Review and Therapeutic Approach to Malalignment of the Great Toenails: A Common Condition That Is Uncommonly Diagnosed

Abstract

BACKGROUND Malalignment of the great toenails is a common nail disorder that is uncommonly recognized in general practice. OBJECTIVE Review available literature on lateral malalignment of the great toenails to increase awareness of this underdiagnosed condition and provide management recommendations. METHODS A PubMed search was conducted using the terms “congenital malalignment toenail” and “malalignment great toenail”. All articles were reviewed, and all relevant articles were included in this analysis. RESULTS Thirty-four distinct articles encompassing 117 patients with similar clinical findings: lateral deviation of the great toenails with yellow brown dyschromia, thickening, and scalloping. Limitations Description of malalignment and terminology can vary, which may have led to exclusion of some relevant articles. CONCLUSION Lateral malalignment is a common nail condition that is underappreciated and often misdiagnosed in general dermatologic and medical practice. This review aims to increase awareness to facilitate better care of these patients.