Using 80% trichloroacetic acid in the treatment of ingrown toenails

Abstract

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.

Treatment of ingrown nail using CO 2 laser – four-year own experience

“…In the studies by Barreiros et al 73% of patients were aged under 30 years [20]. In the group of patients in the presented study, nearly 70% were children and young adults aged up to 23 years, including 58% of males.…”

“…Another cause of ingrowing nails are bad habits in cutting nails -nail edges cut in a semi-circular or semi-elliptical shape. In the study by Barreiros et al, 63% of patients inappropriately cut their nails, and 58% of them suffered from excessive sweating of the feet [1][2][3]20]. In the presented study, the most frequent cause of ingrowing nail was wearing inappropriate shoes -34% of patients, and inappropriate cutting of the nail plate -26%.…”

“…Heifitz and Mogensen classified the intensity of ingrown nail into three stages: 1) mild -with domination of swelling, erythrema, and pain with a pulsating sensation; 2) moderate -increased oedema, exudation, infection with serous or purulent discharge; 3) severe -chronic inflammation, granulation and considerable overgrowth of the eponychium [20]. In turn, Mozen classified onychocryptosis into four stages: -stage I -associated with slight erythema, swelling, and pain; -stage II -continuation of the first stage, with an intensification of erythema, swelling, and pain; -stage III -the above-mentioned symptoms accompanied by serous or purulent discharge and hypertrophy of the skin with granulation of the inflamed tissue in the lateral fold, so-called 'proud flesh'; -stage IV -severe chronic deformation of the nail;…”

“…Surgical treatment should be offered in moderate and severe cases. There is no consensus on the best method for the surgical treatment of ingrown nails [20]. The ideal method of surgical treatment should have such characteristics as: use of local anaesthesia, technically easy to perform, quick healing with minimum post-operative morbidity, and a high indicator of success [21].…”

“…A partial matrixectomy, using a carbon dioxide laser, electrocoagulation, and radio frequency, provides very good outcomes, although according to some researchers, especially Barreiros et al, these are time consuming and costly techniques [20].…”