Letter

Retronychia in children, adolescents, and young adults: A case series

Distal nail embedding due to hyponychium hypertrophy can be caused by traumatic or surgical avulsion of the nail. As a consequence of these changes, the nail plate is blocked through the deformed tip of the toe. Changes that occur at the tip of the big toe are due to bone growth on the dorsal surface of the distal end of the distal phalanx. This study aimed to present a surgical technique for the treatment of hypertrophy of the tip of the toe and evaluate its effectiveness.

The surgical technique involved remodeling of the tip of the big toe, with removal of the hypertrophied bone of the distal phalanx. The procedure was assessed by using a questionnaire.

We included the 108 distal embedded nails. A total of 85% of respondents were satisfied with the procedure. Nearly 80% of patients rated the cosmetic effect as good or very good.

The technique was an effective treatment and increased the quality of life of those with disorders of nail growth associated with hypertrophy of the tip and hyponychium, with bone overgrowth.

Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent paronychia, particularly in the setting of trauma. This disease is probably underdiagnosed due to limited knowledge among dermatologists and the presence of incomplete clinical forms. Nail plate avulsion is the diagnostic and curative procedure of choice, despite reports of relapse.

The incidence of nail conditions in pediatric population is influenced by hereditary, social, and environmental factors. Many conditions are less common than in adults and they differ in clinical aspects, diagnostic approach, and management, while others manifest mainly or exclusively in children. In this chapter, we classify nail diseases in pediatric population by dividing the disorders according to the age group in which they appear in most of the cases:

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  newborns and infants (<12 months): represented by congenital and hereditary disorders;

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  toddlers and preschoolers (1–5 years): represented by traumatic and bacterial and viral infective diseases;

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  school children (6–12 years): represented by inflammatory diseases;

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  teenagers (>12–18 years): represented by fungal infection and benign tumors.

Compared to adults, children are more susceptible to bacterial and viral disease; yet they are less likely to experience fungal infection of the nail apparatus. Furthermore, several conditions may lead to dystrophy of the nails, including trauma, psoriasis, lichen planus, and congenital disorders. Another aspect different from adults is the way of diagnosing a nail disease, because not all the diagnostic procedures are easily possible in the pediatric population. Noninvasive methods are suggested in most cases and the choice of invasive method is selected as the last possibility.