BH30 Congenital pincer nail deformity and evolution over time

Abstract

Pincer nail deformity is characterized by excessive transverse curvature of the nail plate, resulting in compression of the underlying nailbed. It is most frequently described as an acquired condition in adulthood and is infrequently reported as a congenital abnormality, particularly when multiple fingernails are affected. Reports describing its early clinical evolution in childhood remain limited. We report a case of congenital pincer nail deformity involving the right index, ring and little fingernails. The nail changes were present from birth. Initial clinical assessment demonstrated marked transverse overcurvature of the affected nail plates, associated with a well-defined triangular subungual void beneath each nail. There were no other ectodermal abnormalities. In view of the patient’s young age, the absence of functional impairment and the lack of indication for surgical intervention, a conservative management approach was adopted. On follow-up, the previously observed triangular sub­ungual defects of the right little and ring fingernails had filled with keratin, indicating interval morphological change within the nail unit over time. The right index fingernail normalized on further review. Despite this change, transverse nail plate overcurvature persisted. Management consisted of topical urea 30% to soften the nail plates, combined with careful paring of the affected nails in order to reduce curvature-related pressure. Invasive intervention was not considered appropriate at this stage. A plan was made for further clinical review at approximately 5 years of age to assess ongoing nail development, progression of the deformity and the potential requirement for future intervention. This case illustrates the clinical features and early evolution of congenital pincer nail deformity in childhood and demonstrates that interval morphological change within the nail unit may occur over time. It supports a conservative approach with planned reassessment in young children in the absence of symptoms or complications.