Grade V Onychocryptosis: Surgical Treatment of an Exuberant Case

Onychocryptosis is a frequently diagnosed nail condition [1] associated with pain and inflammation in nail folds.Numerous hypotheses about its pathogenesis have been put forward [2].Several classifications exist for the severity of onychocryptosis, the most recent of which is proposed by Kline in 2008, which included risks of complication and treatment approaches [3].Management of onychocryptosis is closely related to the severity of the condition: early stages may be treated with a conservative approach, whereas advanced stages may require surgical intervention.Nevertheless, no consensus exists on specific treatments for each stage [2].We report the case of a previously healthy 25-year-old male patient with onychocryptosis in his left hallux for three years.He had undergone various treatments, but neither the pain nor the appearance of the lesion showed improvement.Dermatological examination revealed grade V onychocryptosis, according to Kline's classification, with severe hypertrophy and inflammatory reaction affecting all nail folds on and around the nail plate (FIG.1).Radiographic evaluation ruled out bone deformities and osteomyelitis.Surgical intervention was the treatment of choice because of previous therapeutic failures.Hypertrophic and inflamed tissues in lateral nail folds and in the distal nail fold were thoroughly excised.The dorsal portion of the proximal nail fold was preserved, while the hypertrophic and inflamed ventral portion was removed.The nail plate was preserved and its lateral portions were excised longitudinally.Subsequently, curettage and phenol cauterization of lateral matrix horns were performed.Finally, a continuous suture with absorbable thread was used around the periungual regions (FIG.2).