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Nail deformity in 8 year old boy since birth

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  #1  
Old 22nd May 2012, 10:51 AM
hill hill is offline
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Default Nail deformity in 8 year old boy since birth

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I had a patient today who is an 8 year old boy, presented with onychogryphosis, onychauxis, general onychodystrophy etc (in almost all the toes, but worse in hallux b/f), things that we all see on a daily basis in the elderly patient. This was most unusual in that it was in an 8 year old boy and that the mother said that he has had it since being a baby. (Pregnancy and birth all normal and unremarkable). Its one thing to see these things in the elderly patient after a lifetime of bad footwear, trauma, sports, neglect, etc, but you don't often see this in a young child who has had it since being a baby. Anyone else seen this kind of thing before? Any ideas on the etiology? Any ideas on treatment other than the general treatment we normally give to the elderly?
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  #2  
Old 22nd May 2012, 11:20 AM
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Default Re: nail deformity in 8 year old boy since birth

No fungal infections present as well?
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Old 22nd May 2012, 11:36 AM
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Default Re: nail deformity in 8 year old boy since birth

no positive fungal culture/microscopy present so far, although they have been sent to do another one in the next few days
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Old 22nd May 2012, 11:43 AM
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Default Re: nail deformity in 8 year old boy since birth

Paronychia Congenita
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Old 22nd May 2012, 12:23 PM
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Default Re: nail deformity in 8 year old boy since birth

besides the toenail issues, no other dermatological problems seen, no fingernails affected and no keratoderma either, just the toenails
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Old 22nd May 2012, 12:49 PM
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Default Re: nail deformity in 8 year old boy since birth

It doesn`t always involve hyperkeratosis, nor all nails in the same manner. There are many genetic variants.

Will upload paper later as I cant attach for some reason...
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Old 22nd May 2012, 01:05 PM
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Default Re: nail deformity in 8 year old boy since birth

thanks
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Old 22nd May 2012, 02:28 PM
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Default Re: nail deformity in 8 year old boy since birth

pachyonchiacongenita

Taken from the above link;
Quote:
The degree of severity varies, even among members of the same family. Toenails may be the only nails affected.
Of course, I can`t state for sure, but the description fits. Can you provide a pic? Be interesting to see if any there is a familial hx of pachyonychia.

Pachyonychia congenita tarda affecting only the nails
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  #9  
Old 29th May 2012, 04:08 PM
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Default Re: Nail deformity in 8 year old boy since birth

I have had several similar cases.
The full phenolization affected nails is the best solution.
There is no better alternative.
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Old 29th May 2012, 09:43 PM
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Default Re: Nail deformity in 8 year old boy since birth

you dont think thats a bit radical ?i guess the question then is if its better not to have any nails or have to come back for regular treatment.
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Old 29th May 2012, 11:23 PM
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Default Re: Nail deformity in 8 year old boy since birth

my patients are happier without nails, nail better than bad.
It is more hygienic and better looking.
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Old 30th May 2012, 10:05 AM
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Thumbs up Re: Nail deformity in 8 year old boy since birth

Quote:
Originally Posted by hill View Post
you dont think thats a bit radical ?i guess the question then is if its better not to have any nails or have to come back for regular treatment.
Patient's choice of course although I too would advise nail surgery on all nails over a period of time. This would save the patient years of attending regular podiatry appointments though his life. Both cost & time effective.

Kind regards,

Mandy.
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Old 12th June 2012, 01:19 PM
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Default Re: Nail deformity in 8 year old boy since birth

Hi,
came on this thread while looking up for a concerned parent. female child 2yo, no medical history, gryphotic 3,4,5. normal 1,2 and normal finger nails. no family history and no fungus present by visual and c&m. parents concerned about appearance when older, ablation and phenol seem a tad extreme for a 2yo, does anyone else have a strategy?
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Old 12th June 2012, 03:55 PM
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Default Re: Nail deformity in 8 year old boy since birth

+ Phenol ablation is the best choice, no doubt.
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Old 13th June 2012, 01:05 PM
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Default Re: Nail deformity in 8 year old boy since birth

I've been treating a little girl and little boy with same condition for a few years - no infection according to lab evaluation, simply gryphosis of 3rd, 4th & 5th on both feet (iu pressure or lack of amniotic fluid perhaps ... guessing?).

The little girl presented to my clinic at 8 months old and the boy at aged 5. The parents were too worried about cutting the nails themselves. It took several treatments to gain the trust of the children but they are now happy to let me drill them down and cut them - they only need to come about 3-4 times a year and they now enjoy their visits.

I would consider that if the nails are not painful, leave them alone and treat conservatively until old enough to make their own decisions about whether they want to have nail surgery or not.
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Old 4th July 2012, 09:55 AM
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Default Re: Nail deformity in 8 year old boy since birth

What procedure would you use for removal of nails? What follow-up care would be needed? Length of recovery time? I've noticed artificial toenails are available; would this be a good option for paitients, especially females, who like to wear open toed shoes. Thanx in advance.
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