Pincers-nail L60.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Forceps Nail; pincers nail; pincers nails; Pliers Nails; Trumpet Nails

History
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Cornelius, 1968

Definition
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Pathological transverse curvature of the usually thickened nail plate, which, when fully developed, embraces the nail bed in a painful, pincer-like manner. The consequence of this constant traumatization is a painful paronychia. Affected are big toes and thumbnails; less frequently also other nails.

Etiopathogenesis
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Pincer nails can be congenital (Mimouni D et al. 2002) or acquired.

Congenital pincer nails can affect all nails on fingers and toes.

Pressure phenomena (e.g. tight shoes) can play a role in acquired pincer nails. They also occur in peripheral circulatory disorders (e.g. systemic scleroderma). Occasionally they are observed in cumulative toxic hand eczema.

Manifestation
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Women seem to be the preferred victims.

Differential diagnosis
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Complication(s)
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Painful ingrowing of the toenails(Unguis incarnatus)

Therapy
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The aim of the therapy is to break through the excessive convex tension by ablating the median part of the nail, thus allowing the nail plate to flatten. The regulating pressure of the nail bed leads permanently to a flattening and thus to a far-reaching normalization of the nail plate. Nails grow largely normally with carefully controlled keratolysis.

External therapy
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Controlled keratolysis with nail softening paste like 40% urea paste(Urea Paste 40% NRF 11.30.) under occlusion. Remove the softened part of the nail every day, apply a new layer of ointment and mask with plaster. With purely conservative therapy, the nail curvature will disappear within 8-12 weeks.

Notice! Apply 40% urea ointment only to the nails and do not apply to the surrounding tissue!

Operative therapie
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Milling of the median nail plate zones almost down to the nail bed. The nail plate can be expanded again by the counter pressure of the nail bed. The nail plate can be softened with a 20-40% urea paste. In case of severe forms, the nail can be removed and the nail bed sclerosed.

Literature
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  1. Cornelius CE, Shelley WB (1968) Pincer nail syndrome. Arch surgeon 96: 321-322
  2. El-Gammal S et al (1993) Successful conservative therapy of the pincer nail syndrome. dermatologist 44: 535-537
  3. Fujita Yet al (2014) Pincer nail deformity in a patient with amyotrophic lateral sclerosis. Neurol Int 11:5716
  4. Hu YH Pincer nail deformity as the main manifestation of Clouston syndrome. Br J Dermatol doi: 10.1111/bjd.13703
  5. Kim KD et al (2003) Surgical pearl: Nail plate separation and splint fixation--a new noninvasive treatment for pincer nails. J Am Acad Dermatol 48: 791-792
  6. Mimouni D et al (2002) Hereditary pincer nail. Cutis 69:51-53.
  7. Sano H et al (2012) Influence of mechanical forces as a part of nail configuration. Dermatology 225:210-214
  8. Sano H et al (2015) Foot loading is different in people with and without pincer nails: a case control study. J Foot Ankle Res 8:43

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020