Anatomical Characteristics and Surgical Treatments of Pincer Nail Deformity

Efficacy and safety of topical acetylcysteine combined with the use of an overcurvature-correcting device in patients with pincer nail deformity: a randomized, vehicle-controlled, investigator-blinded study

BACKGROUND

While pincer nails may be treated using overcurvature-correcting devices, it takes several months to achieve successful outcomes. Nail-softening drugs may reduce the treatment duration required.

OBJECTIVE

To evaluate the efficacy and safety of treatment with acetylcysteine (AC) gel added to an overcurvature-correcting device, and define the optimal AC concentration.

METHODS

In this investigator-blinded study, 70 patients with hallux pincer nail were fitted with an overcurvature-correcting device for 7 days and were randomly assigned to receive a single 24-h administration of a gel containing 10%, 20% or 30% AC or vehicle. Nail improvement was objectively evaluated by calculating the distal narrowed nail width (dNNW) ratio.

RESULTS

All three AC concentrations plus device showed earlier sustained improvement of pincer nails versus vehicle plus device. There was no observable correlation between AC concentration and effectiveness. No clinically problematic adverse events were observed at any AC concentration, and we recommended AC gel at a concentration of 10%.

CONCLUSIONS

By adding AC gel application to an overcurvature-correcting device, early and sustained reductions in transverse curvature were produced compared with using a device alone (vehicle control). The dNNW ratio used in this study was an appropriate objective index for evaluating therapeutic effects.

Grafting and Other Reconstructive Options for Nail Deformities: Indications, Techniques, and Outcomes

This article reviews the nomenclature, anatomic components, and physiologic growth involving the perionychium. Fingertip and nailbed injuries are commonly encountered problems in hand surgery. This article focuses primarily on dealing with chronic nailbed deformities following traumatic injury such as nonadherence, split nails, avulsion loss, and hook nails. Nail deformities secondary to pincer nail, mass effect, and pigmented lesions are reviewed as well. The underlying pathology and treatment options are examined for each deformity. The senior author highlights technical pearls and surgical planning for his preferred methods of reconstruction.

Treatment of pincer nail deformity with 1064-nm Nd:YAG laser

Pincer nail (PN) is a nail disorder that cannot resolve spontaneously and sometimes necessitates surgical intervention. The etiological factors and gold standard treatment for the PN are still uncertain. We present a 24-year-old woman suffering from the PN and were treated with 1064-nm long-pulsed Nd:YAG laser. There were PN deformities in the left and right thumbnails. The left one was treated with four sessions of 1064-nm. Nd:YAG laser.

Prevalence of Onychomycosis among Patients with Transverse Overcurvature of the Nail: Results of a Cross-Sectional Study

Introduction

Transverse overcurvature of the nail (TON) represents one of the main reasons for dermatological consultations due to nail conditions. Association between TON and subungual hyperkeratosis is common and simulates onychomycosis, constituting a difficult differential diagnosis by clinical features. Many cases are treated in daily practice with antifungal therapy even without mycological confirmation. The aim of this study was to determine the prevalence of onychomycosis among patients with TON associated with subungual hyperkeratosis.

Methods

All subjects with clinical diagnosis of TON and subungual hyperkeratosis were subjected to a thorough clinical history, detailed clinical examination, digital photography, and collection of nail clipping and subungual debris for histopathological and microbiological examination (direct microscopy).

Results

Sixty-five samples were collected from 62 female (95.4%) and 3 male (4.6%) participants. Age range was between 34 and 83 years (mean age, 61.2 years). Twenty-eight samples were positive for onychomycosis, giving a 43.07% prevalence rate of onychomycosis among TON associated with hyperkeratosis.

Discussion/Conclusion

According to our data, the prevalence of onychomycosis in patients with TON associated with subungual hyperkeratosis was 43.07%, confirming the need to rule out fungal infection in TON associated with subungual hyperkeratosis prior to considering any unnecessary antifungal treatment.

Short-term results of suture treatment for pincer nail deformity

Objectives

This study aims to evaluate the cosmetic and functional results of suture treatment on pincer nail deformity (PND).

Patients and methods

This study was conducted between June 2018 and November 2018. Sixteen nails of 13 patients (6 males; 7 females; mean age 46.9 years; range, 24 to 74 years) with PND were treated with silk sutures. The pathologic stage (including tissue status and level of pain), visual analog scale (VAS), nail height (H) and width (W) were evaluated pre- and postoperatively. Nail H and W were measured pre- and postoperatively from digital photographs of each nail and H/W ratio was calculated.

Results

The postoperative VAS, severity of pain scores, and nail H showed a significant decrease compared to the preoperative values (p<0.05). Curvature of the nail and pain scores decreased in all patients. Nail W showed a significant increase, therefore H/W ratio decreased significantly (p<0.05). Although recurrence of cosmetic deformity was seen at six months, the VAS and tissue scores remained lower than preoperative values. Patients reported favorable outcomes compared to their preoperative complaints.

Conclusion

The described suture treatment method is an inexpensive, simple technique, not requiring any special material. These results support that this technique is useful for pain relief and tissue healing even if cosmetic recurrence occurs.

Significance of Surgery to Correct Anatomical Alterations in Pincer Nails

Background

Pincer nail deformity and its causes can pose a therapeutic challenge. Ill-fitting shoes and subungual exostosis of the toes may be attributed to pincer nail formation. However, in some cases, the causes of pincer nail deformity could not be determined. The role of mechanobiology in nail configuration and deformities has rarely been considered.

Objective

The present study investigated the effectiveness of surgical procedures to correct pincer nail deformity, in terms of anatomical changes measured by radiographs.

Methods

Two surgical procedures, nail bed widening with matrixectomy or a dermal graft, were used on 30 nails in 20 patients with pincer deformity. Changes in the width, height, and curvature indices were assessed. Radiographs were obtained to evaluate the presence of osteophytes and measure the interphalangeal angle in terms of mechanobiology in nail configuration.

Results

Preoperative and postoperative assessment results revealed marked improvement objectively and subjectively. The mean width index was greater after surgery than that before surgery (84.4% vs. 64.8%). Both mean height and curvature indices were smaller after surgery than before preoperative (23.0% vs. 76.7% and 1.3% vs. 2.2%, respectively).

Conclusion

Nail bed widening with matrixectomy, which corrects anatomical alterations in pincer nails, is suggested to be suitable for patients with pincer nail deformity.

To Study the Outcome of Three-Flap Technique in the Management of Pincer Nail

CONTEXT

Pincer nail deformity is a transverse overcurvature of the nail. Though various conservative and surgical techniques have been described in the literature, very few studies are based on objective measurements. This study was undertaken to evaluate the outcome of three-flap technique in the management of pincer nail.

AIM

To study the outcome of three-flap technique in the management of pincer nail.

SETTINGS AND DESIGN

Prospective interventional study.

SUBJECTS AND METHODS

Fifteen patients with pincer nail deformity, fulfilling inclusion and exclusion criteria were enrolled for the study. Routine X-ray was carried out for all patients to detect underlying bony abnormalities such as exostoses. Width and height indices were calculated before the procedure. A three-flap technique was performed on all affected toe nails and outcome was assessed at the end of 6 months and 1 year.

STATISTICAL ANALYSIS USED

Paired t-test and P value.

RESULTS

Satisfactory cosmetic outcome and statistically significant improvement (P < 0.0001) were achieved in all patients.

CONCLUSIONS

Three flap technique is an useful technique in the management of pincer nail.