Nail Avulsion Research Articles

Clinical features and treatment outcomes of retronychia: A multicenter retrospective analysis in Korea

Clinical features and treatment outcomes of retronychia: A multicenter retrospective analysis in Korea

Risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces: A retrospective observational study of 238 cases.

Background Nail braces are reportedly effective for treating both acute inflamed and chronic dystrophic type ingrown toenails. Aims In this study, risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces were identified. Methods We performed a retrospective study on patients with ingrown toenails between June 1, 2015, and May 31, 2018. The last follow-up date was January 31, 2019. Multivariate logistic regression was performed to evaluate the possible factors associated with poorly controlled status (ongoing paronychia during treatment) and recurrence. Results There were 120 (244 sides) and 118 patients (167 sides) with chronic dystrophic and acute inflamed type ingrown toenails, respectively. The mean treatment duration and follow-up period were 161.2 ± 98.3 days and 432.7 ± 320.9 days, respectively. Poor control and recurrence were seen in 7.3% (17/232) and 12.2% (27/221) of the patients, respectively. In the multivariate analysis, acute inflamed ingrown toenails, previous nail avulsion, proximal nail fold hypertrophy and more than one affected side remained significantly associated with poorly controlled ingrown toenails. Foot bone deformity was significantly associated with recurrence. Limitations This study was a retrospective study so that confounding factors such as comorbidities, body mass index, accompanying nail changes and lifestyle could not be evaluated. Conclusion Several risk factors related to poor control and recurrence were identified. Patients could therefore benefit from more suitable treatment plans with reasonable expectation.

Surgical Intervention for Paronychia Induced by Targeted Anticancer Therapies.

Paronychia is a common toxicity associated with targeted anticancer therapies. Antibiotics and steroids are the standard treatments for severe paronychia, yet they are often inadequate, prolonging the patient's suffering and resulting in changes to effective cancer therapy. This article describes the clinical course of drug-induced paronychia and attempts to identify circumstances under which nail surgery may be beneficial. This is a retrospective case series from a single institution's electronic medical record for patients on paronychia-inducing anticancer therapies with nail disease visit diagnosis codes. The authors identified 36 nail procedures performed on 12 patients, all of whom were managed with conservative steroid and antibiotic therapy with varying degrees of improvement; however, no further improvement was seen after 90 days. Partial matricectomy, nail avulsion, debridement/clipping, and incision and drainage were performed with resolution rates of 100% (11/11), 38.5% (5/13), 12.5% (1/8), and 0% (0/4), respectively. The average time to surgical intervention was 196 days, and the average time to resolution was 268 days. This series highlights the prolonged course of severe drug-induced paronychia and the importance of surgical intervention to reduce pain and impact on cancer treatment. Partial matricectomy should be considered for paronychia unresponsive to conservative therapy by 3 months.

Epidemiology and Outcome of Nailbed Injuries Managed in Children's Emergency Department: A 10-Year Single-Center Experience.

Fingertip injuries are among the most common hand injuries in children and result in significant health, time, and a financial burden. Nailbed injuries constitute a large proportion of fingertip injuries and are frequent in children. This study aimed to examine the epidemiology, injury patterns, and treatment strategies implemented in patients with nailbed injuries between 0 and 18 years of age. We also wanted to identify various acute and chronic complications associated with nailbed injuries in these patients. This was a single-center retrospective study carried out on the data collected between October 1, 2009, and October 31, 2019. We identified 457 patients with upper extremity nailbed injuries during the study period. Most children were male, accounting for 62.8% (287) of the patients. Door crush injuries (59.5%) resulted in the majority of the nailbed injuries. The commonest place of injury occurrence was home (46.4%), followed by playground (28.4%). The next most frequent areas were public areas (17.5%) and school (7.7%). Simple nailbed laceration with partial avulsion of the nail (44.4%) was the most common type of nailbed injury. Most nailbed injury repairs were done by the pediatric emergency doctor (72.2%). The predictors for the occurrence of complications after nailbed injury were the type of injury (stellate laceration and severe crushed nailbed injuries) and fracture of the distal phalanx. The predictors for the use of antibiotics after nailbed injury in our patients were the mechanism of injury (crushed in door, sports injury, and road traffic accident) and fracture of the distal phalanx. Age was found to be associated with subungual hematomas and avulsion, whereas female sex was found to be associated with crush injuries. In this study, most patients (72.2%) had their nailbed injuries repaired by pediatric emergency doctors. The commonest mechanism of nailbed injury was door crush injuries. Increased awareness and education of the caregivers might help avoid these injuries because the injury mechanism in most of the patients is preventable. Partial nail avulsion with underlying simple laceration of the nailbed was the most frequent type of nailbed injury seen. The complications that were seen after nailbed injuries were fingertip sensitivity (5.3%), split nail deformity (5.3%), infection (3.9%), nonadherence of the nail plate (2%), and hook nail deformity (1%). The predictors for the occurrence of complications after nailbed injury were the type of injury (stellate laceration and severe crushed nailbed injuries) and fracture of the distal phalanx. The predictors for the use of antibiotics after nailbed injury in our patients were the mechanism of injury (crushed in door, sports injury, and road traffic accident) and fracture of the distal phalanx. Age was found to be associated with subungual hematomas and avulsion, whereas female sex was found to be associated with crush injuries. Possessing a robust understanding of the mechanism of injury and the underlying anatomy with a detailed assessment of the nailbed injury is of paramount importance in the management of these patients. An initial thorough assessment and meticulous repair of the nailbed injuries will result in good outcomes with overall few complications.

Redesigning the Door Reduces the Potential for Finger Injuries in Children

The standard door is a safety hazard for young children often resulting in crush injuries, nail avulsions, fractures, lacerations, and amputations. This type of injury occurs mostly in households and may sometimes happen to adults, although this is less common. The simplicity of the door’s design has continually become a concern mostly due to its potential to cause injury. The purpose of this study is to redesign the door to reduce the risk of finger injuries in children. A safety door was designed and a model of it was constructed for study. Its two major features utilize silicone rubber fins at the pinch points and a “piano” hinge running the entire door length (instead of the conventional two or three separate hinges) to eliminate the space between the hinges. Ten door closures using five finger models (beef stick, green beans, string cheese, crayons, red licorice twists) were performed to observe and assess the resulting injuries from the safety door compared to a standard door. The severity of the resulting injuries was scored using a 0 – 8 numerical score. The collected data were recorded in a computer spreadsheet for statistical analysis. The safety door resulted in 1 amputation (0.7%) compared to 120 amputations (out of 200 door closures) in the standard door (60%, p<0.0001) and had significantly lower numerical injury scores (0.2 vs 4.8, p=0.0001). The safety door is less injurious than the conventional door and re-designing the door will likely lower the risk of finger injuries in young children.

O uso do ácido tricloroacético para avulsão química de unhas com onicomicose. Relato de caso

Objetivo: Descrever o uso do ácido tricloroacético 90% (ATA 90%) como adjuvante químico para avulsão de unhas com onicomicose, verificando riscos e benefícios ao paciente. Método: Trata-se de um estudo tipo relato de casos, no qual participaram 26 indivíduos com hipótese diagnóstica de onicomicose. As unhas foram quantificadas, medidas, fotografadas e classificadas em onicomicose subungueal distal e onicomicose subungueal proximal, de acordo com o comprometimento da lúnula. A intervenção consistiu na avulsão mecânica da placa ungueal contaminada e aplicação do ATA 90% na placa ungueal residual, sobre o leito ungueal exposto e região periungueal. No retorno dos indivíduos, após 7 dias, foram observados os efeitos do ATA 90%. Resultados:. O ATA 90% não causou o efeito químico desejado de descolamento da placa ungueal, porém causou a descamação da pele nas áreas onde foi aplicado. A redução parcial de tamanho das unhas foi resultado da técnica de onicotomia com instrumental adequado realizado pelo podologista. Conclusão: A avulsão mecânica da unha e a descamação da pele provocada pelo ATA 90% pode beneficiar o paciente no tratamento da onicomicose melhorando a aparência local e motivando-o ao autocuidado e ao tratamento. O podologista pode auxiliar a equipe de saúde com o manejo das contaminações fúngicas e com a educação dos pacientes.

BIO-NAIL: a bacterial cellulose dressing as a new alternative to preserve the nail bed after avulsion.

Avulsion of the nail plate is the most accomplished surgical procedure among the nail apparatus surgeries. Since it is not possible to use the removed nail to cover the nail bed, some materials have been suggested, however, they are generally not available for use and often at a high cost. To evaluate the use of Bacterial Cellulose (BC) dressing as a biological nail (Bio-Nail) after partial or total avulsion of the nail plate. Twenty-six candidates for nail avulsion, were randomized into two groups: Control, using Vaseline with gauze (11 patients) and Experimental group, BC group, using the Bio-Nail (15 patients). The patients were followed up during the 180-day period. The distribution of the patients in the groups was homogeneous for both sociodemographic and clinical data. The occurrence of infection (1 case in the control group) was not statistically relevant. The BC group had lower pain intensity (p = 0.011) with earlier temporal resolution when compared to the control group (p = 0.003). The BC group presented earlier reepithelization (p = 0.022) and better quantitative (p = 0.021) and qualitative conditions (p = 0.011) for the exudate. Regarding satisfaction, all the patients were satisfied. Good preservation of the nail plate area was observed in the BC group at the end of the 180-day period (p = 0.024). Average time of BC dressing permanence was 16.4 ± 7.1 days. BC showed to be appropriate as a dressing after partial or total avulsion of the nail plate. BC is a Bio-Nail promising for nail bed healing.

Once Weekly Application of Urea 40% and Bifonazole 1% Leads to Earlier Nail Removal in Onychomycosis

Introduction: Onychomycosis is a chronic nail fungal infection resulting in nail damage and a decreased quality of life. Chemical avulsion of the nail with urea and bifonazole ­removes fungally infected debris, increasing antifungal treatment efficacy and penetration. Previous clinical ob­servations describe patients who applied their urea and ­bifonazole ointment less frequently, achieving earlier nail removal. In this study, we analyzed the relationship between duration of urea and bifonazole application and time to nail avulsion. Methods: χ² tests, multiple regression analysis, and ANOVA were performed to analyze the similarities between treatment regimens (daily, every 3 days, or once a week), association of regimens or patient characteristics to nail removal, and compare time to nail removal between each regimen, respectively. Results: Daily application of ointment and sealing resulted in an average length of time (±SD) to nail removal of 18.7 days (±6.8 days); once every 3 days resulted in nail removal at 12.7 days (±6.2 days) and once per week at 11 days (±4.46 days) (p < 0.001). Age was the only patient factor that affected duration to nail removal. Conclusion: Once weekly application of ointment with sealing for a 1-week duration is associated with a decrease in time to complete chemical avulsion of the nail by approximately 1 week.

Dermoscopic diagnosis of subungual hematoma: new observations

IntroductionThere are very few studies focusing on the dermoscopic features of subungual hematoma which is one of the major imitators of subungual melanoma.AimTo identify the dermoscopic findings of subungual hematoma, which will facilitate the diagnostic process by reducing the use of more invasive diagnostic methods like nail avulsion or biopsy.Material and methodsIn this study, clinical and dermoscopic findings of the cases were reviewed. The diagnosis of subungual hematoma was confirmed by observing progression of the colour change to the distal edge of the nail plate in all the cases.ResultsA total of 47 subungual hematomas were enrolled in the study. The most common colour was purple-black (53%). Blue-white colour was observed in 12 (26%) lesions. 9 (19%) lesions showed granular leukonychia. All of the lesions had a homogenous pattern. In 25 (53%) lesions, a globular pattern was observed. 14 (30%) lesions showed a streaks pattern. Peripheral fading and periungual haemorrhage were present in 14 (30%) and 9 (9%) lesions, respectively.ConclusionsWe detected two new findings which have not been described previously for subungual hematoma: the first one is “blue-white colour” which is known as an important clue to melanoma. The second one is granular leukonychia localized on the hematoma. We suggest that in any case of the nail discoloration, a thorough dermoscopic examination should be performed. Moreover, progression of the colour change to the distal edge should be observed to ensure that a possible melanoma is not overlooked.

Soft-Tissue Nail Fold Arc Resection Combined with a Shaped Dressing for Ingrown Toenails.

The objective of this study was to evaluate the effectiveness of the surgical method of arc resection of soft-tissue nail fold combined with a shaped dressing for ingrown toenails. The surgical method involved the excision of nail fold granulation tissue and partial or total nail avulsion with preservation of its matrix. This surgical approach was applied to 20 consecutive patients (age range, 11-30 years) admitted to the hospital from January 1, 2014, to December 31, 2015. For assessment of the method, the operative technique, dressing change, and postoperative wound healing were recorded by photography. Finally, we evaluated the therapeutic effects by calculating the recurrence rate and nail groove expansion rate. Twenty patients with 38 surgical sites in 26 toes were analyzed; there was no recurrence at 3, 6, and 12 months. There was a statistically significant difference in the groove expansion rate at different time points. We measured the wound distance on postoperative day 1 compared with the day of healing and found that the method of shaped dressing could expand the nail groove by more than 50% (P ≤ .05). The mean ± SD recovery time was 15.1 ± 2.4 days. Arc resection of the nail folds for ingrown toenails coupled with preservation of its matrix minimizes trauma and is easy to manipulate. Applying a shaped dressing after the operation further reduces the risk of recurrence and ensures enough growth space for the toenails.

Comparative Efficacy of 10% Sodium Hydroxide, 88% Phenol, and 90% Trichloroacetic Acid as Chemical Cauterants for Partial Matricectomy in the Management of Great Toe Nail Onychocryptosis.

Context:Lateral plate avulsion with chemical matricectomy is the treatment of choice for ingrown toenails. Phenol is the most widely used cauterant, followed by 10% NaOH and more recently trichloroacetic acid.Aims:To evaluate the efficacy of 10% NaOH, 88% Phenol, and 90% TCA in cauterizing the matrix with regular follow up post surgery and clinical photographs.Materials and Methods:Fifteen adult patients presenting with ingrowing toe nails were recruited to the study with prior consent. The NaOH group (Group A) had five patients and five nails treated, the phenol group (Group B) had five patients and six nails treated, and the TCA group (Group C) had five patients and six nails treated. A total of 17 great toe nails were treated. Following proximal digital block and partial nail avulsion, the matrix was curetted and the lateral horn cauterized with 10% NaOH (1 min), 88% phenol (3 min), and 90% TCA (3 min). Post-procedure follow-up was done at weekly intervals to evaluate post-operative pain, oozing, and wound healing.Statistical Analysis Used:Graph pad prism software was used for statistical analysis. ANOVA tests were used to test the statistical significance between post-operative parameters of each group.Results:Mean duration of post-op pain in Group A was 4.2 days; Group B was 8.6 days, and Group C was 1.2 days. Oozing occurred for a mean duration of 10.6 days in Group A, 14 days in Group B, and 5.6 days in Group C. Mean duration of tissue re-epithelization was 28.4 days in Group A, 40.5 days in Group B, and 27.4 days in Group C.Conclusions:TCA is an effective cauterant for chemical matricectomy with the advantage of less duration of post-op pain and faster healing.

Chemical or Surgical Treatment in Ingrown Toenails? Practical Issues from a Case Series

Abstract Introduction: An ingrown toenail is a serious medical problem that cannot be overlooked, and the decision of choosing between conservative versus surgical treatment may be difficult in daily practice. Case series presentation: We present the cases of two young men with a long history of ingrown toenails, previously treated by complete nail avulsion, numerous topical applications of antibiotics, and 5% silver nitrate, successfully treated with caustic chemical agents, compared to a 19-year-old athlete with debilitating pain, intense inflammatory changes, infection, granulation tissue induced by skin penetration of lateral nail edge by an incurved toenail, in whom surgical treatment was needed. Conclusion: Chemical matricectomy in the absence of any surgical intervention, along with patience allowing the nail to grow, could be an option that is easy to perform in case of ingrown nails. However, the selection of cases is important, taking into balance the benefit-risk ratio.

Radio-frequency Ablation for Matricectomy in the Management of Ingrown Toenail: A Pilot Study.

Introduction:Ingrown toenail is one of the most commonly encountered nail disorders that adversely affect the quality of life. The common surgical intervention includes partial nail avulsion with chemical matricectomy but it has a relatively longer recovery period. We attempted to study the efficacy and safety of radio frequency (RF) for matricectomy.Materials and Methods:Eight patients with total 10 ingrown toenails (grade 2) were recruited. Partial nail avulsion with RF ablation of matrix was performed. The radio-frequency electrode was placed over the lateral matrix horn for the duration of 3–5s, two to three times. Patients were followed up at regular interval. Outcome was measured in terms of ooze, erythema, pain, and swelling of the lateral nail folds.Results:Of the eight patients, six were males and two were females. Total 10 nails were treated as two patients had bilateral toenail involvement. Average number of days required for postprocedural healing was 7.5 days. Significant improvement was observed in terms of erythema, pain as well as swelling within 4 days of surgery. None of the cases showed any adverse effects or relapse within 3–5 months of follow-up.Conclusion:Matricectomy by radio-frequency ablation is a safe and effective method in the management of ingrown toenail with significant reduction in downtime.

The Efficiency of Partial Nail Avulsion for Paronychia Associated with Epidermal Growth Factor Receptor Inhibitors (EGFRIs)

The Efficiency of Partial Nail Avulsion for Paronychia Associated with Epidermal Growth Factor Receptor Inhibitors (EGFRIs)

The Impact of Subungual Osteochondroma Deformans on Severely Mycotic Toenails

Background: We examined 94 toenails exhibiting clinical signs of severe onychomycosis taking into account multiple contributing factors, not the least of which was Subungual Osteochondroma Deformans (SOD). We hypothesize that SOD plays a significant role in both the etiology and treatment of onychomycosis. Methods/Results: A retrospective post-treatment outcome analysis was performed comparing two groups of severely mycotic toenails. The first group of 25 fungal nails showed 54.31% improvement following treatment by both surgical nail avulsion and a 1064 YAG laser-based Nail Restoration algorithm. The second group of 69 fungal nails was not only treated using the same nail avulsion/laser-based algorithm but was also evaluated for SOD lesions which were surgically removed when present, resulting in 95.31% improvement. The overall incidence of SOD lesions in the second group of severely mycotic toenails was 73.91%. Conclusion: We submit that at 73.91% Subungual Osteochondroma Deformans has an under-reported and under-appreciated association with toenail fungus. Generally, we find that our success rates in treating severe toenail fungus using our laser-based Nail Restoration Protocols are much higher when SOD lesions are surgically removed.

IDIPOPATHIC ONYCHODYSTROPHY IMPROVES WITH INTRADERMAL DEXPANTHENOL INJECTION: AN EXTRAORDINARY USE

Idiopathic onychodystrophy is one of the most challenging conditions for dermatologists to treat. Topical steroids, laser, total nail ablation and nail avulsion had been tried, but no optimal therapy has been decided yet. Herein we present the case of a middle-aged male patient with idiopathic onychodystrophy on his thumb, who improved with six intradermal dexpanthenol injections on weekly basis. This is an extraordinary successful use of dexpanthenol, which is a common medication all over the world. Key words: Dexpanthenol, onychodystrophy, injection.

Chemical nail avulsion—An alternate treatment for nail dystrophy

Chemical nail avulsion—An alternate treatment for nail dystrophy

Nail Changes in Chilblains Mimicking Lichen Planus

Nail Changes in Chilblains Mimicking Lichen Planus

A novel training exercise for learning digital nerve blocks, nail avulsions, matricectomy and matrix biopsies in dermatology residency: A pre- and posttraining workshop research survey

A novel training exercise for learning digital nerve blocks, nail avulsions, matricectomy and matrix biopsies in dermatology residency: A pre- and posttraining workshop research survey

An Assessment of In Vitro Antifungal Activities of Efinaconazole and Itraconazole against Common Non-Dermatophyte Fungi Causing Onychomycosis.

Onychomycosis is a fungal nail infection which is relatively common and difficult to treat. Treatment modalities include nail avulsion, surgical debridement and combination therapy with oral and topical antifungal drugs. In spite of a host of available drugs, clinical cure rates remain discouraging. Drug toxicities, prolonged regimens, lack of patient compliance, and high keratin affinity of drugs are all contributive factors. Efinaconazole is a novel topical triazole antifungal agent that has shown excellent in vitro activity against both dermatophyte and non-dermatophyte fungi causing onychomycosis. This study presents the in vitro susceptibility profiles of 44 common non-dermatophyte fungi against efinaconazole and itraconazole, another azole drug used in the treatment of onychomycosis.