Congenital Malalignment of the Great Toenail: Spontaneous Regression Rate and Limiting Factors for Surgical Outcome.

BACKGROUND

Congenital malalignment of the great toenails (CMGTN) is an underreported nail dystrophy often misdiagnosed and inappropriately treated. Surgery can be performed but data concerning age, technique, and results are limited.

OBJECTIVE

To summarize the clinical presentation, patient characteristics, treatment options (surgery vs wait-and-see) and evolution of CMGTN as well as identifying the limiting factors for spontaneous evolution and surgery, based on a severity score that the authors developed.

MATERIALS AND

METHODS

Records of 60 patients were retrieved from their department's database over an 11-year period (2009-2020). Assessment was evaluated by 3 nail expert dermatologists and self-evaluation.

RESULTS

A total of 60 patients and 94 nails were included. Nail plate deviation, nail bed epithelialization, transverse ridges, and pachyonychia were the most frequent clinical signs. Surgery was performed on 33 nails, and 61 were followed up. Self-evaluation revealed better or completely healed nails in both groups. Severity score was significantly lower ( p < .0001) after surgery but was not improved in the wait-and-see group. No relation could be found between age of diagnosis, age at surgery, and score evolution.

CONCLUSION

Surgery is effective and provides excellent cosmetic results, no matter the age or severity of the condition. Surgical approach should not only be reserved for young patients and severe cases.