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Child nail problems often spontaneously regress.

Florence, Italy -- Unusually shaped or discolored nails may point to congenital abnormalities in children but rarely require surgical intervention, Bianca Maria Piraccini, M.D., noted at the 13th Congress of the European Academy of Dermatology and Venereology.

Diagnostic clues and management tips highlighted a symposium presentation by Dr. Piraccini, a dermatologist from the University of Bologna (Italy) who specializes in nail conditions.

Among the conditions she reviewed, all drawn from cases managed at her institution:

* Partial thumb polydactyly. An unusually wide nail with a bifid lunula should always be x-rayed if it is present at birth because this may reveal abnormal maturation of the distal phalanx.

"The nail follows the severity of the bone polydactyly," Dr. Piraccini said.

A completely or partially duplicated nail may be an important sign of bone abnormalities that may be correctable with surgery.

* Congenital malalignment of the great toenail. This condition occurs when the major axis of the nail plate laterally deviates from the major axis of the digit, potentially causing the distal nail to become ingrown.

While this condition may resolve over time, it can be profoundly painful and difficult to manage when it occurs in infants.

Dr. Piraccini presented the case of a 45-day-old infant who was seen after a 14-day course of a low-potency topical steroid failed to relieve the painful inflammation of her lateral nail fold.

"We can have some problems managing this disease in very young children," she explained, noting that the child's parents encountered a struggle whenever they tried to place socks on their baby's excruciatingly painful feet.

She recommended conservative therapy as described by a number of experts. The technique involves applying tape from the distal nail fold around the digit, with the aim of pulling down on the hypertrophic nail fold, relieving pressure, and redirecting growth of the nail.

* Subungual hemangioma. A nodule under the proximal nail, purplish-bluish discoloration, and possibly pseudoclubbing in an infant all point to this diagnosis. The diagnosis can be confirmed by vitropression, a technique popular in Europe in which pressure is applied under glass and the extent of subsequent skin bleaching measured, Dr. Piraccini said.

Ultrasound is another favored diagnostic technique, as is magnetic resonance imaging, although the latter is difficult in nonsedated young children.

The condition is benign and will spontaneously resolve without intervention, Dr. Piraccini said.

* A darkening nail matrix nevus. Nail matrix nevi are not unusual in infancy. "We all see them. They are not rare," she commented.

Many times such a nevus fades as the child ages, not because it regresses but because the nail matrix nevus cells reduce the production of melanin.

"What is unusual is to see darkening of pigmentation over time," she declared.

Presented with two such cases in children, and concerned that the change might represent malignancy, Dr. Piraccini surgically removed the nail units of both children and performed dermoscopy, with reassuring results.

Both cases revealed junctional nevi, complicated in one child by postinflammatory hyperpigmentation following trauma. "Darkening [of nail matrix nevi] is not a sign of malignancy in children," she said.


Los Angeles Bureau
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Title Annotation:Skin Disorders
Author:Bates, Betsy
Publication:Family Practice News
Geographic Code:4EUIT
Date:Feb 1, 2005
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