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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 44-year-old man visited our department with prominences on both sides of the fifth toe&#44; which had appeared following a walk&#44; on which he had worn tight footwear&#46; The patient complained of discomfort only when pressure was applied to this area&#46; Physical examination revealed external rotation of the fifth toe and increased width of the nail plate on both small toes&#46; Each of these nails was also covered by cuticle&#44; divided by a longitudinal cleft&#44; and the nail plate showed lateral thickening &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Dermatoscopy confirmed that the nail consisted of 2 clearly demarcated parts &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Fig&#46; 1&#44; Fig&#46; 2&#44; and Fig&#46; 2</a>B&#41;&#46; The patient was not aware of this abnormality in any family member&#46; A simple anteroposterior and lateral x-ray of both feet was requested and ruled out the presence of accessory phalanges or other bone abnormalities &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; No treatment was indicated&#44; other than reduction of the direct trauma&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The double nail of the fifth toe &#40;DNFT&#41; or accessory nail of the fifth toe was described in 1969 by Huindeker and is an apparently common entity&#44; although few published cases exist&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The most common clinical presentation is the appearance of a wider-than-normal nail divided by a longitudinal cleft&#44; fold&#44; or depression&#44; and the part corresponding to the accessory nail is smaller&#46; A cuticle covers both nail plates in the proximal area of the nail&#46; DNFT may be unilateral or bilateral&#44; and when both toes are affected there tends to exist considerable symmetry&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Clinical or aesthetic problems due to the size of the nail occur only occasionally&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is rare to find abnormalities in the x-ray of the fifth toe&#46; Of 10 x-rays performed in 1 series&#44; only 3 patients presented a lazy Y on the tip of the distal phalanx&#44; and another patient presented a thorn-like bony excrescence&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A Y-shaped tip of the terminal phalangeal bone was identified during surgery in 2 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">DNFT was initially thought to be a hereditary process limited to the Han ethnic group&#44; the largest ethnic group in China&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Haneke&#44; however&#44; found that the entity showed no racial or ethnic predilection&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Autosomal dominant heredity with variable expression has been proposed&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Familial cases show no clear predisposition by sex&#44; although women consult more for this abnormality&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> DNFT may represent an initial form of hexadactyly&#44; which would give rise to a rudimentary nail&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Acute trauma may act on vestigial bone&#44; inducing the appearance of a nail or on the onychodermis which&#44; as specialized nail mesenchyma&#44; would lead to nail formation and growth&#46; The onychodermis is made up of onychofibroblasts and takes part in nail formation and growth&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The histology of excised accessory nails varies from a depression like a sack of skin with hyperkeratosis like a nail plate&#44; to a small nail with a matrix&#44; proximal fold&#44; nail bed&#44; and hyponychium&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The differential diagnosis is established with ectopic nail&#44; postoperative spiculated nail&#44; onychophosis&#44; or callus of the fifth toe&#46; Ectopic nail or onychoheterotopia refers to growth of a nail outside the nail bed&#46; It may be congenital or be associated with other diseases&#44; and it is most frequent on the palmar region of the fingers&#46; The acquired form is located on the dorsal region of the fingers and toes&#46; Ectopic nails must have a matrix and nail plate but do not require a nail bed&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Onychophosis is a hyperkeratosis of the lateral folds of the nail triggered by frequent trauma to that area&#44; which causes hypertrophy and thickening of the skin surrounding the nail&#46; Calluses or corns on the external surface of the fifth toe consist of hyperkeratosis caused by repeated rubbing of footwear and are usually accompanied by intense pain&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">DNFT does not usually require treatment&#46; If desired&#44; phenolization of the accessory matrix or surgical excision of the accessory nail may be performed&#46; Excision of DNFT allows for a better view and excision of the matrix&#44; facilitates repair of the defect remaining after removing the accessory nail&#44; and faster recovery than with other treatments&#46; Curettage and electrocoagulation are not recommended because of the prolonged scarring process and the intense postoperative pain&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; we present a case of bilateral double nail of the fifth toe&#44; which developed following acute trauma&#46; This entity is considered to be common&#44; not rare&#44; and tends to go unnoticed&#46; Further studies are required to determine the etiology of the entity&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The author declares that he has no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Double Nail of the Fifth Toe
Doble uña del quinto dedo del pie
L. Navarro Campoamor
Corresponding author
lournacam@gmail.com

Corresponding author.
Servicio de Dermatología, Hospital Beata María Ana, Madrid, Spain
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    "titulo" => "Double Nail of the Fifth Toe"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 44-year-old man visited our department with prominences on both sides of the fifth toe&#44; which had appeared following a walk&#44; on which he had worn tight footwear&#46; The patient complained of discomfort only when pressure was applied to this area&#46; Physical examination revealed external rotation of the fifth toe and increased width of the nail plate on both small toes&#46; Each of these nails was also covered by cuticle&#44; divided by a longitudinal cleft&#44; and the nail plate showed lateral thickening &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Dermatoscopy confirmed that the nail consisted of 2 clearly demarcated parts &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Fig&#46; 1&#44; Fig&#46; 2&#44; and Fig&#46; 2</a>B&#41;&#46; The patient was not aware of this abnormality in any family member&#46; A simple anteroposterior and lateral x-ray of both feet was requested and ruled out the presence of accessory phalanges or other bone abnormalities &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; No treatment was indicated&#44; other than reduction of the direct trauma&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The double nail of the fifth toe &#40;DNFT&#41; or accessory nail of the fifth toe was described in 1969 by Huindeker and is an apparently common entity&#44; although few published cases exist&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The most common clinical presentation is the appearance of a wider-than-normal nail divided by a longitudinal cleft&#44; fold&#44; or depression&#44; and the part corresponding to the accessory nail is smaller&#46; A cuticle covers both nail plates in the proximal area of the nail&#46; DNFT may be unilateral or bilateral&#44; and when both toes are affected there tends to exist considerable symmetry&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Clinical or aesthetic problems due to the size of the nail occur only occasionally&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is rare to find abnormalities in the x-ray of the fifth toe&#46; Of 10 x-rays performed in 1 series&#44; only 3 patients presented a lazy Y on the tip of the distal phalanx&#44; and another patient presented a thorn-like bony excrescence&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A Y-shaped tip of the terminal phalangeal bone was identified during surgery in 2 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">DNFT was initially thought to be a hereditary process limited to the Han ethnic group&#44; the largest ethnic group in China&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Haneke&#44; however&#44; found that the entity showed no racial or ethnic predilection&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Autosomal dominant heredity with variable expression has been proposed&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Familial cases show no clear predisposition by sex&#44; although women consult more for this abnormality&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> DNFT may represent an initial form of hexadactyly&#44; which would give rise to a rudimentary nail&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Acute trauma may act on vestigial bone&#44; inducing the appearance of a nail or on the onychodermis which&#44; as specialized nail mesenchyma&#44; would lead to nail formation and growth&#46; The onychodermis is made up of onychofibroblasts and takes part in nail formation and growth&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The histology of excised accessory nails varies from a depression like a sack of skin with hyperkeratosis like a nail plate&#44; to a small nail with a matrix&#44; proximal fold&#44; nail bed&#44; and hyponychium&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The differential diagnosis is established with ectopic nail&#44; postoperative spiculated nail&#44; onychophosis&#44; or callus of the fifth toe&#46; Ectopic nail or onychoheterotopia refers to growth of a nail outside the nail bed&#46; It may be congenital or be associated with other diseases&#44; and it is most frequent on the palmar region of the fingers&#46; The acquired form is located on the dorsal region of the fingers and toes&#46; Ectopic nails must have a matrix and nail plate but do not require a nail bed&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Onychophosis is a hyperkeratosis of the lateral folds of the nail triggered by frequent trauma to that area&#44; which causes hypertrophy and thickening of the skin surrounding the nail&#46; Calluses or corns on the external surface of the fifth toe consist of hyperkeratosis caused by repeated rubbing of footwear and are usually accompanied by intense pain&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">DNFT does not usually require treatment&#46; If desired&#44; phenolization of the accessory matrix or surgical excision of the accessory nail may be performed&#46; Excision of DNFT allows for a better view and excision of the matrix&#44; facilitates repair of the defect remaining after removing the accessory nail&#44; and faster recovery than with other treatments&#46; Curettage and electrocoagulation are not recommended because of the prolonged scarring process and the intense postoperative pain&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; we present a case of bilateral double nail of the fifth toe&#44; which developed following acute trauma&#46; This entity is considered to be common&#44; not rare&#44; and tends to go unnoticed&#46; Further studies are required to determine the etiology of the entity&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The author declares that he has no conflicts of interest&#46;</p></span></span>"
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Article information
ISSN: 15782190
Original language: English
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