INTRODUCTION
Onychodystrophy is a common, chronic malformation of the nail characterized by abnormalities of the nail plate, color, or texture.1 Onychodystrophy is aesthetically displeasing and can significantly impact patient quality-of-life. The etiology of onychodystrophy may be secondary to infectious diseases (most commonly onychomycosis), inflammatory diseases, trauma, or idiopathic causes. Onychodystrophy can be associated with pterygium unguis that contributes to pain and appears as a V-shaped extension of the proximal nail fold skin and adheres to the nail bed. Pterygium unguis results from scarring between the proximal nail fold and matrix.2,3 While treatment of infectious onychodystrophy involves antifungal agents, treatment of noninfectious etiologies, such as traumatic onychodystrophy, or associated pterygium unguis is challenging.1 Treatment options are limited, and topical or intralesional corticosteroids have minimal ef cacy and cause significant patient discomfort. Surgical revision of onychodystrophy is complex, and symptomatic or aesthetic improvements are dif cult to achieve.4 Furthermore, associated pterygium unguis is often refractory to both topical and systemic therapies making it dif cult to treat. There is limited published literature on laser treatment of noninfectious onychodystrophy or associated pterygium unguis.We present a case of a 68-year-old man with a 10-year history of painful traumatic onychodystrophy with associated pterygium unguis, who was successfully treated after three treatments of fractionated carbon dioxide (CO2) laser. Additionally, we review the medical literature on laser treatment of noninfectious ony- chodystrophy and pterygium unguis.
CASE REPORT
Our patient presented to clinic for pain and poor aesthetic appearance of onychodystrophy with associated pterygium unguis of the right hand third digit (Figure 1A).The patient reported nail changes began 10 years prior following direct trauma to the nail, and since then the dystrophic nail was painful and often snagged clothing and fabric. On physical examination, there was splitting of the nail and a midline pterygium extending from the proximal fold to the distal edge and contributing to a raised longitudinal ridge where the patient’s pain was localized. Histologic evaluation of the nail demonstrated changes consistent with traumatic onychitis and Periodic acid–Schiff (PAS) stain was negative for fungal organisms. Prior to seeking medical treatment, the patient tried keeping the nail well trimmed but reported minimal pain relief. The patient underwent three treatments with DEKA SmartXide DOT HP
