Great Toenail Dystrophy: A Single-Center Experience and Review of the Literature

Abstract

BackgroundThere have been a few reported cases of congenital great toenail dystrophy (GTND), described as a congenital malalignment of the great toenails. However, acquired GTDN is rare, and has not been documented extensively. This study aimed to describe the clinical features of 21 patients with acquired GTND.MethodsTwenty-one patients with acquired GTND who visited Yeouido St. Mary's Hospital between June 2005 and August 2012 were retrospectively reviewed.ResultsThe mean patient age was 43.1 years (range, 17 to 88 years), and the cohort predominantly comprised women (18/21). In our experience, all acquired GTND patients presented with yellow or yellow-brownish chromonychia, onychotrophy, and onycholysis. Conservative treatment with tape methods and grinding, as well as nail extraction, was provided and yielded little improvement in any case.ConclusionThis study provides initial data on the nail changes affecting the great toenail, such as yellowish chromonychia, onychomadesis, and onycholysis. These data may help physicians to distinguish various nail disorders, including onychomycosis, congenital malalignment of the great toenails, and yellow nail syndrome.

Yellow nail syndrome, Phrygian cap gallbladder and Saint’s triad? Case report

“…In addition to the characteristics of the pincer nail, there was a yellowbrownish discoloration, which can be consistent with the hypothesis of concomitant acquired first toenail dystrophy 15 . This nail dystrophy is accompanied by growth retardation, and has been also scarcely reported 15 .…”

“…In addition to the characteristics of the pincer nail, there was a yellowbrownish discoloration, which can be consistent with the hypothesis of concomitant acquired first toenail dystrophy 15 . This nail dystrophy is accompanied by growth retardation, and has been also scarcely reported 15 . Kim et al reviewed data from 21 patients with this diagnosis, 85% were woman, the mean age was 43 years old (range: 17 to 88 years old) and main co-morbidities were hypertension and diabetes 15 .…”

“…Disordered lymphatic drainage has been one of the proposed etiologic mechanisms of the YNS [1][2][3][4][5][6] . Great toenail dystrophy can be a congenital or acquired phenomenon, more often due to trauma 15 , and the possibility of eventual trauma on the great toe was not ruled out in the present case study. However, this event did not explain the development of the associated yellowish chromonychia.…”

“…This nail dystrophy is accompanied by growth retardation, and has been also scarcely reported 15 . Kim et al reviewed data from 21 patients with this diagnosis, 85% were woman, the mean age was 43 years old (range: 17 to 88 years old) and main co-morbidities were hypertension and diabetes 15 .…”

“…However, this event did not explain the development of the associated yellowish chromonychia. An alternative hypothesis might be a common factor playing a role both in the YNS and the dystrophy 15 , specially if one takes into account the repeatedly negative results of the search for onychomycosis.…”