To the Editor.—
Congenital malalignment of the great toenail is a dysplasia present at birth affecting one or both large toenails. The main characteristic of this condition is the lateral deviation of the nail plate with respect to the longitudinal axis of the distal phalanx, due to the lateral rotation of the nail matrix.1,2Recently we observed three cases of congenital malalignment of the big toenail with medial deviation of the nail plate (Figs 1 and 2), as opposed to the more common lateral deviation. This variation raises important considerations with regard to treatment.A crescent wedge-shaped resection is carried back proximal to and below the nail bed and the nail matrix. In contrast to the usual type, the crescent has to be larger on the lateral aspect than on the medial one, and a small triangular area is also excised at the start of the medial incision line,
Baran R, Bureau H. Congenital Malalignment of the Big Toenail: A New Subtype. Arch Dermatol. 1987;123(4):437. doi:10.1001/archderm.1987.01660280037019
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