Pincer nails are a toenail disorder in which the lateral edges of the

nail Nail or Nails may refer to: In biology * Nail (anatomy), toughened protective protein-keratin (known as alpha-keratin, also found in hair) at the end of an animal digit, such as fingernail * Nail (beak), a plate of hard horny tissue at the tip ...

slowly approach one another, compressing the nailbed and underlying

dermis The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided i ...

. It occurs less often in the fingernails than toenails, and there usually are no symptoms.James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. .

Hereditary Heredity, also called inheritance or biological inheritance, is the passing on of traits from parents to their offspring; either through asexual reproduction or sexual reproduction, the offspring cells or organisms acquire the genetic inform ...

pincer nails have been described although the genes or mutations causing the hereditary form seem to be unknown.

Signs and symptoms

Pincer nail is characterized by an increase in the maximum transverse curvature, which pushes the nail edges down into the lateral nail fold, as well as thickening and narrowing of the nail bed at the distal end along the longitudinal axis of the nail plate in a proximal to distal manner. Affected patients' daily lives are negatively impacted by the curvature that rises along the distal sides of the nail, resulting in excruciating pain, persistent

inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

, and recurring infections.

Causes

Pincer nails cause is unknown, although it may be acquired or inherited. There have been several reports of hereditary pincer nails. Acquired pincer nails are asymmetrical in contrast to inherited pincer nails. Pincer nails are linked to a number of systemic conditions, such as

amyotrophic lateral sclerosis Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND) or Lou Gehrig's disease, is a neurodegenerative disease that results in the progressive loss of motor neurons that control voluntary muscles. ALS is the most comm ...

renal failure Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...

, gastrointestinal cancers,

Kawasaki disease Kawasaki disease is a syndrome of unknown cause that results in a fever and mainly affects children under 5 years of age. It is a form of vasculitis, where blood vessels become inflamed throughout the body. The fever typically lasts for more tha ...

, and

systemic lupus erythematosus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...

Diagnosis

The diagnosis of pincer nails in clinical. Differential diagnoses are necessary because pincer nails and ingrown nails differ in ways that are confounding despite having clinical similarities. Whereas pincer nails are recognized by their morphology, ingrown nails are recognized by their symptoms. The biggest physical distinction between pincer and ingrown nails is that the former have a transverse curve of the long axis of the

nail plate A nail is a claw-like plate found at the tip of the fingers and toes on most primates. Nails correspond to the claws found in other animals. Fingernails and toenails are made of a tough protective protein called alpha-keratin, which is a polymer. ...

that grows from proximal to distal. Additionally, the contour of the nail plate in ingrown nails stays normal while the nail steadily grows in height.

Treatment

Correcting the curvature that pinches the fingers and toes in order to produce a nail that is aesthetically normal is the goal of pincer nail treatment. There is no established course of treatment for pincer nails, despite the use of conservative, surgical, and combination therapies. Conservative treatment is associated with recurrence/temporary remission and is a straightforward procedure. On the other hand, although the surgical treatment has a decreased rate of recurrence, it comes with a price: extreme pain, an unattractive appearance, secondary infection, wound necrosis, and sensory disruption.

Epidemiology

Pincer nail has an incidence rate of about 0.9% and usually affects the hallux toenails on the outer, inside, and bilateral sides; fingernails and other toenails are rarely affected.

References

External links

VisualDx

Merck Manual
{{Disorders of skin appendages Conditions of the skin appendages