Involuted Nail (pincer nail; omega nail)
Excessive transverse curvature of nail – can affect both sides or one side of nail.
Predisposes to onychophosis and onychocryptosis
1) Tile shaped – bulk of surface of nail is relatively flat, but both edges are curved/involuted, but do not go past perpendicular (least painful type)
2) Plicatured – bulk of surface of nail is relatively flat, but one or both edges are curved/involuted beyond vertical and embedded in nail sulcus
3) Pincer – entire nail plate is involuted – nail plate is drawn up between edges; in severe cases, lateral edges almost meet, pinching soft tissues giving the appearance of a ‘cylinder’ (most painful type)
May be familial. Could be due to subungual exostosis.
Acquired case may be due to pressure from shoes.
May occur with other conditions (eg yellow nail syndrome)
Minor cases usually asymptomatic, so correct nail cutting advice is often all that is needed.
Severe cases usually symptomatic nail cutting and clear sulcus of debbis; wire nail braces to flatten nail; total or partial nail avulsion
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