Pincer nail deformity and pseudo-Kaposi's sarcoma: complications of an artificial arteriovenous fistula for haemodialysis

Onychodystrophy as the Presenting Sign of Steal Syndrome

A man in his 70s presented to the dermatology nail clinic with a 1-month history of worsening onychodystrophy, leukonychia, and pain in his left fifth finger. Physical examination revealed a cool hand and absent radial pulse. Ischemia was suspected, and the patient was sent to the emergency department where the diagnosis of steal syndrome was made and his previously required arteriovenous fistula was ligated. This case highlights the clinical features of steal syndrome, that nail changes should be recognized as clinical features, and that urgent triage of these patients to vascular surgery is of critical importance.

To Study the Outcome of Three-Flap Technique in the Management of Pincer Nail

CONTEXT

Pincer nail deformity is a transverse overcurvature of the nail. Though various conservative and surgical techniques have been described in the literature, very few studies are based on objective measurements. This study was undertaken to evaluate the outcome of three-flap technique in the management of pincer nail.

AIM

To study the outcome of three-flap technique in the management of pincer nail.

SETTINGS AND DESIGN

Prospective interventional study.

SUBJECTS AND METHODS

Fifteen patients with pincer nail deformity, fulfilling inclusion and exclusion criteria were enrolled for the study. Routine X-ray was carried out for all patients to detect underlying bony abnormalities such as exostoses. Width and height indices were calculated before the procedure. A three-flap technique was performed on all affected toe nails and outcome was assessed at the end of 6 months and 1 year.

STATISTICAL ANALYSIS USED

Paired t-test and P value.

RESULTS

Satisfactory cosmetic outcome and statistically significant improvement (P < 0.0001) were achieved in all patients.

CONCLUSIONS

Three flap technique is an useful technique in the management of pincer nail.

Pincer Nail Deformity Associated with Systemic Lupus Erythematosus

Background:

Systemic lupus erythematosus (SLE) is an autoimmune disorder with various systemic and cutaneous manifestations. Nail abnormalities, including onycholysis, red lunulae, pitting, and ridging, have been seen in patients with the disorder. To our knowledge, however, pincer nail deformity has yet to be reported coincident with the onset of SLE.

Objective:

We report a case of pincer nail deformity subsequent to the development of SLE and describe surgical treatment of the deformed nails. This is followed by a review of the literature.

Conclusion:

Acquired pincer nail is a dystrophy with numerous reported causative associations, including psoriasis, tumors of the nail apparatus, tinea ungium, ß-blocker usage, and now SLE. Pain from the resulting constriction can interfere greatly with daily activities and can be debilitating to the extent of requiring therapy.

A clinical study of 35 cases of pincer nails

BACKGROUND

Pincer nail is a nail deformity characterized by transverse overcurvature of the nail plate. Pincer nail can affect a patient's quality of life due to its chronic, recurrent course; however, there have been no clinical studies on the pincer nail condition in Korean patients.

OBJECTIVE

The purpose of this study was to characterize the clinical findings and treatment of pincer nail. In addition, possible etiological factors were considered, and treatment efficacy was evaluated.

METHODS

The medical records and clinical photographs of 35 patients (12 males, 23 females) who were diagnosed with pincer nail between August 1, 2005 and July 31, 2009 were studied.

RESULTS

Patient age ranged from 10 to 77 (52.09±17.26) years, and there was a predominance of female (23 out of 35 patients, F:M=2:1). The mean duration of the disorder was 7.45 years (range 0.25~40); 85% had pincer nail for at least 1 year. In addition, 40% had a history of previous treatment and recurrence. There were 82.8% patients with the common type of pincer nails. The most commonly involved nails were both great toenails. Among 35 patients, nail grinding was started in 30 patients, and 25 patients showed clinical improvement with nail grinding. The width index increased and the height index decreased after treatment. The mean follow up period was 8.42 months (range 1~27), and 7 patients showed recurrence after 8.8 months (range 2~20). Among 35 patients, 5 patients were treated with nail extraction with matricectomy, and the symptoms resolved immediately. The mean follow up period was 7.6 months (range 0~19), and recurrence was not observed. Onychomycosis was also present in 37.1% of patients, and itraconazole pulse therapy for 3 months was added.

CONCLUSION

The results of this study demonstrate the clinical features of pincer nail in Korean patients. The findings show that the common type of pincer nail was most common, and nail grinding as a conservative treatment greatly improved pincer nails despite a risk of recurrence. When onychomycosis was also present, oral antifungal therapy added to nail grinding resulted in a more rapid change in nail thickness and clinical improvement.

Nail changes in chronic renal failure patients under haemodialysis

BACKGROUND

Chronic renal failure is known to cause various nail pathologies. They may be directly related to the renal condition itself or its complications or to the therapy.

OBJECTIVE

To compare nail changes in end-stage renal failure patients under haemodialysis with healthy persons and to study the potential relationship with various parameters in the patients.

PATIENTS AND METHODS

The study comprised 100 patients with chronic renal failure under regular haemodialysis as well as 100 healthy control subjects of matched age and sex. Both groups were subjected to full history taking and thorough general and nail examination. Complete blood picture, liver and kidney function tests and fasting blood glucose level were investigated.

RESULTS

Nail disorders were more prevalent in patients (76%) than in control group (30%). The half and half nail was the most common finding (20%) followed by - in descending manner - absent lunula, onycholysis, brittle nail, Beau's lines, clubbing, longitudinal ridging, onychomycosis, subungual hyperkeratosis, koilonychias, total leukonychia, splinter hemorrhage, pitting and pincer nail deformity. There was non-significant correlation between nail changes and age of the patients or duration of haemodialysis. In addition, no evidence of significant relation was found between nail changes and both haemoglobin and albumin levels.

CONCLUSION

Frequent nail changes are observed on systematic nail examination of uraemic patients undergoing haemodialysis; however, the cause of them remains obscure and could not be traced to a particular abnormality in the renal condition, medication or the procedure itself and it needs further investigations.

Pincer nails complicated by distal phalangeal osteomyelitis

SUMMARY

Besides the known cosmetic implications, pincer nails are often complicated by pain, chronic inflammation and recurrent suppurative infections. We report two such cases of chronic paronychia of the thumb secondary to pincer nails. Both were complicated by osteomyelitis. Although both cases eventually healed after excisional debridement, one case required elective amputation because the significant loss of bony support resulted in a painful, floppy fingertip and poor pinch. Regular radiographic assessments may be useful in the management of patients with chronic inflammation or recurrent paronychias secondary to pincer nails to detect osteomyelitis.

Central vein obstruction in vascular access

Central venous obstruction has become a major problem because of the frequent need for central venous catheters in haemodialysis patients. This article discusses the epidemiology and clinical features of central venous obstruction and the different surgical and interventional alternatives for its treatment.

Pincer Nail Deformity Associated with Systemic Lupus Erythematosus

BACKGROUND

Systemic lupus erythematosus (SLE) is an autoimmune disorder with various systemic and cutaneous manifestations. Nail abnormalities, including onycholysis, red lunulae, pitting, and ridging, have been seen in patients with the disorder. To our knowledge, however, pincer nail deformity has yet to be reported coincident with the onset of SLE.

OBJECTIVE

We report a case of pincer nail deformity subsequent to the development of SLE and describe surgical treatment of the deformed nails. This is followed by a review of the literature.

CONCLUSION

Acquired pincer nail is a dystrophy with numerous reported causative associations, including psoriasis, tumors of the nail apparatus, tinea ungium, ss-blocker usage, and now SLE. Pain from the resulting constriction can interfere greatly with daily activities and can be debilitating to the extent of requiring therapy.

A splint for pincer nail surgery: a convenient splinting device made of an aspiration tube

BACKGROUND

To treat pincer nail, both conservative therapy and surgical therapy have been reported. However, there is no consensus about the best method of treatment.

OBJECTIVE

The use of a splint prepared from an aspiration tube after pincer nail surgery is introduced.

METHODS

Pincer nail was treated by surgery with splinting in seven patients (nine toes).

RESULTS

Nine toes from seven patients were evaluated. The postoperative follow-up period ranged from 6 to 37 months (mean 17.7 months). An excellent result was obtained in eight toes, but ingrowth of the nail occurred in one toe. The cosmetic improvement was marked and satisfactory.

CONCLUSION

This splint is cheap and easy to make, can prevent contracture of the nail matrix and nail bed, can reduce pain, and allows direct observation of the nail bed because it is transparent. Thus, this technique seems to be convenient and useful.