Management of Ingrown Nails

Abstract@#Ingrown nails mainly affect the great toes, much less frequently lesser toes and rarely fingers. There are many speculations as to their etiology and pathogenesis; however, at the end, there is almost always a imbalance between too wide the nail plate and too narrow the (distal) nail bed. Ingrown nails occur at all age periods, from newborns to the over-100s though with different frequency, clinical characteristics, and management options. In recent years, conservative treatment options – taping, packing, gutter, braces, and many more - were developed avoiding the often disfiguring results of inadequate surgery. However, they require consistent and long-term therapy. Surgery is either aimed at narrowing the wide nail plate or reducing the hypertrophic lateral nail folds. The number of operation methods is vast; already 150 ago, more 75 different surgical techniques had been known, and there is virtually a new one published every week. Despite ingrown nails being a matter of concern for medical doctors since antique, new aspects continue to be detected, such as retronychia. Further, it was found that orthopedic foot abnormalities are very frequently seen in association with ingrown nails. Their treatment is often necessary to prevent recurrences.

Six steps to standardize the surgical approach for ingrown toenail

Abstract Background: Dermatologists don't have a good knowledge of the surgical treatment for ingrown toenails and there is no consensus on which is the best approach. Objective: To develop an easy and effective surgical approach to solve the problem of ingrown toenails. Methods: We identified 67 patients with ingrown toenails in varying degrees of severity which were treated with the standardized approach. Results: All the patients had a completely recovery from the disease and none complained about the cosmetic result. Study limitations: The number of cases is limited. Conclusion: The standardized surgical approach is easily learned and very effective. The recurrence rate is lower than with other treatments.

Ingrowing toenails in children and adolescents: is nail avulsion superior to nonoperative treatment?

INTRODUCTION@#Ingrowing toenail (IGTN) or onychocryptosis is not uncommon in children and adolescents. However, there is a dearth of evidence in the literature on the management of IGTN in this age group. This study aimed to compare the results of nonoperative treatment for IGTN with that of operative treatment among children and adolescents.@*METHODS@#All children and adolescents who were treated for IGTN at our institution between 2010 and 2014 were included for this retrospective study. Demographic data, treatment prescribed and outcome at six months after presentation were analysed.@*RESULTS@#Overall, 199 patients were recruited. There were 123 (61.8%) boys and 76 (38.2%) girls. Median age was 14 years. Among 199 toes, 162 (81.4%) were treated nonoperatively, with nail care advice, topical antibiotics and daily cleansing. Only 37 (18.6%) toes were treated operatively. In the operative group, 23 (62.2%) patients underwent wedge resections, while the remaining 14 (37.8%) had total nail avulsions; for all patients, germinal matrices were preserved. At the six-month follow-up, there were 5 (3.1%) cases of recurrence in the nonoperative group when compared to 3 (8.1%) recurrences in the operative group.@*CONCLUSION@#We recommend that IGTN in children and adolescents be treated in the first instance by nonoperative methods. Operative options can be considered for resistant cases or in case of recurrence of IGTN.

Short-Term Surgical Outcome of the Partial Nail Extraction in Ingrown Nail of Military Trainee: Is Matrixectomy Necessary? / 대한족부족관절학회지

PURPOSE: An ingrown nail is common in military trainees who are exposed to highly demanding activities. Although the matrixectomy procedure has been the main treatment modality, several drawbacks may follow after the procedure, such as infection, periostitis, and continued pain that causes a delayed return to duty. This study examined the outcomes of a simple partial nail extraction with the hypothesis that this procedure may bring an earlier return to duty, lower the perioperative complications, and produce a comparable recurrence rate. MATERIALS AND METHODS: The medical records of patients who had surgical treatment for an ingrown nail in the authors' institution between April 2016 and December 2017 were reviewed retrospectively. Under the inclusion and exclusion criteria, 28 patients with a simple partial nail extraction (group A) and 29 patients with a partial nail extraction with matrixectomy (group B) were investigated. As the clinical outcome, the visual analogue scale (VAS) and satisfaction score, time to return to duty, complications, and recurrence rate were checked and compared between the groups. RESULTS: The VAS scores of group B were significantly higher during the first (p<0.001) and second (p=0.026) follow-up week than group A. The time to return to duty was shorter in group A (7.8 days) than group B (10.1 days), and this difference was significant (p<0.001). Group B had five patients with complications, whereas group A had none (p=0.028). No differences in the recurrence rate (p=0.197) and patient satisfaction (p=0.764) were found between the groups. CONCLUSION: In this study, simple partial nail extraction in military trainees resulted in lower postoperative pain, lower complication rates, and earlier return to duty than the procedure with matrixectomy. Military trainees are temporarily exposed to highly demanding activities. Thus, a satisfactory outcome would be expected with simple partial nail extraction without performing a radical procedure, such as a matrixectomy.

Retronychia

Abstract: Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent paronychia, particularly in the setting of trauma. This disease is probably underdiagnosed due to limited knowledge among dermatologists and the presence of incomplete clinical forms. Nail plate avulsion is the diagnostic and curative procedure of choice, despite reports of relapse.

Padronização da técnica cirúrgica de fenolização de matriz ungueal para onicocriptose / Standardization of the nail matrix phenolization surgical technique for treating onychocryptosis

A onicocriptose é afecção bastante comum em adolescentes e adultos jovens. Muitos tratamentos já foram descritos, conservadores e clínicos. Descrevemos a padronização da técnica de cirurgia de onicocriptose com fenol 88% realizada desde 2009 no ambulatório de dermatologia ligado a um serviço universitário.

Onychocryptosis is a common condition in adolescents and young adults. Many conservative and clinical treatments have already been described. The authors of the present paper describe the standardization of the onychocryptosis surgical technique using 88% phenol, which is performed at a university hospital's dermatology outpatient clinic since 2009.

Gutter Splint for Ingrown Toe Nail in Young Patients / 대한족부족관절학회지

PURPOSE: Ingrown toenails are a common disease in the adolescent period and the treatments could be more conservative for this early stage of the disease. This study is a case series on the results of a gutter splint for an adolescent ingrown toe nail as a simple, comfortable treatment method. MATERIALS AND METHODS: From 2011 to 2018, 22 patients (mean age, 12.2 years; range, 8~15 years) with ingrown toenails were treated with a gutter splint. There were 16 boys and 6 girls with 7 patients on both great toes, and additional 4 both corners of a nail, giving a total of 33 splints. Flat, plastic straws and glue or suture were used to protect the nail corners under local anesthesia. The medical records were reviewed retrospectively and phone calls were made to obtain the long-term results. RESULTS: Fifteen splints were fixed with a suture and the other 18 splints were fixed with glue. There were 9 cases of recurrence out of 33 gutter splints, 8 out of 15 sutured splints and 1 out of 18 glued splints (p=0.010). There was no gender (p=0.383) or age (p=0.305) difference in the number of recurrences. CONCLUSION: For growing people, ingrown nails can be cured easily by conservative treatment for a transiently shortened or broken toenail. The glued gutter splint had a reasonable success rate as a first line treatment.

Anatomical Characteristics and Surgical Treatments of Pincer Nail Deformity

BACKGROUND: Pincer nail deformity is a transverse overcurvature of the nail. This study aimed to define the anatomical characteristics of pincer nail deformity and to evaluate the surgical outcomes. METHODS: A retrospective review was conducted on 20 cases of pincer nail deformity of the great toe. Thirty subjects without pincer nail deformity or history of trauma of the feet were selected as the control group. Width and height indices were calculated, and interphalangeal angles and base widths of the distal phalanx were measured with radiography. We chose the surgical treatment methods considering perfusion-related factors such as age, diabetes mellitus, kidney disease, and peripheral vascular disease. The zigzag nail bed flap method (n=9) and the inverted T incision method (n=11) were used to repair deformities. The outcomes were evaluated 6 months after surgery. RESULTS: The interphalangeal angle was significantly greater in the preoperative patient group (14.0degrees+/-3.6degrees) than in the control group (7.9degrees+/-3.0degrees) (P<0.05). The postoperative width and height indices were very close to the measurements in the control group, and most patients were satisfied with the outcomes. CONCLUSIONS: We believe that the width and height indices are useful for evaluating the deformity and outcomes of surgical treatments. We used two different surgical methods for the two patient groups with respect to the perfusion-related factors and found that the outcomes were all satisfactory. Consequently, we recommend taking into consideration the circulatory condition of the foot when deciding upon the surgical method for pincer nail deformity.

Treatment of Ingrowing Toenails: Comparision of Surgery and Conservative Method Using Memory Alloy / 대한피부과학회지

BACKGROUND: Many techniques for the treatment of ingrown toenails have been described in the medical literature. Surgical removal of the nail plate with partial matricectomy is associated with the lowest recurrence rates. Shape-memory alloy (KD wire) has shown promising results for the treatment of ingrown toenails. However, the results of long term follow-up or a comparison with surgical treatment have not been reported, and the adequate removal time of the wire remains unknown. OBJECTIVE: To compare the results of surgical treatment using partial matricectomy (PM) to those of conservative treatment using KD wire (KD) and to determine the adequate removal time of the wire. METHODS: The KD and PM groups were compared regarding pain relief, quality of life improvement, pain and discomfort during the procedures and 3 weeks after, improvement of nail index by using clinical photos, and patient's satisfaction with the treatments. The nail index improvement in the KD group was compared between postprocedural days 14 and 21. RESULTS: Recurrence was higher (p=.039) in KD group (18.64%) than PM group (6.35%). Patient satisfaction was significantly better (p=0.025) in the PM group than in the KD group. Other parameters showed no significant differences between the two groups. Nail index improvement in the KD group was not significantly different between postprocedural day 14 and day 21. CONCLUSION: Conservative treatment using the KD wire is as effective as surgical removal with partial matricectomy for the treatment of ingrown nails in pain relief, QOL improvement and nail index improvement, but has higher recurrence. The adequate application period of KD is 2 weeks.

Success Rates of Multiple Treatments for Ingrown Nails / 대한피부과학회지

BACKGROUND: An ingrown nail is a common condition of inflammation and infection that can occur when nails are clipped too much or pressure is applied by tight shoes. In Korea, a study on the success of tube insertion after nail guttering has been reported, but studies including other treatments are lacking. OBJECTIVE: To evaluate the success rates of three treatments for ingrown nails: 1) nail splinting via a flexible tube; 2) partial nail extraction and electrocautery; or 3) partial nail extraction and phenol cauterization. METHODS: Fifty-one patients who underwent nail splinting via a flexible tube or partial nail extraction followed by either electrocautery or phenol cauterization of the nail matrix over a 6-year period at our hospital were evaluated for treatment outcome. The disease severity was classified using the Heifetz grading scale. We evaluated the success rates of the various treatments according to reduced disease severity. Treatment failure was defined as persistence or re-occurrence of disease symptoms. RESULTS: 1. Out of 51 cases of ingrown nails, 31 (60%) showed no recurrence after treatment. 2. There were conflicting results between the severity grade and success rate. 3. Treatment via partial nail extraction and either electrocautery or phenol cauterization was more effective (success rates of 63% and 60%, respectively) than nail splinting via a flexible tube (56% success rate). However, the results were not statistically significant. CONCLUSION: Selecting the proper therapeutic method is important for successful treatment of an ingrown nail.

Using 80% trichloroacetic acid in the treatment of ingrown toenails / Acido Tricloroacetico a 80% no tratamento da onicocriptose

BACKGROUND: Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times. OBJECTIVE: This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail. METHODS: One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery. RESULTS: There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery. CONCLUSION: It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method. .

FUNDAMENTO: A unha encravada é uma patologia muito frequente. A doença engloba diferentes estadios existindo diferentes soluções terapêuticas. O fenol e o hidróxido de sódio são largamente utilizados na matricetomia química porém ambos cursam com longos tempos de cura. OBJETIVO: O principal objectivo deste estudo prospectivo foi avaliar a eficácia da mactricectomia com ácido tricloroacético a 80% no tratamento da unha encravada. MÉTODOS: Foram incluídos no estudo 133 doentes com 197 unhas encravadas. Factores predisponentes foram avaliados pré-operatoriamente. No período pós-operatório os doentes foram avaliados para potenciais complicações ao dia 3, 30, 180, 270 e 360. A dor foi avaliada antes da cirurgia, 24 horas e 72 horas depois da cirurgia. RESULTADOS: Ocorreram apenas 3 (em 197) casos de recorrência da unha encravada. Antes da cirurgia registou-se exsudação em 82% dos doentes sendo que na primeira visita após a cirurgia este número foi reduzido para 19%. Observou-se ainda tecido de granulação persistente em 3% dos doentes (versus 75% antes da cirurgia). Os factores predisponentes mais frequentemente encontrados para unha encravada foram o corte excessivo da porção lateral da placa ungueal (63%), hiperhidrose plantar (58%) e pregas ungueais espessadas (39%). A dor teve uma redução dramática após a cirurgia. CONCLUSÃO: É assumido que os procedimentos químicos para a unha encravada estão associados com longos tempos de cura mas os nossos resultados mostraram uma rápida recuperação. No tratamento da unha encravada a matricectomia parcial com ácido tricloroacético a 80% é um método rápido, eficaz e de fácil execução. .

Clinical Study of Efficacy of Super Elastic Wire for Ingrown Nails of Great Toe / 대한피부과학회지

BACKGROUND: Ingrown toenail is one of the most common nail complaints. It occurs mostly on the great toes, where is an excessive lateral nail growth into the nail fold, leading to painful irritation, inflammation, and growth of the granulation tissue. Many treatments have been described, but these classic treatment modalities may lead to severe damage of the nail fold or frequent relapses. OBJECTIVE: We attempted to evaluate the therapeutic efficacy of super elastic wire (SE-wire, Machiwire(R)), a non-invasive treatment for ingrown toenails. METHODS: Fifteen patients with ingrown toenail were treated with super elastic wire. Objective assessment was evaluated by use of the width index (width of the nail tip/width of the nail root) and height index (height of the nail tip/width of the nail root). Subjective assessment was evaluated by use of a visual analogue scale declared by patients. In addition, wound complications and recurrence were described. RESULTS: The width index and height index were improved (width index: 75.0%-->90.0%, height index: 76.5%-->27.7%). Pain was relieved in 100% of the cases. For subjective assessment, all of the patients were satisfied (more than "satisfactory": 100%). There were two relapsed cases during 5 to 12 month period (mean time: 9 months). CONCLUSION: We recommend super elastic wire method as an alternative treatment for ingrown toenail, because it is simple, easy to perform, noninvasive, effective, and well-tolerated.

Tratamento da unha encravada: comparação da taxa de cura entre a técnica de fenolização clássica e a técnica de fenolização associada à curetagem da matriz ungueal - é necessária a associação? / Treatment of ingrown nail: comparison of recurrence rates between the nail matrix phenolization classical technique and phenolization associated with nail matrix curettage - is the association necessary?

No Brasil, alguns serviços associam a curetagem da matriz ungueal à fenolização, como tentativa de aumentar a eficácia do tratamento da unha encravada. O objetivo deste trabalho foi comparar a taxa de cura entre a fenolização e a fenolização associada à curetagem da matriz. Foi realizado um estudo retrospectivo e incluídos 271 cantos encravados. Recorreram 5 por cento após a realização da fenolização, e 7,7 por cento após a fenolização com curetagem da matriz. Não houve diferença estatística entre as duas técnicas, mostrando não ser necessária a associação com a curetagem da matriz. A fenolização mostrou-se eficiente mesmo para o grau III.

Some services in Brazil combine curettage of the nail matrix with phenolization in the treatment of ingrown nails, with the objective of further increasing efficacy. The objective of this research was to compare the cure rates between the phenolization technique and phenolization associated with nail matrix curettage. A retrospective study was done which included 271 cases. There was only a 5 percent recurrence rate for the phenolization procedure, compared with 7.7 percent for combined phenolization/nail matrix curettage. There was no statistically significant difference between the two techniques, which indicated that there is no need for curettage of the nail matrix. Phenolization worked even for level III disease.

Onicocriptosis en pediatría: tratamiento conservador y espiculotomía / Onichocryptosis in pediatrics: conservative treatment and spiculectomy

La onicocriptosis (de onyx, uña y kriptos, oculto) constituye elprincipal motivo de consulta por dolor ungueal.Es la penetración del borde lateral de la lámina ungueal en la pared del pliegue lateral, con dolor e inflamación del tejidocircundante.La expresión clínica oscila entre eritema, edema y dolor a lapresión del pliegue lateral, hasta la infección secundaria y la impotencia funcional.Se trata de una onicopatía mecánica, casi exclusiva del primer dedo del pie, que reconoce múltiples causas.Presentamos el manejo terapéutico en pediatría mediante medidas conservadoras y espiculotomía.

Onicocriptosis del hallux: analisis comparativo entre la tecnica de preservacion de la matriz y la tecnica con lesion de la matriz ungular / Onychocryptosis on the hallux: comparison between matrix preserving and ungueal matrix excision techniques

Introduccion: La onicocriptosis es una patología de observación común en la especialidad. Se describieron múltiples tratamientos, con resultados variados, según consta en la bibliografía. El objetivo del presente estudio es comparar los resultados clínicos-funcionales de los pacientes tratados por onicocriptosis mediante dos técnicas diferentes: con conservación de la matriz ungular y con lesión de la matriz ungular. Materiales y métodos: Entre marzo de 2002 y octubre de 2006 se evaluaron dos grupos de pacientes tratados quirúrgicamente por onicocriptosis: grupo A sin lesión dela matriz (54 casos) y grupo B con lesión de la matriz (33 casos). La edad promedio de ambos grupos fue de 35 años. Se analizó la evolución clínica, la comodidad con el resultado estético y con el calzado, y las complicaciones y recidivas. El seguimiento promedio fue de 19 meses en el grupo A y de 24 meses en el grupo B. Se utilizó el método estadístico para comparar ambos grupos. Resultados: Recidiva: grupo A 11 por ciento y grupo B 6 por ciento. En cuanto al dolor posoperatorio, ambos grupos presentaron, según la escala visual, menos de 0,5/10 de dolor. En el grupo A, el 16,6 por ciento presentó dolor leve y en el grupo B lo presentó el 3 por ciento. Estética: satisfacción del 100 por ciento en ambos grupos. Conclusiones: El tratamiento de onicectomía sin lesión de la matriz estaría indicado en los casos primarios. En el caso de recidiva indicamos la cirugía con lesión parcial de la matriz (borde comprometido), ya que presenta menor tasa de recidiva.

Matricectomia com ácido tricloroacético estudo retrospectivo / Trichloroacetic acid matricectomy: a resprospective study

Introdução: O tratamento da unha encravada pode ser conservador ou cirúrgico. O tratamento cirúrgico com matricectomia é o mais efetivo e pode ser realizado de forma mecânica ou química. Embora o fenol seja o agente mais utilizado, o ácido tricloroacético tem revelado bons resultados na matricectomia parcial química da unha encravada. Objetivo: Demonstrar a utilização do ácido tricloroacético como opção no tratamento da unha encravada. Métodos: Foram analisados 33 pacientes, totalizando 37 unhas encravadas que foram submetidas à matricectomia com ácido tricloroacético 50%, após exerese parcial da lâmina ungueal.Avaliaram-se os fenômenos agudos no período pós-operatório imediato e a efetividade do tratamento, em relação à recorrência de unha encravada no local tratado, após período variável de sete a 24 meses. Resultados: A taxa de sucesso do tratamento foi de 70,27%. Observaram-se leve exsudação pós-cirúrgica, ausência de necrose tecidual e boa cicatrização. Conclusão: A matricectomia com ácido tricloroacético apresenta poucos efeitos colaterais, é de fácil manuseio e tem boas taxas de resolutividade, podendo ser alternativa no tratamento da unha encravada.

Introduction: The treatment of ingrown nails can be conservative or more invasive, including surgical methods. Surgical treatment through matricectomy is the most effective and can be performed mechanically or chemically. Although phenol is the most commonly used agent, trichloroacetic acid has led to satisfactory results in the partial chemical matricectomy of ingrown nails. Objective:To describe the use of trichloroacetic acid as an option to treat ingrown nails. Methods: 33 patients were analyzed, with 37 ingrown nails subjected to matricectomy with 50% trichloroacetic acid following the partial exeresis of the nail plate. Acute phenomena were assessed in the immediate post-operative period.Treatment effectiveness regarding the recurrence of the ingrown nail in the treated site was assessed 7 to 24 months after the procedure. Results: The treatment’s success rate was 70.72%. Light post-surgical exudation, the absence of tissular necrosis and good healing process were observed. Conclusion: Trichloroacetic acid matricectomy is an effective treatment for ingrown nails: it causes few side effects, is easy to perform and has good resolution rates.

Tratamento de disfunções ungueais com órteses / Treatment of nail disorders using orthesis

Neste artigo abordaremos causas comuns de afecções ungueais que causam dor: a hipercurvatura transversa da unha (HT) e a onicocriptose.A primeira tem como etiologia principal o fator hereditário e deformidades dos artelhos, enquanto a segunda também pode estar associada à má poda das unhas e uso inadequado de calçados.Tanto a HT quanto a onicocriptose podem advir de disfunções na biomecânica da marcha. Uma HT pode evoluir para onicocriptose e por isso seus tratamentos muitas vezes são semelhantes, tanto cirúrgica quanto conservadoramente.Dentre os tratamentos, este artigo enfoca o conservador, particularmente a aplicação de órteses ungueais, suas indicações e eficácia.