Nail deformity in 8 year old boy since birth

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I had a patient today who is an 8 year old boy, presented with onychogryphosis, onychauxis, general onychodystrophy etc (in almost all the toes, but worse in hallux b/f), things that we all see on a daily basis in the elderly patient. This was most unusual in that it was in an 8 year old boy and that the mother said that he has had it since being a baby. (Pregnancy and birth all normal and unremarkable). Its one thing to see these things in the elderly patient after a lifetime of bad footwear, trauma, sports, neglect, etc, but you don't often see this in a young child who has had it since being a baby. Anyone else seen this kind of thing before? Any ideas on the etiology? Any ideas on treatment other than the general treatment we normally give to the elderly?

 

No fungal infections present as well?

 

no positive fungal culture/microscopy present so far, although they have been sent to do another one in the next few days

 

Paronychia Congenita

 

besides the toenail issues, no other dermatological problems seen, no fingernails affected and no keratoderma either, just the toenails

 

It doesn`t always involve hyperkeratosis, nor all nails in the same manner. There are many genetic variants.

Will upload paper later as I cant attach for some reason...

 

thanks

 

pachyonchiacongenita

Taken from the above link;

Of course, I can`t state for sure, but the description fits. Can you provide a pic? Be interesting to see if any there is a familial hx of pachyonychia.

Pachyonychia congenita tarda affecting only the nails

 

I have had several similar cases.
The full phenolization affected nails is the best solution.
There is no better alternative.

 

you dont think thats a bit radical ?i guess the question then is if its better not to have any nails or have to come back for regular treatment.

 

my patients are happier without nails, nail better than bad.
It is more hygienic and better looking.

 

Patient's choice of course although I too would advise nail surgery on all nails over a period of time. This would save the patient years of attending regular podiatry appointments though his life. Both cost & time effective.

Kind regards,

Mandy.

 

Hi,
came on this thread while looking up for a concerned parent. female child 2yo, no medical history, gryphotic 3,4,5. normal 1,2 and normal finger nails. no family history and no fungus present by visual and c&m. parents concerned about appearance when older, ablation and phenol seem a tad extreme for a 2yo, does anyone else have a strategy?

 

+ Phenol ablation is the best choice, no doubt.

 

I've been treating a little girl and little boy with same condition for a few years - no infection according to lab evaluation, simply gryphosis of 3rd, 4th & 5th on both feet (iu pressure or lack of amniotic fluid perhaps ... guessing?).

The little girl presented to my clinic at 8 months old and the boy at aged 5. The parents were too worried about cutting the nails themselves. It took several treatments to gain the trust of the children but they are now happy to let me drill them down and cut them - they only need to come about 3-4 times a year and they now enjoy their visits.

I would consider that if the nails are not painful, leave them alone and treat conservatively until old enough to make their own decisions about whether they want to have nail surgery or not.

 

What procedure would you use for removal of nails? What follow-up care would be needed? Length of recovery time? I've noticed artificial toenails are available; would this be a good option for paitients, especially females, who like to wear open toed shoes. Thanx in advance.