engleski

Skin bridging as a result of untreated onychocryptosis in a ten-year-old boy

A 10-year-old boy was examined for a problem with his right big toe that had been present for two years. In the family history there was no onychocryptosis. The child had not presented any worthy of note diseases in the past history. For two years he had presented a painful swelling of the lateral folds of the right big toe with repeated episodes of suppurative inflammation. The latter had always been treated with topical antiinflammatory and antibiotic therapy. He had never undergone surgery for fear of the scalpel. Physical examination showed a distally dystrophic nail with blood crusts at the level of the lateral grooves. The periungual skin presented chronic inflammation and above all formed cutaneous bridge that passed over the nail. The child underwent radical removal of the nail and its matrix under local anaesthesia. The ingrown toenail of the big toe is a non-exceptional condition in children. When not treated properly it can become chronic. As in our case, the fear of the needle and the scalpel, which is frequent in children, can contribute to the chronicity. When chronic onychocryptosis is not treated adequately, it can be responsible for fibrous lesions, skin bridges and keloids. Although few cases of supraungual skin bridges have been described so far, it is known that hypertrophic granulation tissue can give rise to fibrous tissue covered by epidermis and then to skin bridges that join the two lateral folds. Two pathogenetic mechanisms have been hypothesized for this condition as follows: fusion of the highly inflamed lateral folds and penetration of the nail plate into the distal nail groove.

onychocryptosis ; nails ; ingrown

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