Huge hypertrophic scar secondary to chronic ingrown toe nail mimicking tumor: A case report.

RATIONALE: A huge hypertrophic scar formation secondary to chronic ingrown toe nail mimicking tumor is a rare disease. It is not only causing concerns cosmetically, but also hindering normal daily activities physically and socially. In this paper, we present an unusual case of bilateral ingrown nails with different phases. One resulted in a large hypertrophic scar caused by stimulation from secondary to chronic ingrown nail. PATIENT CONCERNS AND DIAGNOSIS: A 44-year-old man with a huge mass (7 × 4 × 8.5 cm) in his right great toe and inflamed ingrown nail in his left great toe visited the clinic. The mass in the right toe showed an irregular and bizarre shape with a stellate ulcer (2 × 2 cm) at the distal end. After removing an ingrown nail 3 years ago with minor repetitive trauma, self-managed wound has grown into a tumor-like mass, resulting in intolerable discomfort. In gross appearance, a stalk appeared to originate from the lateral side of the nail bed with the ingrown nail in the great toe showing inflamed medial and lateral gutter and causing redness and tenderness. Huge hypertrophic scar formation secondary to chronic ingrown toe nail mimicking tumor is a rare disease that is not only causing a cosmetic concern, but also hindering normal daily activities physically and socially. INTERVENTION AND OUTCOMES: Excisional biopsy was performed for both great toes. Biopsy confirmed chronic ulcerative inflammation with a hypertrophic scar. The resection site healed and persisted well at 12 months after surgery. CONCLUSION: Our unusual case suggests that the natural course of an untreated ingrown toe nail may result in hypertrophic scar extending far to mimic tumorous conditions.

A novel cosmetic approach for partial matricectomy in treating ingrown toenails.

BACKGROUND: Toenails play a great part in protecting toes and peripheral soft tissues, simultaneously playing a cosmetic role. The ideal treatment should result in a functional and aesthetic outcome. OBJECTIVE: To describe a novel, aesthetic and minimally invasive method to treat ingrown toenail. METHODS: We retrospectively analyzed 436 lesions of 395 ingrown toes in 353 patients with a mean age of 26.0 ± 13.4 (range 10-55) from June 2014 to March 2020 in our department. A novel cosmetic approach for partial matricectomy in treating ingrown toenails was undergone. The average follow-up time was 27.5 ± 2.8 months. The average period prior to work resumption, recurrence rate, and infection rate were measured. Mean pain Visual Analogue Scale (VAS) and Mean satisfaction VAS were used to evaluate the foot appearance. RESULTS: The average period prior work resumption was 2.2 ± 2.1 days (range, 0-7 days). The recurrence rate was 1.6% (7 lesions in 6 patients) at more than 2 years of follow-up. There was no critical complication except infection (0.46%). Mean pain VAS reduced from a preoperative score of 7.7 ± 1.5 points (range, 6-10 points) to a postoperative 3-day score of 2.2 ± 1.0 points (range, 1-4 points; p < 0.001) while Mean satisfaction VAS improved from 1.5 ± 1.3 points (range, 0-3 points) to 9.2 ± 0.6 points (range, 8-10 points; p < 0.001). CONCLUSION: Our proposed approach is minimally invasive relative to conventional methods, which can achieve comparable efficacy to treat ingrown toenails with granulation tissue. Therefore, it can serve as another option to treat this specific type of ingrown toenails.

Efficacy of Nail Braces for Acute and Chronic Ingrown Toenails: A Prospective Study.

BACKGROUND: Nail braces are an alternative treatment for ingrown toenails. OBJECTIVE: This study aimed to prospectively examine the efficacy of nail braces for treatment of acute inflamed (AI)-type and chronic dystrophic-type ingrown toenails. MATERIALS AND METHODS: The authors conducted a prospective study of patients with ingrown toenails treated at Wan Fang Hospital between January 1, 2017, and July 31, 2018. Evaluation using physician global assessment scores and patient satisfaction questionnaires was performed at 1, 3, and 6 months after the start of treatment and during the final visit. Patient demographics, treatment courses, and outcomes were compared between the 2 types of ingrown toenails. RESULTS: Chronic dystrophic-type and AI-type ingrown toenails were observed in 25 (61 sides) and 28 patients (35 sides), respectively. Of the affected sides, 80.9%, 94.9%, and 100% achieved an excellent or fair result at 1, 3, and 6 months, respectively. Treatment duration and follow-up period were 179.2 ± 96.8 days and 281.6 ± 120.9, respectively. The recurrence rate was 7.4%. The treatment course and response were different between the 2 types of ingrown toenails. CONCLUSION: Ingrown toenails could be effectively treated with nail braces with excellent outcomes, favorable patient satisfaction, and low recurrence rates.

Clinical and Sociodemographic Characteristics of Patients with Ingrown Nails.

BACKGROUND: Ingrown nail is a common health problem that significantly affects daily life due to its painful nature. The purpose of this study was to reveal the clinical and sociodemographic characteristics of ingrown nails. METHODS: The clinical and sociodemographic characteristics of patients older than 18 years presenting with ingrown nail were investigated. RESULTS: Two hundred six patients aged 18 to 77 years (mean age, 39 years; female to male ratio, 1.45) were included in the study. A total of 729 lesions were evaluated (718 ingrown nails were on the feet and 11 were on the fingers). A family history of ingrown nail was present in 7.6% of the participants. Of the 206 patients, 26.7% were treated with surgical methods for ingrown nails previously and experienced recurrence. Ingrown toenails were in the hallux in 81.3% of patients, and 52% were on the lateral margin. Incorrect nail-cutting habits (73.5%), poorly fitting shoes (46.2%), excessive angulation of the nail plate (35.8%), obesity (34.1%), trauma to the feet (24.3%), pregnancy (23.8% of women), hyperhidrosis (16.8%), and lateral deviation of the nail plate (9.9%) were closely associated with ingrown nails. CONCLUSIONS: This study revealed the clinical and sociodemographic characteristics of ingrown nails. The study data will be useful in preventing the development of ingrown nail and recurrences after treatment by identifying and then eliminating conditions establishing a predisposition to it.

Ingrown Toenails During Chemotherapy and Stem Cell Transplantation in Children With Hematologic Malignancies and Solid Tumors.

BACKGROUND: At our institution, we noted that children with hematologic malignancies and solid tumors often suffered from ingrown toenails (IGTNs) during hospitalization for chemotherapy and stem cell transplantation. However, only few reports have dealt with IGTNs in the above setting. PROCEDURE: Between August 2007 and July 2017, 180 children who received treatment for hematologic malignancies and solid tumors at our institute were enrolled in this study. Twelve patients with insufficient data and 7 patients with past histories of IGTNs were excluded. A total of 161 patients were analyzed. Median age at admission was 7.9 years (range, 1.0 to 25.4 y), with 92 males and 69 females. Diagnoses were hematologic diseases in 128 patients, including acute lymphoblastic leukemia (ALL) in 75 patients, and solid tumors in 33 patients. RESULTS: A total of 22 patients (13.7%) suffered from IGTNs (or toe paronychia) during hospitalization. Multivariable analysis disclosed a strong correlation between the occurrence of IGTNs and older age (over 9.0 y) and ALL. CONCLUSIONS: Patient-related factors, such as age over 9 years and ALL were associated with IGTNs. This is the first report of a survey on IGTNs in patients with hematologic malignancies and solid tumors hospitalized for chemotherapy and stem cell transplantation.

Retronychia: an underdiagnosed disease.

Retronychia is a recently described cause of ingrowth of the nail plate on the ventral surface of the proximal nail fold. Clinical features are repeated episodes of proximal paronychia, nail plate thickening, and occasionally granulation tissue emergence. The usual treatments for paronychia such as antibiotics and antifungals are ineffective in these cases. Avulsion of the nail plate is the treatment of choice for these patients, but effective treatment is usually delayed owing to inadequate diagnosis. Herein, we describe a 28-year-old woman with a case of retronychia. She was treated for two months with oral and topical antifungal and antibiotics by her general practitioner. After proper diagnosis and avulsion of the nail she presented a normal and non-painful growth of the affected nail.

Onychomatricoma: a tumor unknown to dermatologists.

A sixty-one year old white female was referred to the Dermatology Department to treat an ingrown nail in the inner corner of the left hallux. Examination of the entire nail unit showed the presence of xanthonychia in the outer corner besides thickening and increase in the transverse curvature of the nail plate. Dermoscopy and nuclear magnetic resonance of the free edge of the nail plate detected characteristic signs of onychomatricoma, a diagnosis that was later confirmed by anatomopathological exam.

"Cotton nail cast": a simple solution for mild and painful lateral and distal nail embedding.

BACKGROUND: Onychocryptosis is one of the most common painful nail conditions. Conservative treatment may take a long time to obtain effective results. OBJECTIVE: The purpose of this study is to show the effectiveness of a conservative treatment of ingrown nails that shows rapid results. METHODS AND MATERIALS: Patients with painful Stage 1 to 2 onychocryptosis who were not candidates or refused surgery were treated with the cotton cast. The severity and cause of onychocryptosis was clinically evaluated during a 2-month period. A questionnaire was applied to all patients to evaluate pain, final treatment, and possible complications. RESULTS: All patients noticed results in less than 72 hours. Pain subsided in less than 24 hours in half of the patients and before 72 hours in 100% of the patients without the need of other treatments. The use of the cast prevented surgery and the accompanying morbidities in most of the patients (80%). CONCLUSION: The "cotton nail cast" is an effective conservative method for mild nail embedding. It is easy to apply, inexpensive, relieves pain rapidly, and avoids surgery in most patients.

Comparison of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion in the treatment of ingrown toenails.

The present retrospective study compared the efficacy of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion for the treatment of ingrown toenails (onychocryptosis). Two surgical methods were performed in 95 patients with a stage 2 or 3 ingrown toenail. Each patient was examined weekly until healing and then at 1, 6, and 12 months of follow-up. The outcomes measured were surgical duration, healing time, recurrence rate, the incidence of postoperative infection, and cosmetic appearance after surgery. Of the 95 patients (115 ingrown toenails) included in the present study, 39 (41.1%) underwent wedge resection (Winograd procedure) and 56 (59%), wedge resection plus complete nail plate avulsion. The mean surgical duration for wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion was 14.9 ± 2.4 minutes and 15.1 ± 3.2 minutes, respectively (p = .73). The corresponding healing times were 2.8 ± 1.2 weeks and 2.7 ± 1.3 weeks (p = .70). Recurrence developed in 3 (3.2%) patients after wedge resection (Winograd procedure) and in 4 (4.2%) after wedge resection plus complete nail plate avulsion. In addition, postoperative infection occurred in 3 (3.2%) patients after wedge resection (Winograd procedure) and 2 (2.1%) after wedge resection plus complete nail plate avulsion. Both of the surgical procedures were practical and appropriate for the treatment of ingrown toenails, being simple and associated with low morbidity and a high success rate. However, cosmetically, wedge resection (Winograd procedure) would be the better choice because the nail plate remains intact.

[Ingrown nails or onychocryptosis]. / L'ongle incarné ou onychocryptose.

Ingrown nails come down to a conflict between the nail plate and the periungual tissue, causing pain, morbidity and impairment. The feet are mainly affected. The treatments are numerous: medical, podiatric, or surgical. Surgical management has two approaches: the techniques focused on the periungual skin and those on the nail plate. Among the latter, partial nail avulsion followed by matrix phenolization, known as "Boll's technique", is still highly regarded.

Physics of nail conditions: why do ingrown nails always happen in the big toes?

Although surgical treatment of nail conditions can be traced back centuries to the writings of Paul Aegineta (625-690 AC), little is known about the physical laws governing nail growth. Such a poor understanding together with the increasing number of nail salons in the high street should raise legitimate concerns regarding the different procedures applied to nails. An understanding of the physics of nail growth is therefore essential to engage with human medicine and to understand the aetiology of nail conditions. In this context, a theory of nail plate adhesion, including a physical description of nail growth can be used to determine the transverse and longitudinal curvatures of the nail plate that are so important in the physical diagnosis of some nail conditions. As a result physics sheds light on: (a) why/how nails/hooves adhere strongly, yet grow smoothly; (b) why hoof/claw/nail growth rates are similar across species; (c) potential nail damage incurred by poor trimming; (d) the connection between three previously unrelated nail conditions, i.e. spoon-shaped, pincer and ingrown nails and; last but not least, (e) why ingrown nails occur preferentially in the big toes.

[Retronychias]. / Rétronychies.

Retronychia usually affects young female (between 20 and 30 years old). It starts with the disruption of the longitudinal growth of the nail, because of a microtraumatic insult. Others diagnostic criteria: proximal nail plate rose upward proximal nailfold, pachyonychia and dyschromia, paronychia. Management consists of total nail avulsion.