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interesting case: 16 year old healthy male presents with paronychia and onychocryptosis of all the toes, both feet; onset a couple of months only. first treatment was conservative removal of nail spikes and dressings, no improvement. after a couple of weeks of dressings and no improvement i repeated the above and sent him to his g.p for oral antibiotics. i will see in a couple of weeks if there is an improvement, but if not then i am thinking of gradually doing partial nail avulsions on all of the toes.

has anyone had this kind of case that improved without having to resort to pnas on all of the toes? it just seems to me that there may be something else here involved. as i say, its only been a couple of months onset with no hx of o/c before this. its seems radical to have to resort to pnas on all of the toes.
thanks
hill

 

I won't be able to see the photo until tomorrow (as I'm using my phone), but is he is taking an oral retinoid or any other med for acne?

 

i dont think so but I can double check the computer records tommorow
hill

 

Are they taking oral roaccutane (isotretinoin) for juvenile acne or any other reason?

 

the patient is not taking and has not taken any meds at all, other than oral antibiotics for the last few days for this problem

 

I had a French chap, in his thirties, who presented with exactly the same condition. I could not find out any reason for the problem. After lots of conservative treatment and antibiotics, the only solution was to resect and phenolise all the nails under local anaesthesia.
Because the lesser toes needed only small amounts of local, I was able to treat three or four toes at a time.
At the end of a couple of months, all the nails were treated and healed successfully.
The patient was very happy, as was I, and I seem to remember giving him a 'discount for bulk' fee!

 

Yep, what she says. Good advice.:drinks

 

I have never seen so much involvement before. My son had sudden bilateral OC of both hallux and in the end the cause was a sudden growth spurt, 2 sizes from January to September which he did not notice! Could be that simple.
Jo BB

 

Thanks to all for this useful post. I'm not sure how I escaped knowing about this side effect.

I've just gone back through a similar case with a 16 year old male. Despite suffering from acne he does not take this drug. I was rather hoping this was the answer to his recurrent o/c.

What IS interesting (and sad) with this young male is that despite his parents separating (and remarrying) eight years ago he is using his foot appointments as a way to have bonding time with his Dad. When Dad is out of the room he admits to picking at his nails and not following any of the NaCl bath, dressing and so on advice. Then Dad comes back in and tries to assert himself and demand answers as to why this keeps happening, why do the two oh so important parents have to keep taking time off work to come to these blessed apointments.

I have reluctantly perfomred two PNA, one which was probably necessary after the ER residents had a go.