Case report: Retronychia recurrence prevented by patient empowerment

Abstract

Introduction: Retronychia is a unique type of nail ingrowth that has been described by De Berker and Renall in 1999. We present a case that was diagnosed and treated involving a multidisciplinary team consisting of dermatologist, radiologist, and a general surgeon. Furthermore, recurrence of such condition was prevented by patient education and empowerment. Case presentation: This is a young female who presented with two months history of right great toe pain and discharge. Antibiotic alone was prescribed but did not show improvement. She previously underwent left side nail avulsion for a similar complaint. In examination, she had tender hallux valgus of the right big toe, associated with turbid discharge from the nail bed. We confirmed the diagnosis of retronychia using ultrasound and treated the condition with nail avulsion. However, she had signs of recurrence during follow up, and we advised her to raise the distal end of the nail manually using a local anesthetic which was successful. Discussion: This unique condition needs timely diagnosis to choose the proper treatment. Treatment depends on the stage, and starts with topical steroids and eventually might end with nail avulsion. Recurrence is uncommon, unlike our case. We hypothesized that early lifting of the distal end of the nail can prevent full recurrence. This maneuver proved to be effective in our case and there was no recurrence. Conclusion: Retronychia is a new term that shares treatment with other nail disorders. Patient education and empowerment is crucial in the treatment. Further studies in that matter are needed.

Keywords

• Retronychia
• Ingrowth
• Nail
• Avulsion
• Patient empowerment