Eur. J. Pediat. Dermatol.                    Contents vol. 9, 1999
9, 23-4, 1999

Congenital ingrown toenails.

Inalöz H.S.°*, Harman M.*, Akdeniz S.*, Inalöz S.S.^
°Dept. of Dermatology, University of Wales, College of Medicine, Cardiff, South Wales (UK)
*Dept. of Dermatology and Venereology, ^Dept. of Histology and Embryology
Dicle Univ. Med. Faculty, Diyarbakir (Turkey)

Summary. A case of a 7-month-old boy with bilateral symmetrical congenital hypertrophy of the lateral nail folds of the allux is described. The types of ingrown nails in infancy are discussed. A partial remission of the disease after 6 months was observed.

Key words. Congenital ingrown toe nail.

Ingrown toenails commonly occur in adolescents and adults but very rarely in infancy. Congenital ingrown toenails are even less common. Congenital ingrown toenails are characterized by a benign, self-healing clinical course in most cases, thus not requiring a surgical operation, in contrast with the acquired form af adolescents and adults.
A case of a 7 month old boy with bilateral symmetrical congenital hypertrophy of the lateral nail folds of the hallux is described.



Fig. 1: A 7-month-old boy was initially diagnosed
as having congenital ingrown toe nails. The final
diagnosis was congenital hypertrophy of the lip
of the hallux.

  

Case Report

A 7-month-old boy had abnormalities of both great toenails since birth. His mother had noticed that the nail plates of the toes grew into the thickened lateral nail folds after birth. Marked erythema and swelling together with several attacks of slight bleeding developed at 6 week old.
The physical examination of both great toes revealed erythema, swelling and the distal end of the nail plates grew into the tissue at the distal end of the great toes (Fig. 1).

The further details of the physical examination of the skin revealed cavernous hemangioma on the scalp. There was no family history of ingrown toe nails. Roentgenography of the toes revealed no bone or joint abnormalities. Cultures grew only commensal flora. Acute inflammation disappeared with a topical treatment and a partial remission was observed after 6 months.

Discussion

Ingrown toenails may occur at all ages and may cause a considerable degree of morbidity. However, ingrown toenails are quite rare in infancy (4, 1). Three different types of infantile ingrown toe nails have been described: congenital malalignment of the big toe nail (2, 6) distal embedding with a normally directed nail (3) and congenital hypertrophic lip of the hallux (7, 12). Congenital hypertrophic lip of the hallux, which is the diagnosis for our patient, was first described by Martinet et Al. (11). After then, Hammertan and Shrank (7), Ceccolini et Al. (5) and Rufli et Al. (12) described new patients.
Congenital ingrown toenails can closely mimic acquired forms of ingrown toenails. Because congenital ingrown toenail is often a self-limited condition that corrects itself within the first few years of life, conservative treatment, such as application of a topical antibiotic, has been advocated (3, 8, 9, 10). In our patient, the hypertrophy of the lateral nail folds showed a clear regression after 6 months. The progression of ingrown nails to normal nails over a period of time suggested that these variations may be developmental in nature. These variations do not need to cause a concern for the physician or parent. Surgical intervention is not useful, because most of the cases eventuate in a normally appearing nail with time. However, complicated cases may require surgical intervention to realign the nail matrix and bed.


Address to:
Dr. H.S. Inalöz
Department of Dermatology
University of Wales, College of Medicine
Heath Park, Cardiff
CF4 4XN, South Wales (UK)

References

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