Cosmetic surgery for congenital nail deformities

Review and Therapeutic Approach to Malalignment of the Great Toenails: A Common Condition That Is Uncommonly Diagnosed

BACKGROUND

Malalignment of the great toenails is a common nail disorder that is uncommonly recognized in general practice.

OBJECTIVE

Review available literature on lateral malalignment of the great toenails to increase awareness of this underdiagnosed condition and provide management recommendations.

METHODS

A PubMed search was conducted using the terms " congenital malalignment toenail" and "malalignment great toenail" . All articles were reviewed, and all relevant articles were included in this analysis.

RESULTS

Thirty-four distinct articles encompassing 117 patients with similar clinical findings: lateral deviation of the great toenails with yellow brown dyschromia, thickening, and scalloping.

LIMITATIONS

Description of malalignment and terminology can vary, which may have led to exclusion of some relevant articles.

CONCLUSION

Lateral malalignment is a common nail condition that is underappreciated and often misdiagnosed in general dermatologic and medical practice. This review aims to increase awareness to facilitate better care of these patients.

Congenital and Hereditary Nail Disease

Nail disorders in newborns can show independently or as components of systemic illnesses or genodermatoses. The examination of these abnormalities is complex and sometimes challenging. However, familiarity with these disorders can significantly contribute to uncovering potential underlying conditions. This review includes the physiological nail changes seen within the first few months of life, such as Beau's lines, onychoschizia, koilonychia, congenital nail fold hypertrophy of the first digit, and onychocryptosis. This review also focuses on the most relevant congenital disorders reported and how to perform differential diagnosis. Finally, this review highlights those hereditary diseases in which nail involvement is crucial for diagnosis, such as nail-patella syndrome, congenital pachyonychia, or congenital dyskeratosis, among others.

[Translated article] Congenital and Hereditary Nail Disease

Nail disorders in newborns can show independently or as components of systemic illnesses or genodermatoses. The examination of these abnormalities is complex and sometimes challenging. However, familiarity with these disorders can significantly contribute to uncovering potential underlying conditions. This review includes the physiological nail changes seen within the first few months of life, such as Beau's lines, onychoschizia, koilonychia, congenital nail fold hypertrophy of the first digit, and onychocryptosis. This review also focuses on the most relevant congenital disorders reported and how to perform differential diagnosis. Finally, this review highlights those hereditary diseases in which nail involvement is crucial for diagnosis, such as nail-patella syndrome, congenital pachyonychia, or congenital dyskeratosis, among others.

Nail cosmetology

Nail cosmetics is enjoying growing success due to recent technological advances. Manicures can be responsible for mechanical, infectious or allergic adverse effects. Nail cosmetics (e.g., nail varnishes, acrylic false nails, light-curing gels, and adhesive false nails) incorporate substances that harden after solvent evaporation or after polymerization. Allergic reactions can occur, remotely with conventional varnishes and locally with polymerizing substances. Artificial nails incur a risk of carrying infectious agents which can cause serious infection, and should not be used by caregivers. Recently, there has been a worrisome increase in the frequency of acrylate allergy, due to the appearance of home kits and lack of information in the general public. The infectious, allergic and toxic risks incurred by consumers and professionals regarding manicure or pedicure treatments and the application of nail cosmetics are the subject of recommendations and monitoring measures.

Congenital Malalignment of the Great Toenail, the Disappearing Nail Bed, and Distal Phalanx Deviation: A Review

<b><i>Importance:</i></b> Congenital malalignment of the great toenail (CMGT) is an idiopathic deviation of the nail apparatus. CMGT predisposes patients to recurrent stress forces, microtrauma, and secondary complications. The purpose of this study was to review the current published photographs to determine the relationship between variants of CMGT and the disappearing nail bed (DNB). <b><i>Observations:</i></b> A search in PubMed and Google using the terms congenital malalignment of the great toenail, disappearing nail bed, and lateral nail deviation was performed. Of the 53 photographs found in a total of 35 articles, 23 were disqualified due to low picture resolution or poor angle. The remaining 30 photographs were evaluated. Pure nail malalignment with associated dystrophy and DNB was found in 22 of 30 photographs. Four of 30 cases demonstrated pure deviation of the distal phalanx, with nail dystrophy but minimal DNB. The remaining 4 cases demonstrated a combination of toe deviation and nail unit deviation with varying degrees of DNB. <b><i>Conclusions and Relevance:</i></b> DNB was associated with all forms of pure CMGT. Moreover, a variant of malalignment of the distal phalanx was noted in 8 photographs. This has potential implications for further studies and treatment to correct secondary complications.

Congenital malalignment of the great toenail: Conservative and definitive treatment

Congenital malalignment of the great toenail, or ungual malalignment, is a rarely recognized disorder. It is characterized by lateral deviation of the longitudinal axis of the nail plate with respect to the distal phalanx, and if untreated, complications in the late teens and adulthood may arise. In this study, we have reviewed conservative and definitive treatments for this disorder.

New Technique for Correcting Bony Deformity in Racquet Thumb

: This article aims to present a new method for correcting bony deformity in racquet thumb.

METHODS

We operated on 37 thumbs of 32 patients (age, 17-52 years) with racquet thumb using a procedure that included narrowing the nail bed, recreating the lateral nail fold, making a bone defect in the widened proximal base, and exposing more proximal nail bed. The ratio of the length to the width of the nail was calculated.

RESULTS

The ratio of the length to the width of the nail increased from 0.55 before surgery to 0.78 at the final follow-up visit. Most patients were satisfied with the cosmetic and functional results.

CONCLUSIONS

This technique is simple, safe, and both cost- and time-effective and is a good option for the repair of racquet thumb.

Congenital Malalignment of the Great Toenails: A Review

Congenital malalignment of the great toenail is an under-estimated dystrophic disorder of unknown origin characterized by lateral deviation of the nail plates, which are not parallel to the major axis of the distal phalanx. It usually presents in infancy or childhood, while late onset is uncommon. Treatment depends on the degree of deviation. If minimal, a conservative and expectant attitude, based on prevention and treatment of possible complications, is recommended because of the possibility of spontaneous regression of the nail deviation. Surgical therapy may be considered in patients with severe or complicated forms.

Congenital malalignment of the big toe nail

Congenital malalignment of the big toe nail is based on a lateral deviation of the nail plate. This longitudinal axis shift is due to a deviation of the nail matrix, possibly caused by increased traction of the hypertrophic extensor tendon of the hallux. Congenital malalignment of the big toe nail is typically present at birth. Ingrown toenails and onychogryphosis are among the most common complications. Depending on the degree of deviation, conservative or surgical treatment may be recommended.

Nail disorders in children: diagnosis and management

Nail disorders in children can be divided into seven categories. The first is physiologic alterations, which every physician should be aware of in order to reassure parents. These usually disappear with age and do not require any treatment. Among congenital and inherited conditions, the nail-patella syndrome, with its pathognomonic triangular lunula, should not be missed as recognition of the disease allows early diagnosis of associated pathologies. The most common infection is the periungual wart, whose treatment is delicate. Herpetic whitlow should be distinguished from bacterial whitlow as their therapeutic approaches differ. Dermatologic diseases encompass eczema, psoriasis, lichen planus, lichen striatus, trachyonychia, and parakeratosis pustulosa. Lichen planus, when it presents as in adults, is important to recognize because, if not treated, it may lead to permanent nail loss. Systemic or iatrogenic nail alterations may be severe but are usually not the first clue to the diagnosis. Beau lines on several fingernails are very common in children after temperature crest. Tumors are rare in children. Radiographic examination allows confirmation of the diagnosis of subungual exostosis. Other cases should undergo biopsy. Single-digit longitudinal melanonychia in children is mostly due to nevi. Its management should be tailored on a case-by-case basis. Acute trauma should never be underestimated in children and hand surgeons should be involved if necessary. Onychophagia and onychotillomania are responsible for chronic trauma.