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Congenital onychodysplasia, or Iso-Kikuchi syndrome, is classically defined as a congenital nail abnormality of one or both index fingers that is often associated with a bone abnormality in the affected finger. We report an unusual case of a 6-year-old girl who presented with an S-shaped, bifid nail of the left ring finger that had been present since birth. X-ray findings were used to confirm a diagnosis of congenital onychodysplasia of the ring finger.

Retronychia is a frequently misdiagnosed nail disorder characterized by proximal ingrowth of the nail into the proximal nail plate. Often presenting with chronic paronychia, retronychia is commonly misdiagnosed and treated ineffectively with antimicrobials. The main cause is repeated micro-trauma to the affected nail, therefore a thorough history of exposures and insults to the toenail is crucial in identifying the cause of this nail abnormality. Herein, we describe a case of a UPS employee who presented with a painful nail after dropping a package on her foot that was unresponsive to medical treatment for 2 years. This case highlights the importance of taking a thorough history and physical examination for diagnosing retronychia.

Congenital curved nail of the fourth toe represents an unusual deformity in which the nail of the fourth toe curves in a plantar direction. It is unknown why only this toe is affected; however, the initial descriptions suggest that this is a mesodermal defect. We describe a case of congenital curved nail of the fourth toe associated with bifid uvula. There are only 2 reports mentioning the association of this nail abnormality with cleft palate and/or lip. In our patient, there was an association with bifid uvula that is considered a minor form of palatine fissure. There seems to be an association of congenital curved nail of the fourth toe with cleft palate to different degrees; however, the pathogenesis of the deformity remains unknown.

Squamous cell carcinoma of the nail unit (SCCNU) is often misdiagnosed and improperly treated because it mimics a number of other conditions. This review details current knowledge of anatomy, pathophysiology, clinical presentation, diagnosis, and treatment of SCCNU. A heightened clinical awareness is critical to treating SCCNU and preventing development of advanced disease at which time amputation is needed and metastasis may occur. Physicians should consider SCCNU in each case of a nail abnormality unresponsive to topical treatment. For adequate diagnosis and excision of SCCNU, timely and appropriate specialist referral is necessary.

The prevalence of skin mycoses in the elderly remains unclear. The proportion of people with skin eruptions who are positive for mycoses using direct microscopy is not known. The purpose of this study is to identify the prevalence of skin eruptions and skin mycoses (e.g. candidiasis and tinea) in the buttocks and feet, which are common sites of skin mycoses in residents of long-term care facilities. This multi-site cross-sectional study used visual inspection and direct microscopy to diagnose the type of skin eruption. Subjects were residents of facilities covered by long-term care insurance schemes in Japan. Of the 171 residents enrolled in this study, 72.5% had a skin eruption. Only 4.8% of participants had tinea in the buttocks; 2.4% had buttock candidiasis. In those with a nail abnormality, 58.3% of residents had tinea unguium. For tinea pedis, residents who had any form of interdigital or plantar region skin eruption, 22.5% and 31.4% of residents were positive, respectively. The prevalence of observed skin mycoses was: buttock candidiasis 1.8%; buttock tinea 3.5%; tinea unguium 56.2%; interdigital tinea pedis 20.5%; and plantar tinea pedis 22.5%. The very low proportion of residents with mycoses in the buttocks suggests that anti-inflammatory agents, such as steroids, should be used as first choice. Our observation that not all residents with skin eruptions on the feet had tinea, should remind clinicians to perform direct microscopy before initiating antifungal treatments.

Pterygium Inversum Unguis (PIU) is a rare nail abnormality characterized by adherent hyponychium to the ventral surface of nail plate. Most of the few cases reported are acquired conditions associated with connective tissue disorders. Very few cases of congenital PIU have been reported. We report for the first time, PIU in two sisters born of second degree consanguineous marriage involving second toe of both feet present since birth.

Pterygium inversum unguis (PIU) is a rare nail abnormality in which the distal nail bed adheres to the ventral surface of the nail plate, with obliteration of the distal groove. Because of the rarity of this condition, its exact origin is unknown. This disorder can be either congenital or acquired, with or without a family history. The acquired forms may be idiopathic or secondary to systemic connective tissue diseases or other causes such as stroke, neurofibromatosis, leprosy, or the use of nail fortifiers. We present an unusual case of acquired idiopathic PIU of the 10 fingernails in a 22-year-old man.

Ingrowing of the nail of the hallux has been ascribed to an abnormality of the shape of the nail; our prospective study was planned to test this association. Twenty-three consecutive patients and 23 age-matched controls were assessed by caliper measurement and standard photographs, before a first operation for ingrowing toenail. We found no differences in shape between the toenails of the patients and those of the controls, both groups showing great variation. Our results suggest that the ingrowth is not commonly associated with an abnormal shape of the nail.

Pterygium inversum unguis is a nail abnormality in which the distal aspect of the nail bed/hyponychium is adherent to the ventral surface of the nail plate, resulting in obliteration of the distal groove. We present a 50-year-old man who developed this abnormality on his right fingers and toes after a stroke that resulted in paresis of his right side. Unusual features of this case include the association with a neurologic disorder, assymetric distribution, involvement of toes as well as fingers, and occurrence in the male gender.

Eight patients are described with both vitiligo and nail abnormalities. Two had additional autoimmune disorders but these did not develop at the same time as the nail abnormality. Both had thyrotoxicosis. The proposed association with certain autoimmune disorders is discussed.