Abstract
Parrot beak nail dystrophy is an excessive forward curvature of the nail plate that can affect both fingernails and toenails. Few cases have been reported since its original description in 1971; however, the incidence is estimated to be 2.5% in healthy individuals. Although the pathogenesis has not yet been established, parrot beak nail has been associated with chronic crack cocaine use, congenital bone or soft tissue abnormalities, other nail dystrophies, peripheral neuropathy, systemic sclerosis, and trauma to the nail. We describe an 86-year-old man with dementia and neuropathy who presented with an unperceived parrot beak nail of his left fourth toenail and concurrent onycholysis of his left great toenail. He had stopped visits with his podiatrist for nail care, which fostered the growth of these nail dystrophies. Our patient’s parrot beak nail was successfully treated with nail clipping and regular nail maintenance to prevent its recurrence. The associated conditions, etiologies, and treatment of parrot beak nails are discussed.
Highlights
Nail dystrophies can be congenital or acquired
The pathogenesis has not yet been established, parrot beak nail has been associated with chronic crack cocaine use, congenital bone or soft tissue abnormalities, other nail dystrophies, peripheral neuropathy, systemic sclerosis, and trauma to the nail
We describe an 86year-old man with dementia and neuropathy who presented with an unperceived parrot beak nail of his left fourth toenail and concurrent onycholysis of his left great toenail
Summary
Nail dystrophies can be congenital or acquired. some conditions frequently present in pediatric patients, whereas others are more commonly observed in elderly individuals. An 86-year-old man who is regularly followed with total body skin checks presented for his periodic visit His medical history is significant for chronic kidney disease, chronic obstructive pulmonary disease (COPD), dementia, hypothyroidism, and prostate cancer. Examination of his finger and toenails was performed His left foot showed forward over-curvature of his fourth toenail with an extension of the nail into the distal soft pulp of the digit (Figure 1). This is commonly referred to as a parrot beak nail. Thickening of the left great toenail with distal onycholysis (white circle) was observed on the same foot as the parrot beak nail (red circle). The removed parrot beak nail (D) shows over-curvature from the proximal (white arrow) to the distal (black arrow) nail plate
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