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Subungual corn: a tender pigmented subungual lesion in older people
Author(s) -
Berker D.A.R.,
Wlodek C.,
Bristow I.R.
Publication year - 2014
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.12858
Subject(s) - medicine , coffin , dermatology , library science , computer science , anatomy
Summary Background Heloma durum occurs as a tender mass in the distal nail bed beneath the big toenail in older women. Objectives To define and report a variant of heloma durum not referenced in the literature. Methods This was a retrospective study whereby records, including photographs, of all cases of subungual corn were reviewed. All patients were seen in an outpatient setting. Results The records of 16 patients [15 women, one man, mean age 68 years (range 49–87)] were examined; history was between 6 and 30 months, none of the patients had received effective treatment. Mycology was negative. All reported discomfort under the big toe nail; 12 had associated subungual haemorrhage. The right big toenail was involved in 10 of 16 patients. Shared clinical features were of a subungual focus of hyperkeratosis (100%) with haemorrhage admixed in 75% of cases. The lesion was in the midline third of the nail in 11 of 16 patients (69%). The affected distal margin of nail was the uppermost point in the lateral profile of the toe (100%). Hyperextension at the distal interphalangeal joint of the affected toe was demonstrated with the patient standing. Local excision was performed when diagnosis was unclear (eight patients); simple clearance of the keratin plug was performed in the other eight patients. There was no relapse in patients who were followed up for > 6 months ( n = 7). Conclusions Clinical explanation and paring down should be attempted in order to avoid surgery at this poor healing site in the elderly.