated with Ingrown Toenail: Histopathological Features and Case Report

Lobular capillary hemangioma (LCH-PG) is a type of pyogenic granuloma characterized by proliferating blood vessels that resemble conventional granulation tissue. Granulation tissue is very often seen in association with ingrown toenails. Despite the close relationship between both entities, LCH-PG shows clinically different behaviors, such as rapid growth and frequent recurrence. Currently, it is unknown exactly how the different etiological factors contribute to the formation of differences between entities. We present a case of a large LCH-PG associated with chronic onychocryptosis in a 26-year-old man. Histopathological features included extensive signs of ulceration, hyperkeratosis, and patchy epidermal acanthosis with the presence of fibrous septa with lobular areas beneath the ulcerative area. The presence of stroma with a marked proliferation of blood vessels with wall thickening and mixed-type inflammatory changes was also characteristic. In advanced stages of onychocryptosis, as presented here, conventional granulation tissue or pyogenic granuloma can be clinically difficult to distinguish from other benign or malignant neoplasms. Histological examination is mandatory, and excisional biopsy can provide a definitive diagnosis.

Soft-Tissue Nail Fold Arc Resection Combined with a Shaped Dressing for Ingrown Toenails

The objective of this study was to evaluate the effectiveness of the surgical method of arc resection of soft-tissue nail fold combined with a shaped dressing for ingrown toenails. The surgical method involved the excision of nail fold granulation tissue and partial or total nail avulsion with preservation of its matrix. This surgical approach was applied to 20 consecutive patients (age range, 11-30 years) admitted to the hospital from January 1, 2014, to December 31, 2015. For assessment of the method, the operative technique, dressing change, and postoperative wound healing were recorded by photography. Finally, we evaluated the therapeutic effects by calculating the recurrence rate and nail groove expansion rate. Twenty patients with 38 surgical sites in 26 toes were analyzed; there was no recurrence at 3, 6, and 12 months. There was a statistically significant difference in the groove expansion rate at different time points. We measured the wound distance on postoperative day 1 compared with the day of healing and found that the method of shaped dressing could expand the nail groove by more than 50% (P ≤ .05). The mean ± SD recovery time was 15.1 ± 2.4 days. Arc resection of the nail folds for ingrown toenails coupled with preservation of its matrix minimizes trauma and is easy to manipulate. Applying a shaped dressing after the operation further reduces the risk of recurrence and ensures enough growth space for the toenails.

Umbilical Granuloma in a 2-Month-Old Patient: Histopathology of a Common Clinical Entity

Umbilical granulomas are the most common anomaly of the umbilicus in neonates and infants. These lesions are characterized by an overgrowth of granulation tissue that persists at the base of the umbilical cord after its separation. Histologically, they consist of granulation tissue, which is composed of fibroblasts, inflammatory cells, and vascular endothelial cells set in an edematous stroma. Although umbilical granulomas are commonly seen clinically, there are no reports of their histopathology in the literature. The authors present the histology of this clinical finding in a 2-month-old infant, as it is important for the pathologist to be aware of this benign entity and distinguish it from other umbilical anomalies that may be of greater clinical significance.