By Gary M. White, MD
A pincer nail is a one with abnormal transverse curvature along the longitudinal axis of the nail. Some have said the nail has a trumpet-like appearance as the curvature increases from proximal to distal. Reported causes have included a hereditary predisposition, psoriasis, wearing of narrow shoes, subungual exostoses, osteoarthritis of the distal phalanx and the taking of beta blockers [JAAD 1998;39;486]. The patient may complain of pain from the nail.
Surgery may be done [Dermatologic Surgery 2015:41:736]. According to the authors, a modified double Z-plasty provides a long-standing effective treatment with an excellent aesthetic result.
Alternatively, nail abrasion may be done [Ann Dermatol 2011;23]. From that article "The entire nail surface, except for the margin, was abraded with a high-speed grinder (Sae Yang Machinery Co. Gwangju, Korea) until the nail became flexible. Nail grinding was performed every one or two months until the symptoms resolved with flattening of the plate (end of treatment)." 25 of 30 patients showed improvement.
Although the association of transverse overcurvature of the nail and onychomycosis is not frequent, it does occur and treatment with oral terbinafine can greatly improve the condition [JEADV 2017;31;e202]. Otherwise for really bothersome nails, partial or full nail ablation can be done.
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