A pincer nail (PN) 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.
A pincer nail is a one with abnormal transverse curvature along the longitudinal axis of the nail. The patient may complain of pain from the nail as the lateral edges dig into the tissue. Inflammation and bleeding may occur in the form of an ingrown nail.
Surgical interventions are the mainstay of therapy. But many patients just live with the deformity, not desiring permanent nail dystrophy. If pain, inflammation and bleeding are recurrent, then avulsion of the lateral 1/3 of the nail on each side with ablation of the nail matrix is usually curative. However, the patient is left with a narrow/abnormal-looking nail. Complete avulsion and ablation of the entire matrix is of course another option.
Corrective surgery may be attempted. According to one article, 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.
Treatment utilizing dental correction principles helped the majority in one study [JAAD 2018;78;1002]. This involved surgically removing any nail plate buried in perungual tissue, grinding down thick and inflexible nails, and applying dental wire to pull the nail flat.
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.
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