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Dispensing tape effective for pediatric nail conditions.

MIAMI BEACH -- All it takes is tape, a pair of scissors, and some time to treat nail disorders in young children.

Taping the fingers or toes of young children can treat a variety of nail disorders and has its advantages over surgery, Dr. Antonella Tosti said at the symposium. "This taping technique is an easy way to treat these nail disorders in a really painless way."

Committed parents are integral for this strategy to succeed because nail realignment can take weeks and the tape needs to be reapplied daily. Demonstrate the technique the first time in front of the parents, Dr. Tosti said. First affix elastic gauze tape to the side of the nail with the problem. Then turn the tape around and create pressure. Finally, use surgical tape to secure the tape around the finger or toe.

"You can get very, very good results in a few weeks," said Dr. Tosti, professor of clinical dermatology at the University of Miami. The tape can wrap up a number of common pediatric nail disorders. The technique works well for congenital hypertrophy of the lateral nail fold, for example, Dr. Tosti said. This condition is common in young infants. Look for a dome shaped lip that partially covers their nail plate. Some infant nails will also feature koilonychia. In addition, although most infants remain asymptomatic, some will experience pain from lateral ingrowing of the fingernail as a result of the congenital hypertrophy.

Koilonychia on its own is common. However, no treatment is necessary when you see these thin, concave nails with raised edges (described by some as "spoon shaped"). "Tell parents it's normal and will go away," Dr. Tosti said.

Taping also is useful for correcting other conditions associated with lateral ingrowing of fingernails, Dr. Tosti said. For example, multiple and bilateral paronychia of the fingernails is not uncommon among newborns from day 6 to about 4 months of age. "It is linked to the grasp reflex. Newborns have thin nails and the nail can penetrate the proximal nail fold, causing these pyogenic granulomas," she said.

In general, the condition resolves with age and the long-term prognosis is good, Dr. Tosti said. "I'm absolutely against surgery in this situation." If there is any inflammation, topical steroids or antibiotics can be prescribed.

"You can also use taping for an ingrowing toenail," Dr. Tosti said. "It takes time, but without surgery you have the same results. So try the taping."

Prevention of further complications as the child grows is a benefit of intervention when they are young. For example, "juvenile ingrowing toenail" of the big toe of teenagers and young adults "is almost always a complication of congenital malalignment," Dr. Tosti said, although improper nail trimming and footwear also contribute.

Congenital malalignment appears as abnormal nail growth with lateral deviation of the nail plate. An abnormality in how the ligament connects the matrix to periosteum of the distal phalanx is the likely cause. "It is often complicated by nail ingrowing," Dr. Tosti said.

Sweating is one challenge with taping around the toes. If this is an issue, instruct parents to wipe the toe with an alcohol swab before applying the tape.

Dr. Tosti gave credit to Dr. Hiroko Arai and colleagues of Yokohama City University in Japan. They invented the technique and described it in detail in a previous report (Int. J. Dermatol. 2004;43:759-65).

Dr. Tosti said she did not have any relevant financial disclosures.


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Title Annotation:SKIN DISORDERS
Author:McNamara, Damian
Publication:Family Practice News
Geographic Code:1USA
Date:Apr 15, 2012
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