Controlled trial comparing the efficacy of 88% phenol versus 10% sodium hydroxide for chemical matricectomy in the management of ingrown toenail.

BACKGROUND: Partial nail avulsion with lateral chemical matricectomy is the treatment of choice for ingrown toenails. Phenol (88%) is the most widely used chemical agent but prolonged postoperative drainage and collateral damage are common. Sodium hydroxide (NaOH) 10% has fewer side-effects. METHODS: Adult, consenting patients with ingrown toenails were alternately allocated into two treatment groups in the order of their joining the study, to receive either 88% phenol (Group 1, n = 26) or 10% NaOH (Group 0, n = 23) chemical matricectomy. The patients as well as the statistician were blinded to the agent being used. Post-procedure follow-up evaluated median duration of pain, discharge, and healing along with recurrence, if any, in both the groups. The group wise data was statistically analyzed. RESULTS: Both the groups responded well to treatment with the median duration of postoperative pain being 7.92 days in Group 0 and 16.25 days in Group 1 (P < 0.202). Postoperative discharge continued for a median period of 15.42 days (Group 0) and 18.13 days (Group 1) (P < 0.203). The tissue condition normalized in 7.50 days (Group 0) and 15.63 days (Group 1) (P < 0.007). LIMITATIONS: Limited postsurgical follow up of 6 months is a limitation of the study. CONCLUSION: Chemical matricectomy using NaOH is as efficacious as phenolisation, with the advantage of faster tissue normalization.

Antinociceptive properties of the ethanolic extract and of the triterpene 3beta,6beta,16beta-trihidroxilup-20(29)-ene obtained from the flowers of Combretum leprosum in mice.

The present study examined the antinociceptive effects of the ethanolic extract (EE) and of the triterpene 3beta,6beta,16beta-trihidroxilup-20(29)-ene obtained from the flowers of Combretum leprosum in chemical and thermal behavioural models of pain in mice. The EE (10-1000 mg/kg) given orally (p.o.), 1 h prior to testing, produced dose-dependent inhibition of acetic acid-induced visceral pain, with mean ID50 value of 131.9 mg/kg. In the formalin test, the EE (10-300 mg/kg, p.o.) also caused significant inhibition of both the early (neurogenic pain) and the late (inflammatory pain) phases of formalin-induced licking, however, it was more potent and efficacious in relation to the late phase of the formalin test, with mean ID50 values for the neurogenic and the inflammatory phases of approximately 300 and 88.8 mg/kg, respectively. The EE (10-1000 mg/kg, p.o.) also caused significant and dose-dependent inhibition of capsaicin- and glutamate-induced pain, with mean ID50 values of 160.5 and 38.3 mg/kg, respectively. Furthermore, the triterpene 3beta,6beta,16beta-trihidroxilup-20(29)-ene (1-30 mg/kg), given p.o., 1 h prior to testing, also produced dose-related inhibition of glutamate-induced pain, with a mean ID50 value of 5.6 mg/kg. When assessed in a thermal model of pain, the EE (10-300 mg/kg, p.o.) and fentanyl (100 microg/kg, s.c.) caused a significant and marked increase in the latency response on the hot-plate test (50 degrees C). The antinociception caused by EE (100 mg/kg, p.o.) in the glutamate test was significantly attenuated by intraperitoneal (i.p.) treatment of mice with naloxone (opioid receptor antagonist, 1 mg/kg), pindolol (a 5-HT 1A/1B receptor/beta adrenoceptor antagonist, 1 mg/kg), WAY100635 (a 5-HT 1A receptor antagonist, 0.7 mg/kg) or ketanserin (a 5-HT 2A receptor antagonist, 0.3 mg/kg). In contrast, EE (100 mg/kg, p.o.) antinociception was affected neither by L-arginine (precursor of nitric oxide, 600 mg/kg) nor by ondansetron (a 5-HT3 receptor antagonist, 0.5 mg/kg) i.p. treatment. It was not associated with non-specific effects such as muscle relaxation or sedation. Together, these results indicate that EE produces dose-related antinociception in several models of chemical and thermal pain through mechanisms that involve an interaction with opioid and serotonergic (i.e., through 5-HT 1A/1B and 5-HT 2A receptors) systems.