Demonstration of the correlation between salivary cortisol concentration and post-operative healing times following nail avulsion

Abstract

Twenty-eight subjects complaining of nail disorders were randomly selected over a period of three months. Each subject underwent either partial or a total nail avulsion with phenolisation under local anaesthesia. Subjects underwent weekly follow-up appointments to debride any eschar or callosity from the wound site. Following debridement post-operative healing was assessed. Post-operative healing was recorded as the period when there was no further discharge evident and there was normal healthy epidermis at the site of the wound. Saliva samples were collected from each subject. Salivary cortisol concentration was determined by radioimmunoassay of the samples. Three samples were collected for each subject, the first at the initial assessment, the second immediately prior to the administration of the local anaesthesia and the third 20 min after the second sample. Salivary cortisol concentration was compared with post-operative healing times. It was found that as the mean salivary cortisol concentration increased, there was an associated increase in the post-operative healing times following the nail surgery, r = 0.84. Cortisol in excess has been found to suppress immunological and anti-inflammatory responses. Increases in salivary cortisol concentrations may indicate a greater inflammatory response. It is likely that this response suppresses the post-operative healing times following nail surgery.