Pincer Nails Research Articles

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

BackgroundWhile 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.ObjectiveTo evaluate the efficacy and safety of treatment with acetylcysteine (AC) gel added to an overcurvature-correcting device, and define the optimal AC concentration.MethodsIn 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.ResultsAll 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%.ConclusionsBy 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.

Common diseases of the nail: Diagnosis and therapy.

This review focuses on nail changes that do not belong to the group of benign or malignant nail tumors. These common afflictions of the nail include structural changes in and under the nail plate as well as inflammation around and in the nail bed. They include onychomycoses, nail psoriasis, onychodystrophies, subungual hematoma, paronychia, ingrown nails and pincer nails. Due to the peculiar anatomy and physiological growth conditions of the nail, the pathology does not necessarily stem from the site of the clinical problem and calls for careful inspection and interpretation.

Presence of a family history and excessive pressure on the first toe pad during walking in female subjects with pincer nails.

Pincer nails (PN) are defined as a transverse overcurvature of the nail plate. Although there have been advancements in therapeutic approaches, the precise underlying mechanisms for the development of PN are still not fully understood. Currently, PN are assumed to develop due to lack of upward mechanical force on the toes. We developed a novel wireless device to observe detailed gait motion. We analyzed trends of gait motion in healthy individuals without PN, healthy individuals with PN without a family history of PN, and healthy individuals with PN and a family history of PN. We found that a family history of PN is an independent risk factor for PN, irrespective of gait motion. Moreover, healthy individuals with PN but without a family history of PN exhibit strong and concentrated pressure on the first toe pad during walking. In sum, a family history of PN and excess upward mechanical forces on the first toe pad during walking may be risk factors for the development of PN.

Differences Between Patient-Reported Versus Clinician-Observed Nonulcerative Signs and Symptoms of the Foot in Patients With Diabetes Mellitus.

The primary aim of this study was to compare patient reported versus clinician-observed nonulcerative foot conditions in patients attending a diabetic foot clinic and deemed at risk for diabetic foot ulcers. Retrospective review of medical records. The medical records of 126 patients with diabetes mellitus and deemed at risk for developing diabetic foot ulcers were reviewed. All patients received care from a diabetic foot outpatient clinic in a university-based hospital in Tokyo, Japan, between November 2008 and October 2009. We compared patients' self-identified foot complaints with clinically observable conditions affecting the feet of these individuals with diabetes mellitus. Patients' medical records were retrieved, and patient complaints and identified preulcerative signs of the foot were documented. All clinical observations were made by nurse specialists with knowledge of diabetic foot conditions. Nonulcerative diabetic foot conditions we observed included calluses, corns, abnormal nails, fissures, tinea pedis, and tinea unguium. Patient sensitivity to correctly identify these signs was calculated using the following formula: patient-reported foot signs divided by clinically identified preulcerative signs. Patient sensitivity for identifying nonulcerative signs varied based on the foot condition was 51.4% for calluses, 47.8% for pincer nails, 44.4% for corns, 33.3% for fissures, 19.4% for nail abnormalities, 3.9% for scales/maceration between the toes, 2.6% for interdigital tinea pedis, and 18.2% for tinea unguium. These findings suggest that persons with diabetes vary in their awareness of conditions affecting their feet and enhancing their risk for the development of diabetic foot ulcers. We recommend additional education on foot-related self-care including how often to observe their feet and how to recognize symptoms that may elevate their risk for diabetic foot ulcers.

Significance of Surgery to Correct Anatomical Alterations in Pincer Nails.

BackgroundPincer 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.ObjectiveThe present study investigated the effectiveness of surgical procedures to correct pincer nail deformity, in terms of anatomical changes measured by radiographs.MethodsTwo 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.ResultsPreoperative 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).ConclusionNail bed widening with matrixectomy, which corrects anatomical alterations in pincer nails, is suggested to be suitable for patients with pincer nail deformity.

陥入爪・巻き爪の違いと治療 －この似て非なるもの－

陥入爪・巻き爪の違いと治療 －この似て非なるもの－

Nail Plate and Bed Reconstruction for Pincer Nail Deformity.

Pincer nail deformity is a severe condition in which the nail bed becomes compressed and the nail shows an overcurvature. We retrospectively analyzed 13 pincer nail deformities treated using our nail plate and bed reconstruction technique. Visual analogue scale scores, the width of nail root, width of nail tip, height of nail tip, width index, and height index were assessed before and after surgery. The overcurvature was corrected after detachment of the nail plate. The nail fold was pushed underneath the nail plate and then fixed. The width of nail tip significantly increased after surgery (p < 0.05) and was maintained during follow-up. The height of nail tip decreased after surgery (p < 0.05). This nail plate and bed reconstruction technique is a simple and quick surgical method for correcting deformities and reduces risks of complications such as skin necrosis and infection compared to other existing surgical techniques. We recommend this efficient surgical technique for the treatment of pincer nails.

Use of a Makidume Robo to Straighten Pincer Nails during Dialysis

Use of a Makidume Robo to Straighten Pincer Nails during Dialysis

Pachyonychia congenita: Affecting three generations!

Pachyonychia congenita is an autosomal dominantly inherited disease that primarily presents as nail dystrophy and dyskeratosis of skin and mucous membranes. A 32-year-old female presented with thickening of the nails and thickening of both heels. Her father showed pincer nails with periungual thickening of skin and fissures with focal plantar keratoderma. Her two sons had similar nail changes.

Paznokcie pincetowate – początkowy i izolowany objaw skórny tocznia rumieniowatego układowego

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Pawar M. Pincer nails: an initial and isolated cutaneous manifestation of systemic lupus erythematosus. Dermatology Review/Przegląd Dermatologiczny. 2017;104(3):337-343. doi:10.5114/dr.2017.68781. APA Pawar, M. (2017). Pincer nails: an initial and isolated cutaneous manifestation of systemic lupus erythematosus. Dermatology Review/Przegląd Dermatologiczny, 104(3), 337-343. https://doi.org/10.5114/dr.2017.68781 Chicago Pawar, Manoj Karbhari. 2017. "Pincer nails: an initial and isolated cutaneous manifestation of systemic lupus erythematosus". Dermatology Review/Przegląd Dermatologiczny 104 (3): 337-343. doi:10.5114/dr.2017.68781. Harvard Pawar, M. (2017). Pincer nails: an initial and isolated cutaneous manifestation of systemic lupus erythematosus. Dermatology Review/Przegląd Dermatologiczny, 104(3), pp.337-343. https://doi.org/10.5114/dr.2017.68781 MLA Pawar, Manoj Karbhari. "Pincer nails: an initial and isolated cutaneous manifestation of systemic lupus erythematosus." Dermatology Review/Przegląd Dermatologiczny, vol. 104, no. 3, 2017, pp. 337-343. doi:10.5114/dr.2017.68781. Vancouver Pawar M. Pincer nails: an initial and isolated cutaneous manifestation of systemic lupus erythematosus. Dermatology Review/Przegląd Dermatologiczny. 2017;104(3):337-343. doi:10.5114/dr.2017.68781.

Respiratory changes, hand fingers edema and yellow nails in a 94-year old woman

A 94-year old woman, with antecedent of chronic bronchitis, bronchiectasis, recurrent pneumonitis, arterial hypertension and chronic renal failure was admitted to control an episode of cardiac and respiratory insufficiency. Yellow nail changes and a tendency to pincer nails developed in her hand and toe fingers, preceded by longstanding course of respiratory diseases with pleural involvement. Laboratory tests detected moderate anemia and mildly elevated levels of urea and creatinine, thyroid function was normal. This case study is about yellow nail syndrome in absence of ankle lymphedema, and affecting a woman of the oldest-old age group with renal failure.

Long-pulsed 1064 nm Nd:YAG laser treatment for ingrown toenails and pincer nails

Long-pulsed 1064 nm Nd:YAG laser treatment for ingrown toenails and pincer nails

Foot loading is different in people with and without pincer nails: a case control study.

BackgroundRecent studies suggest that pincer nails are caused by lack of upward mechanical forces on the toe pad. However, clinically significant pincer nails are also often observed among healthy walkers. It was hypothesized that in these cases, the affected toes do not receive adequate physical stimulation from walking and loading. To test this, the gait characteristics of pincer nail cases were assessed by measuring plantar pressure during walking.MethodsIn total, 12 bilateral pincer nail cases (24 affected feet) and 12 age- and sex-controlled healthy control subjects (24 ft) were enrolled in this prospective case–control study. Plantar pressure during free ambulation in both the barefoot and shod state was assessed using a digital pressure-plate system named S-Plate platform (Medicapteurs Co. France). First toe pressure and the frequencies of peak pressure in the first toe, metatarsal head, or other foot areas were calculated.ResultsIn both the barefoot and shod state, the pincer nail group had significantly lower pressure on the first toe than the control group. In both the barefoot and shod state, the peak pressure area was mostly the metatarsal head area in the pincer nail group, whereas it was mostly the first toe area in the control group. Binomial logistic regression analysis revealed that peak pressure area was a significant risk factor for pincer nail development.ConclusionWalking behavior appears to contribute to pincer nail development. Pincer nails of walkers could be treated by correcting the walking behaviour so that more pressure is placed on the toe pad.

A Constellation of Nail Changes in A Child with Kawasaki Disease.

A two-year-old boy was brought with high grade intermittent fever of 6 days duration with congestion of eyes, perioral and perianal skin peeling of two days duration. On examination, he had an enlarged right upper deep cervical lymph node of size 2x2 cm, dry and cracked lips, red tongue, congested oropharynx, bilateral nonpurulent conjunctival infection, perioral and perianal desquamation, macular rash with central clearing in his neck and trunk, swollen hands and feet. Investigations revealed neutrophilic leukocytosis, ESR of 98 mm/hr, platelet count of 2 lacs/cubic mm and positive CRP. Blood antistreptolysin O was negative. There was no history of sore throat, difficulty in swallowing or history of any drug intake. As the boy satisfied the clinical criteria for Kawasaki disease [1], antiinflammatory therapy was started with which he became afebrile in 48 hours. Echocardiogram did not reveal coronary aneurysms. On day ten of illness, he was noticed to have periungual desquamation (red arrow), orange brown discolouration (chromonychia) of nail on right ring finger (blue arrow), transverse nail crease ( yellow arrow) on his right middle finger and spontaneous separation of nail (onychomadesis) on his right index finger (white arrow) [Table/Fig-1]. On follow-up, his nail changes normalized and he continued to remain free of coronary aneurysms. [Table/Fig-1]: Nails in Kawasaki disease Extremity changes in Kawasaki disease are well known and include erythematous swelling of hands and feet in the acute phase followed by periungual desquamation in the convalescent phase [1]. Several nail changes have been described in Kawasaki disease. Spontaneous nail separation from the matrix or onychomadesis resulting from inhibition of nail plate growth due to inflammation of nail matrix [2], Beau`s lines [3], pincer nails (transverse over curvature of nails) [4], leukonychia (non uniform white discolouration of nail plate) and transverse orange brown chromonychia [5]. However, all the nail changes occurring in a single child has not been reported previously, to the best of our knowledge.

Clinical Evidence for the Relationship between Nail Configuration and Mechanical Forces

Summary:Mechanobiology is an emerging field of science that focuses on the way physical forces and changes in cell or tissue mechanics contribute to development, physiology, and disease. As nails are always exposed to physical stimulation, mechanical forces may have a particularly pronounced effect on nail configuration and could be involved in the development of nail deformities. However, the role of mechanobiology in nail configuration and deformities has rarely been assessed. This review describes what is currently understood regarding the effect of mechanical force on nail configuration and deformities. On the basis of these observations, we hypothesize that nails have an automatic curvature function that allows them to adapt to the daily upward mechanical forces. Under normal conditions, the upward daily mechanical force and the automatic curvature force are well balanced. However, an imbalance between these 2 forces may cause nail deformation. For example, pincer nails may be caused by the absence of upward mechanical forces or a genetic propensity increase in the automatic curvature force, whereas koilonychias may occur when the upward mechanical force exceeds the automatic curvature force, thereby causing the nail to curve outward. This hypothesis is a new concept that could aid the development of innovative methods to prevent and treat nail deformities.

Quick and easy correction of a symptomatic pincer nail using a shape memory alloy device.

Pincer nails are characterized by the transverse curvature increasing from the proximal to the distal aspect along the longitudinal axis. A novel treatment technique using a shape memory alloy device was recently introduced. To determine the treatment outcomes and safety of a shape memory alloy device. This was a retrospective analysis of 21 cases of pincer nail of the great toe in 14 patients. Subjective indices (pain, inconvenience, global assessment scores) and objective parameters (transverse angle, width index) on days 0 (D0) and 1 (D1) and weeks 2 (W2) and 12 (W12) were investigated. All parameters started to show significant improvement on D1. From D0 to D1, pain score fell from 3.6±1.0 to 1.5±0.7, inconvenience score fell from 3.3±1.0 to 1.5±0.7, global assessment score increased from 1.5±0.7 to 2.5±0.7, transverse angle improved from 86.4±27.7° to 114.7±21.6°, and width index improved from 67.6±13.1% to 89.0±9.7%. These effects were consistent during 12weeks of follow-up. Two cases (9.5%) recurred, but symptoms were less severe than before. No complication was identified. A shape memory alloy device was an effective and safe way to rapidly correct symptomatic pincer nail deformity.

Curvature index of pincer nail.

Summary:Pincer nails are a common problem, and various treatments have been reported. However, there is no simple assessment of severity. We designed a curvature index for the nail plate to assess the severity of pincer nail. Measurement of the curvature index was as follows. The apparent width of the nail tip was defined as A, and the traced length of the nail tip was defined as B. The curvature index was defined as B divided by A (B/A). With this curvature index, it is easy to describe the severity of the pincer nail and to compare the improvement before and after treatment.

Nail surgery

Nail surgery is a special branch of hand and dermatologic surgery. It is not widely performed, and many physicians do not feel at ease to perform it. The objective of this contribution is to give a short overview of the most important surgical procedures in clinical practice. References from the literature and the author’s own experiences are condensed to describe what a dermatologic practitioner with knowledge of the nail and some surgical skills can perform. Nail surgery is a precise technique that requires careful administration and attention to details. Proper patient preparation starts with a patient history to identify potential contraindications and to prevent unnecessary complications. The author recommends isopropyl alcohol scrub and chlorhexidine for disinfection and ropivacaine 1% for anesthesia. The technique used for anesthesia depends on the type of surgery. Surgical procedures are described for diagnostic biopsies, nail avulsion in general, onychogryposis, paronychia treatment, hematomas and bone fracture due to trauma, removal of subungual foreign bodies, ingrowing nails, pincer nails, warts, ungual fibrokeratomas, digital myxoid pseudocyst, subungual exostoses, and various tumors. If performed correctly with adequate skills, nail surgery will lead to functionally and aesthetically satisfying results in the majority of instances.

Surgical Treatment of Pincer Nails

1Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland 2Dermatology Clinic Dermaticum, Freiburg, Germany 3Centro Dermatol Epidermis, Inst CUF, Porto, Portugal 4Department of Dermatology, Academic Hospital, University of Gent, Gent, Belgium

Influence of Mechanical Forces as a Part of Nail Configuration

Background: Clinicians encounter pincer nails at a high incidence among bedridden cases who are free from weight bearing. The mechanical force transmitted by walking and loading may affect the nail configuration. This study was aimed at evaluating the influence of mechanical forces on the nail configuration. Methods: Study 1 was conducted on a sample size of 318 great toenails, with the subjects classified into the following 3 groups: healthy volunteers, participants who were bedridden for less than 3 months, and participants who were bedridden for more than 3 months. Study 2 was conducted in 12 subjects with unilateral loading. Assessments: The configuration of the great toenails, in terms of the curve index (defined as the nail height/nail width), was compared. Results: In study 1, the curve index increased significantly as the duration of the bedridden state became longer (17.5 ± 4.75, 28.9 ± 11.0, 36.4 ± 9.58, respectively). In study 2, the curve index on the nonloaded side was significantly higher than that on the loaded side (40.0 ± 8.63 vs. 27.0 ± 8.39). Conclusion: Our results suggest that mechanical forces may affect the nail configuration and be involved in the pathophysiology of nail deformities.