Case report
Retronychia: Report of two cases

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Retronychia is an incomplete form of nail shedding that leads to embedding of the nail into the proximal nail fold and subsequent inflammation. Patients present with persistent paronychia in the setting of disrupted nail growth. Other nail changes may be present. Simple avulsion is curative, and unlike other forms of ingrown nails, it does not tend to recur. We report 2 cases of retronychia that were associated with distal onycholysis and subungual hematoma, respectively. Both were successfully treated with nail avulsion.

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Case 1

A 60-year-old female presented with a 4-month history of painful left great toenail changes following trauma. Although she initially sought medical advice, she was reassured and advised expectant observation. Later, she presented to our department because of progressively worsening pain that impaired her walking.

Physical examination revealed a massive subungual hematoma of the left great toenail along with proximal nail fold erythema, swelling, and tenderness (Fig 1, A). Avulsion was performed

Case 2

A 30-year-old female presented with a 3-month history of stunted nail growth and painful swelling of her left great toe that did not respond to topical steroids and systemic antibiotics. Her symptoms were precipitated by wearing, on multiple occasions and over a period of 4 weeks, a pair of “steel-toed boots” that pressed against her left great toenail. The right boot had a proper fit, and her right great toenail was not affected.

On examination, the left great toenail exhibited yellowish

Discussion

Ingrown nails affect predominantly the toenails and result from embedding of the nail plate into the periungual skin. Because of the outward direction of growth of the nail, embedding occurs into the lateral nail folds or the distal digital pulp.

In contrast, retronychia involves embedding of the nail into the proximal nail fold, and is a process that may involve the fingernails as well as the toenails. Retronychia starts with disruption of the longitudinal growth of the nail because of an acute

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Conflicts of interest: None declared.

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