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Abstract

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  2. Abstract
  3. References

A 7-month-old girl was evaluated for V-shaped ridging of the fingernails consistent with chevron nails. Chevron nails are a normal variant in the pediatric population that is frequently outgrown. This case nicely demonstrates this normal finding that has so rarely been reported in the literature.

A 7-month-old girl was evaluated for V-shaped nail ridging of most of her fingernails, present since birth. Her past medical history was notable for maternal chronic hypertension during pregnancy, intrauterine growth restriction, and postnatal hypoglycemia, which necessitated a brief stay in the neonatal intensive care unit. She was otherwise healthy and had met all developmental milestones. There was no significant history of other nail, teeth, hair, or skin disorders in the family.

On examination, the patient had longitudinal ridging of her nonthumb fingernails that angled in, forming a V with the point at the midpoint of the distal nail (Fig. 1). The thumbs were spared. There was mild onychoschizia on some nails. Her onychodermal bands were normal and there was no erythronychia. The remainder of the examination was unremarkable.

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Figure 1. A 7-month-old girl with V-shaped ridging of the nails consistent with chevron nails.

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Isolated oblique nail ridging that forms a V at the distal nail edge in children has generated debate in terms of its incidence, pathophysiology, and what phrase should describe the phenomenon. Parry et al (1) first described such ridging as “herringbone nails” in an 11-month-old girl. They suggested that it is a rare occurrence in children probably caused by discordant growth in the lateral and central nail matrix. Shuster [2] asserted the phenomenon is “very common” and underreported, offering up the term “chevron nails” for oblique ridging without the central spine of herringbone nails. He proposed that there is axial growth of the nail. Specifically he stated that synchronous growth may occur from a chevron-shaped growing edge of the nail root. Alternatively he proposed sequential growth whereby localized variation of the nail production rate is propagated in a wave from the center of the nail to the edges [2]. Zaiac et al [3] later reported chevron nails in five other children. There have been other reported cases of chevron nails in newborns, as well as in children with a personal or family history of atopy [4]. There is typically no family history of nail findings. Baran et al [5] mention that teenagers occasionally demonstrate half of a nail with longitudinal ridges and half with oblique lines.

Our patient adds to the few reports of chevron nails in the literature. It is important to recognize that these oblique ridges are normal in children and that they are frequently outgrown.

References

  1. Top of page
  2. Abstract
  3. References
  • 1
    Parry EJ, Morley WN, Dawber RPR. Herringbone nails: an uncommon variant of nail growth in childhood? Br J Dermatol 1995;132:10211022.
  • 2
    Shuster S. The significance of chevron nails. Br J Dermatol 1996;135:151152.
  • 3
    Zaiac MN, Glick BP, Zaias N. Chevron nail. J Am Acad Dermatol 1998;38:773.
  • 4
    Malakar S, Malakar RS. Chevron nail and atopic dermatitis: an incidental association. Indian J Dermatol Venereol Leprol 2002;68:106107.
  • 5
    Baran R, Dawber RPR, Richert B. Physical signs. In: Baran R, Dawber RPR, eds. Diseases of the nails and their management, 3rd ed. Oxford: Blackwell Scientific, 2001:48103.