Ingrown toenail, or onychocryptosis, is a highly prevalent nail condition that occurs when the nail edge grows into the periungual dermis. It most frequently affects the hallux and has a biphasic presentation, being most common in the second and fifth decades. It is often painful and may be debilitating in severe cases. Risk factors include trauma, weight changes, poor nail-cutting technique, and hyperhidrosis. Both conservative and surgical treatments have been described, and choice of therapy is dependent on patient co-morbidities, severity, and associated symptoms. This review covers the epidemiology, risks factors, pathogenesis, evaluation, and staging of ingrown toenails, as well as, treatment options. Although there is an unmet need for clinical trials comparing therapies, current recommendations are to treat conservatively and then proceed to surgical therapies if symptoms persist.

We describe an interesting case of pleomorphic fibroma of the subungual region in a middle aged woman who presented with a recurrence of thickening, lateral ridging, and a midline split of the right third fingernail, 20 years after initial excision. Histology of the specimen demonstrated hyperchromatic stellate cells within the superficial corneum, which were CD34 positive, consistent with a pleomorphic fibroma. Pleomorphic fibroma is a rare mesenchymal neoplasm characterized by atypical spindled cells amidst a collagenous stroma. It is a benign, slow growing tumor that has only been reported in the subungual region twice previously. Although histology may show cellular atypia, the slow-growing benign nature of the tumor, reassuring features histologically i.e low cellularity, and lack of myxomatous change in the stroma, make a conservative approach to therapy reasonable.