Tube nail L60.84

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 07.10.2021

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Synonym(s)

Tower nail; Unguis in turriculo

History
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Cornelius and Shelley 1968

Definition
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Excessive nail curvature in the longitudinal axis with tubular deformation of the nail plate and digging of the lateral nail edge into the nail bed. Finally, the tubular nail can be considered an advanced variant of the pincer nail (see below Pincer-nail syndrome). It can cause severe pain. Complications can include paronychia and partial resorption of the end phalanges. In all cases an osteophyte develops at the tip of the bony end phalanx.

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Classification
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Hereditary tubular nails
Posttraumatic tubular nails (traumatic damage to the nail matrix)
tubular nails for deformities of the end phalanx (psoriasis osteoarthopathica, hallux valgus)
Tubular nails in the case of subungual neoplasms of the distal phalanx (usually infestation of a nail)

Etiopathogenesis
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Unclear, partly secondary development on the ground of exostoses, osteoarthritides or too narrow footwear. Not infrequently, the tubular nail (comparable to the pincer-nails) is associated with a Heberden's arthrosis.

Therapy
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The aim of the therapy is to break through the excessive convex tension by ablating the median part of the nail, thus allowing the nail plate to flatten. The regulating pressure of the nail bed leads permanently to a flattening and thus to a far-reaching normalization of the nail plate. After carefully controlled keratolysis, the nails grow largely normally.

General therapy
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Treatment with nail correction systems, such as wire or adhesive braces, can achieve a significant improvement in symptoms and even cause a permanent change in shape.

External therapy
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Controlled keratolysis with nail softening paste like 40% urea paste R110, R109 under occlusion. Remove the softened part of the nail every day, apply another layer of ointment and mask with plaster.

Remember! Apply 40% urea ointment only to the nails and do not apply to the surrounding tissue!

Operative therapie
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Alternatively, the median nail plate zones can be milled down to almost the nail bed. In severe forms, removal of the nail and sclerotherapy of the nail bed.

Literature
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Effendy I et al (1993) Forceps nail. Conservative correction by gluing on a plastic brace. Dermatologist 44: 800-802
El-Gammal S et al (1993) Successful conservative therapy of the pincer nail syndrome. dermatologist 44: 535-537
Haneke E ()2013). Nail surgery. Clin Dermatol 31:516-525
Kim KD et al (2003) Surgical pearl: Nail plate separation and splint fixation--a new noninvasive treatment for pincer nails. J Am Acad Dermatol 48: 791-792
Kim JY et al (2013) Quick and easy correction ofa
symptomatic pincer nail using a shape memory alloy device. Dermatol Surgery 39:1520-1526