Congenital Nonsyndromic Anonychia of Toes Due to Amniotic Bands

Abstract

Madam, Congenital anonychia is a rare disorder which might be either a part of a syndrome or an isolated occurrence.[1] Non-syndromic anonychia can be partial or total. Amniotic band syndrome (ABS) may present with a variety of congenital anomalies or as a very subtle, localized form.[2] ABS is due to rupture of the amnion early in pregnancy resulting in multiple loose strands called amniotic bands, that adhere to and may entangle the fetus as well.[3] Invasive procedures like chorionic villus sampling may lead this condition. We report a 3-day-old male neonate who presented with absence of all 10 toenails with normal fingernails, since birth. Constriction bands were present circumferentially in all toes, proximal to the areas of absent nails, and also over the ball of great toe on the left foot [Figures 1-3]. The fingernails were normal and there were no band-like depressions over them [Figure 4]. The baby was born by normal vaginal delivery as the first child of non-consanguineous parents and there was no history of any maternal drug intake, hypertension, or diabetes mellitus during pregnancy. The baby was otherwise normal with no other skin lesions or congenital anomalies. Radiology of feet showed no abnormality. Based on the clinical findings, a diagnosis of congenital anonychia due to amniotic constriction bands was made.Figure 1: Whitish areas representative of absent nails with ring-like constrictions proximallyFigure 2: Constriction rings on the plantar surfaceFigure 3: Bilaterally symmetrical involvement of both feetFigure 4: Normal fingernailsWhile the formation of amniotic bands in early gestation may lead to spontaneous abortions, in more advanced adanced gestation, classical rings, fissures, acro-syndactylization, or amputation of limbs may occur.[4] Clinically, constrictive rings, limb defects, neural or spine defects, and craniofacial defects are the four categories of presentation. Recently developed advanced three-dimensional ultrasound can diagnose these defects easily. Craniofacial abnormalities, such as encephalocele, cleft lip and palate, and spinal defects are rarely reported anomalies due to ABS. Most ABS cases are sporadic with no known recurrence risk unless in cases of familial ABS.[3] Our patient fortunately was mildly affected with only the absence of nails distal to the ring-like constrictions. This type of congenital nonsyndromic anonychia due to amniotic bands is a rare occurrence. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.