Subungual corn: a tender pigmented subungual lesion in older people.
BACKGROUND
Heloma durum occurs as a tender mass in the distal nail bed beneath the big toenail in older women.


OBJECTIVE
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.
Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol, BS6 7EL, U.K.
D A R
DA
de Berker
C
C
Wlodek
I R
IR
Bristow
D000368:Aged; D000369:Aged, 80 and over; D002145:Callosities / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology; D009260:Nail Diseases / Q000473:pathology* / Q000601:surgery; D010859:Pigmentation Disorders / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies