Ingrown toenails: an evaluation of elevating the nail bed-periosteal flap.

Many procedures to correct ingrown toenails are available; however, they cannot avoid recurrence and nail deformities. We have performed a procedure which corrects ingrown toenail without reducing the width of the nail plate by elevating the nail bed-periosteal flap. Sixty patients were observed for longer than six months and exhibited excellent results. Only two cases of incurvated nails (2) required re-operation.     

Treatment of ingrown nail with a special device composed of shape‐memory alloy

Ingrown nail is a common nail problem resulting in pain and disability in daily life. Recently, a new treatment modality for an ingrown nail was reported that used a device composed of shape‐memory alloy, K‐D. The aim of the present study was to determine the efficacy, recurrence rate and complications of K‐D. Between June 2010 and September 2012, 24 patients (31 nails) underwent treatment of symptomatic incurved nails with a K‐D. Patients were evaluated at pretreatment and during every visit. The mean age of the patients involved was 43.4 years. The mean period of follow up was 161 days. The mean maintenance period was 41 days. The right first toenail was the most common site. Almost ingrown nails healed and the nail deformity was corrected after the procedure. Among the 31 nails, seven of the ingrown nails recurred during follow up (22.6% recurrence rate). The recurrence rate of the patients with stage 1, 2 and 3 ingrown nails was 22.2%, 33.3% and 14.2%, respectively. The majority of patients were very satisfied. There were no side‐effects in most patients except loss of nail in one patient. K‐D has some advantages such as simple application steps, no deformity after the procedure, high patient satisfaction and obvious effect compared to other non‐invasive and invasive methods.     

Nail abrasion: a new treatment for ingrown toe-nails

A simple new method for the treatment of ingrown toe-nails was devised and applied to 33 toe-nails in 22 patients. The entire nail surface, except for the margin, was abraded until the nail became flexible with a Schreu's skin grinder equipped with a steel bar. When there was infection or granulation of the nail wall, the imbedded nail corner was trimmed before abrasion. The patients underwent additional treatments when one treatment was not enough to achieve cure or when discomfort appeared, which was the first symptom of recurrence. The average number and duration of treatments was 2.9 times and 16 months, respectively. Relief from pain occurred in all patients soon after abrasion was performed. Recurrence of infection and granulation was observed in only one patient. Five patients (23%) remained problem-free for more than one year without any additional treatment, because their incurved nail was gradually improved in shape by repetition of this procedure. This therapy was particularly effective in patients with severely incurved nails.     

部分甲基质切除甲沟重建治疗嵌甲

目的研究1种利用甲侧襞皮瓣改变甲体与甲沟的位置结构,从而彻底治愈嵌甲的手术方法。方法切除部分甲体、甲床,并利用甲侧襞皮瓣重建甲床、甲沟、甲侧襞联合结构。结果2000年1月～2003年5月对158 例嵌甲患者,足趾209、手指3,共276侧嵌甲进行甲沟重建手术。随访6月～2年,效果满意。结论该手术从根本上治愈嵌甲,且并发症少,复发率极低。     

Nail damage from gel polish manicure

Manicures can result in nail damage via instrumentation, nail polish, nail polish removers, and artificial nails. We report nail weakness, brittleness, and thinning in five subjects after the application of a new manicure system called gel polish and removal with acetone and manual peeling. All subjects complained that the polish was very difficult to remove and that their nails became much thinner after the procedure. Pseudoleukonychia and onychoschizia lamellina were noted on examination. One subject underwent ultrasound and reflectance confocal microscopy (RCM) measurements of nail plate before and after the gel polish application, which showed thinned nail plate (0.063 vs. 0.050 cm and 0.059 vs. 0.030 cm, respectively). Overall, we call attention to the adverse effects of gel polish manicures in five subjects. In addition, our case illustrates potential utility of ultrasound and RCM in measuring nail plate thickness.     

Modified Emmet's operation for ingrown nails using the Er:YAG laser

BACKGROUND: Ingrowing nails are a common problem. Standard procedure is surgery according to Emmet (a gycecologist) or Emmert (a surgeon) where postoperative pain, swelling and bleeding are major side effects and traumatic damage of the nail organ is not completely avoidable. Laser surgery may provide an alternative with less tissue damage.

METHODS: We compared 138 patients with 212 affected great toe nails (98 males, 40 females) were bloodless Emmet's operation was performed with digital nerve block with 11 patients (12 affected nails) using an Er:YAG laser for atraumatic nail plate removal. Pain was registered by a semiquantitative pain scale (ranging from “zero?–?no pain” to “10?–?maximum pain“). Swelling was scored from “0?–?absent” to “3?–?severe”. Side effects like bleeding, infection or relapse were registered.

RESULTS: Emmet's nail operation: Pain was scored 7.8±3.2 on the operation day (evening), 5.3±3.1 (day 1) and 3.8±4.0 (day 3). Swelling was scored 2.7±1.8 (operation day, evening), 2.1±1.9 (day 1) and 1.3±2.1 (day 3). Wound healing lasted 16.8±3.3 days. The infection rate was 2.4%, i.e. 5 of 212 nails. The relapse rate after 6 months was 12 of 212 nails (5.7%). Spicules were observed in 9 of 212 nails (4.2%). Laser procedure: Pain was scored 8.0±1.9 (operation day, evening), 4.1±1.5 (day 1) and 0.7±2.3 (day 3). The swelling was scored 2.4±1.8 (operation day, evening), 1.5±0.9 (day 1) and 0.9±1.3 (day 3). Wound healing was complete after 12.9±3.5 days. Infections and relapse were not observed. In one case spicules occurred after 5 months. No other side effects were noted.

CONCLUSIONS: The modified Emmet's operation for ingrown nails using the Er:YAG laser provides a safe method with increased efficacy that causes less pain and swelling, a faster healing and less complications.     

拔甲联合甲旁真皮-脂肪瓣填塞术治疗7例双侧重度卷曲型嵌甲

【摘要】 目的 探讨拔甲联合甲旁真皮-脂肪瓣填塞术治疗双侧重度卷曲型嵌甲的临床效果。方法 回顾性分析2018年1月至2020年1月就诊的7例双侧重度卷曲型嵌甲患者的临床资料,男3例,女4例,年龄25 ~ 49岁,平均35岁。采用拔甲联合甲旁真皮-脂肪瓣填塞术进行门诊手术治疗。结果 7例患者术后切口均为一期愈合,无感染。术后1~ 2周疼痛全部缓解。随访12 ~ 24个月,新生甲板均长出,无卷曲畸形,甲沟无红肿,无甲沟炎复发,患者均对疗效满意。结论 拔甲联合甲旁真皮-脂肪瓣填塞术治疗双侧重度卷曲型嵌甲临床效果良好。     

Treating ingrown toenails by nail splinting with a flexible tube: an Indian experience

Ingrown toenail is a common problem, and currently available treatments are either quite invasive or associated with unacceptably high recurrence rate. Recently a new non-invasive therapy. "Nail splinting", has been introduced. In this procedure, the nail is splinted with a longitudinally incised plastic tube. We conducted the present study to evaluate the efficacy and safety of this procedure in fifty patients (68 nail edges in 61 nails) with ingrown toenails at all stages. The pain disappeared almost immediately, and inflammation subsided in about one week in all nail edges. Thirty-nine patients came for regular follow-up for six months after removal of the tube. Eight (20.5%) of these patients showed recurrence of the problem. No serious side effects were noted.     

甲沟重建联合甲内卷矫正术治疗重度嵌甲型甲沟炎48例

目的:评价甲沟重建联合甲内卷矫正术治疗嵌甲型甲沟炎的临床疗效。方法:选择2019年12月至2021年10月在我科就诊的重度嵌甲型甲沟炎患者48例，均采用甲沟重建联合甲内卷矫正术治疗。手术要点：(1)楔形切除增生的肉芽组织缩小甲襞，通过新的缝合方法使甲襞侧组织与甲床同一水平，构建正常甲沟；(2)橡胶片固定在甲缘下以钝化甲边缘；(3)用橡皮筋牵拉甲缘下橡胶片以抬高甲侧缘以纠正甲内卷畸形。结果:48例患者(81个拇趾)全部治愈，甲形态正常且美观，随访6个月无复发。结论:甲沟重建联合甲内卷矫正术疗效好。     

A simple and practical method in treatment of ingrown nails: splinting by flexible tube

BACKGROUND: The ingrown nail (or onychocryptosis) is a common problem that occurs mostly in the big toe and causes high amounts of morbidity in affected patients. Many therapeutic methods have been described, most of them leading to severe damage to the nail or to frequent relapses. The nail splinting technique is a successful, simple and non-invasive therapeutic method for treating ingrown nails. OBJECTIVE: To determine efficacy of the plastic tube insertion technique in patients with ingrown toenail and its use as a standard treatment. MATERIALS AND METHODS: We encountered 32 cases (age range 9-67 years) of ingrown toenails in this clinical trial. All of the patients were treated using the plastic nail tube insertion technique for 7 to 15 days. Patients were examined daily for the first 3 days of treatment and were evaluated 3 and 6 months after treatment. All patients were followed up by a single observer. RESULTS: Recurrence was seen in only two patients after 6 months of treatment (6.25%). CONCLUSION: The low recurrence rate using the nail splinting technique in the treatment of ingrown toenail, as well as its simple application, shows that this treatment constitutes an effective, non-invasive method. It appears that this technique can substitute other more invasive surgical methods, particularly in the early stages of this disease.     

Using 80% trichloroacetic acid in the treatment of ingrown toenails

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.     

Nail thickness measurements using optical coherence tomography and 20-MHz ultrasonography

BACKGROUND: Nail diseases are often troubling to the patient and may present a diagnostic challenge to the dermatologist. Biopsies from the nail may be required although often perceived uncomfortable by the patient and potentially scarring. Noninvasive technologies are therefore of particular interest in the study of nails. Optical coherence tomography (OCT) is an optical imaging modality which may provide improved data. OBJECTIVES: This study evaluates nail morphology and thickness in OCT images in comparison with high-frequency ultrasound (HFUS) imaging of the nail. METHODS: Ten healthy volunteers were recruited for imaging and nail measurements; OCT and HFUS images were compared qualitatively. Nail thickness measurements with four different techniques were compared: ultrasound, OCT, polarization-sensitive (PS) OCT and callipers. The OCT system was developed at Risoe National Laboratory, Denmark. A commercially available 20-MHz ultrasound system (Dermascan; Cortex Technology, Hadsund, Denmark) was used. RESULTS: In standard OCT the nail plate appeared as a layered structure containing a varying number of horizontal homogeneous bands of varying intensity and thickness. PS-OCT images of the nail plate also showed a layered structure. The refractive index of the nail was 1.47 +/- 0.09. OCT and PS-OCT had low coefficients of variation, 6.31 and 6.53, respectively, compared with other methods: HFUS 12.70 and callipers 14.03. CONCLUSION: PS-OCT has to our knowledge not been applied to OCT analysis of the nail, and offers some advantages in separation of the nail bed from the nail plate.     

甲真菌病病指甲与正常指甲生长速率比较研究

目的　了解甲真菌病的病指甲与正常指甲生长速率的差异。方法　运用游标卡尺测量指甲生长长度 ,计算每日生长速率。结果　正常甲组 14 94个指甲 ,甲速为 0 .10 3± 0 .0 2 7mm/d ;病甲组 463个指甲 ,甲速为 0 .13 4± 0 .0 3 7mm /d。结论　病甲生长速度明显加快。病甲的生长速率也与甲位相关 ,受年龄 ,性别和温度的影响 ,但影响的程度远不如正常甲。     

Nail alterations in 250 infant patients: a clinical study

Aims To investigate the frequency and the nature of nail alterations in infants. Study design A total of 250 infant patients from newborn to 2 years of age were evaluated from the outpatient clinics of paediatrics and dermatology departments, Fatih University Hospital. The nail alterations were documented. The data were presented as percentages, and for categorical comparisons, Chi‐squared or Fisher's Exact test were used. P < 0.05 was considered statistically significant. Results Of the 250 infant patients, nail alterations were seen in only 17 (6.8%). Most of the patients had toe nail involvement. In 12 of 17 (70.6%) infants, there was one type of nail alteration; in 4 of 17 (23.5%) infants, there was two type of nail alterations; and in 1 of 17 (5.9%) infants, there was three type of nail alterations. The most frequent diagnosis was onychoschizia in 6 of 17 (2.4%) and congenital hypertrophy of the lateral nail fold together with ingrown nail in 6 (2.4%) infants. Conclusion Because nail alterations could be a manifestation of systemic or dermatologic diseases in infants, fingernail and toenail examination should be a part of the paediatric dermatology examination.     

Nail beauty

Nail beauty depends firstly upon nail health. It is a truism to say that a beautiful nail is always a healthy nail. In addition, there are subjective and evolving aspects of nail beauty which are related to fashion. The texture of the nail affects its appearance and function. Soft or brittle nails are fragile. This results in unattractive longitudinal and horizontal splitting. Fragility is encouraged by wet work and excessive nail manicuring, especially by the removal of nail cosmetics. Critical to the aesthetic appeal of the nail is its shape. Most pleasing are nails are those that conform to the 'magic' ratio, in which the nail's length is approximately equal to its breadth, especially for the thumbs. The role of nail decoration and nail art in nail beauty is a subjective and evolving question of fashion.     

Ingrown and pincer nails: evaluation and treatment

Ingrown toenails are mainly a condition of children and young adults, whereas ingrown fingernail and pincer nails are seen in adults. Their etiology is multifactorial. Different types of ingrowing nails require different treatments. Neonatal ones are always treated conservatively. The hypertrophic lateral nail wall seldom requires surgery. Congenital misalignment of the big toenail may resolve spontaneously, but delay in treatment may cause permanent nail dystrophy. The juvenile type is most common and is treated conservatively in its early stages. Selective matrix horn phenolization or excision is the treatment of choice for later stages. Pincer nails are due to widening of the base of the distal phalanx. Treatment is aimed at reducing the outward pressure of the lateral osteophytes on the matrix horns and permanently flattening the nail. A variety of different methods are discussed.     

A Clinical Study of 35 Cases of Pincer Nails

Background

Pincer nail is a nail deformity characterized by transverse overcurvature of the nail plate. Pincer nail can affect a patient''s quality of life due to its chronic, recurrent course; however, there have been no clinical studies on the pincer nail condition in Korean patients.

Objective

The purpose of this study was to characterize the clinical findings and treatment of pincer nail. In addition, possible etiological factors were considered, and treatment efficacy was evaluated.

Methods

The medical records and clinical photographs of 35 patients (12 males, 23 females) who were diagnosed with pincer nail between August 1, 2005 and July 31, 2009 were studied.

Results

Patient age ranged from 10 to 77 (52.09±17.26) years, and there was a predominance of female (23 out of 35 patients, F:M=2:1). The mean duration of the disorder was 7.45 years (range 0.25~40); 85% had pincer nail for at least 1 year. In addition, 40% had a history of previous treatment and recurrence. There were 82.8% patients with the common type of pincer nails. The most commonly involved nails were both great toenails. Among 35 patients, nail grinding was started in 30 patients, and 25 patients showed clinical improvement with nail grinding. The width index increased and the height index decreased after treatment. The mean follow up period was 8.42 months (range 1~27), and 7 patients showed recurrence after 8.8 months (range 2~20). Among 35 patients, 5 patients were treated with nail extraction with matricectomy, and the symptoms resolved immediately. The mean follow up period was 7.6 months (range 0~19), and recurrence was not observed. Onychomycosis was also present in 37.1% of patients, and itraconazole pulse therapy for 3 months was added.

Conclusion

The results of this study demonstrate the clinical features of pincer nail in Korean patients. The findings show that the common type of pincer nail was most common, and nail grinding as a conservative treatment greatly improved pincer nails despite a risk of recurrence. When onychomycosis was also present, oral antifungal therapy added to nail grinding resulted in a more rapid change in nail thickness and clinical improvement.     

Finger Nail Pitting in Psoriasis and its Relation with Different Variables

Incidence of pitting, vary considerably in different types of psoriasis. In clinical practice, toe nail examination is inconvenient. There are inadequate studies which show relation of nail pitting with duration and severity of the disease. The objective was to examine the incidence of finger nail pitting in all types of cutaneous psoriasis and its relation with different variables. This is a clinico-epidemiological study. A careful clinical examination of finger nails was done in day time. Severity of disease was calculated by psoriasis area severity index (PASI). Statistical analysis was done using Microcomputer statistics software (MSTAT). In study group, 621 patients and in control group 350 people were taken. Finger nail pitting was present in 37% (total number was < 20 in 17%; 20-60 in 8% and > 60 in 12%) in study group. In control group, it was present in 10% (in all cases total number was < 20). In < 1 year duration group, pitting was present in 32% of cases, while in > 1 year duration group it was 40.5%. In mild psoriasis, pitting was present in 34.2%, while in severe cases it was 47.6%. Finger nail pitting is an important nail finding in psoriasis and its incidence increases with duration and severity of disease.     

棉条填塞联合甲襞楔形切除治疗嵌甲型甲沟炎疗效观察

【摘要】 目的 探讨棉条填塞联合甲襞楔形切除治疗嵌甲型甲沟炎的临床效果。方法 将2017年8月至2019年4月宁夏医科大学总医院急诊科接诊的96例嵌甲型甲沟炎患者按照随机数字表法随机等分为对照组和治疗组,各48例,对照组采用Winograd术治疗,治疗组采用棉条填塞联合甲襞楔形切除术治疗。术后随访6 ~ 23个月。结果 术后6个月时治疗组患者治愈47例（97.92%）,对照组治愈41例（85.42%）,两组治愈率差异有统计学意义（χ2 = 4.909,P < 0.05）。治疗组术后第3天和1个月时疼痛视觉模拟评分显著低于对照组（均P < 0.05）。治疗组术后复发率（0）和感染率（2.08%）,明显低于对照组（6.25%、12.5%）,差异均有统计学意义（P < 0.05）。结论 棉条填塞联合甲襞楔形切除术式简单,疗效显著,术后复发率低,值得临床推广应用。     

Modified Emmet's operation for ingrown nails using the Er:YAG laser.

BACKGROUND: Ingrowing nails are a common problem. Standard procedure is surgery according to Emmet (a gynecologist) or Emmert (a surgeon) where postoperative pain, swelling and bleeding are major side effects and traumatic damage of the nail organ is not completely avoidable. Laser surgery may provide an alternative with less tissue damage. METHODS: We compared 138 patients with 212 affected great toe nails (98 males, 40 females) were bloodless Emmet's operation was performed with digital nerve block with 11 patients (12 affected nails) using an Er:YAG laser for atraumatic nail plate removal. Pain was registered by a semiquantitative pain scale (ranging from "zero--no pain" to "10--maximum pain"). Swelling was scored from "0--absent" to "3--severe". Side effects like bleeding, infection or relapse were registered. RESULTS: Emmet's nail operation: Pain was scored 7.8+/-3.2 on the operation day (evening), 5.3+/-3.1 (day 1) and 3.8+/-4.0 (day 3). Swelling was scored 2.7+/-1.8 (operation day, evening), 2.1+/-1.9 (day 1) and 1.3+/-2.1 (day 3). Wound healing lasted 16.8+/-3.3 days. The infection rate was 2.4%, i.e. 5 of 212 nails. The relapse rate after 6 months was 12 of 212 nails (5.7%). Spicules were observed in 9 of 212 nails (4.2%). Laser procedure: Pain was scored 8.0+/-1.9 (operation day, evening), 4.1+/-1.5 (day 1) and 0.7+/-2.3 (day 3). The swelling was scored 2.4+/-1.8 (operation day, evening), 1.5+/-0.9 (day 1) and 0.9+/-1.3 (day 3). Wound healing was complete after 12.9+/-3.5 days. Infections and relapse were not observed. In one case spicules occurred after 5 months. No other side effects were noted. CONCLUSIONS: The modified Emmet's operation for ingrown nails using the Er:YAG laser provides a safe method with increased efficacy that causes less pain and swelling, a faster healing and less complications.