Assessment of Ingrown Toenails Treated with Nail Fold Cryotherapy in Adolescent Patients: An Observational Pilot Study.

BACKGROUND: Cryotherapy reduces pain by making some reversible functional changes in peripheral nerves. It has also been reported to have a positive effect on the regression of inflammation and granulation tissue. Few studies have evaluated the efficacy and safety of nail fold cryotherapy in ingrown toenails (IGTN) in adults, and there are no studies in the pediatric population. We aimed to evaluate the clinical efficacy of cryotherapy applied to the nail fold in juvenile IGTN. METHODS: This study was conducted in adolescent patients aged 12 to 16 years with unilateral juvenile IGTN. Liquid nitrogen was sprayed into the nail fold for 10 to 15 seconds with a double freeze-thaw cycle. The effectiveness of cryotherapy was interpreted by the clinician's decision, the improvement in visual analogue scale score, Children's Dermatology Life Quality Index score, and granulation tissue. RESULTS: According to the physician, good efficacy was achieved in 91.7% of patients (n = 22 of 24). We found that 54.5% of them (n = 12 of 22) were still in remission after 6 months. Rates of complete regression in granulation tissue were pronouncedly less in sizes larger than 5 mm (≤5 mm, 55.6%; >5 mm, 16.7%). However, adequate symptomatic relief was observed in 83.3% of stage 3 patients, even if complete granulation tissue response was not achieved yet. Significant improvements in visual analogue scale and the Children's Dermatology Life Quality Index scores were observed after cryotherapy (P < .05). CONCLUSIONS: Nail fold cryotherapy is a useful alternative among conservative methods because of its rapid and high efficiency (91.7%), especially in mild to moderate cases, despite the high recurrence rates (45.5%) in juvenile IGTN.

[Conservative treatment options for unguis incarnatus]. / Conservatieve behandelopties bij unguis incarnatus.

Unguis incarnatus (ingrown toenail) is a common problem in daily practice. Persons with unguis incarnatus stage two and three are often referred for surgical partial nail excision, however conservative treatment or minimal-invasive alternatives exist. In the latest Dutch guideline for ingrown toenails, there is minimal attention to these alternatives. A podiatrist can do a spiculectomy and places a bilateral orthonyxia (nail brace) or tamponnade afterwards. This treatment option was studied in a prospective cohort study in 88 persons with high risk for wound healing problems and was found to be a safe and effective treatment option. In this clinical lesson we discuss three casus and their treatment options including minimal-invasive treatments. Guidance of the nail growth needs more attention after procedures just like adequate nail clipping advices to prevent for recurrences. Both are not announced in the latest Dutch guideline.

Matrix Cauterization With Silver Nitrate in the Treatment of Ingrown Toenails in Children: Pilot Study / Cauterización de la matriz con nitrato de plata para el tratamiento de las uñas encarnadas en los dedos de los pies en niños: estudio piloto

Background Although partial onychectomy with chemical matricectomy has been described as the treatment of choice, there is sparse evidence in the literature regarding the use of silver nitrate for matricectomy. Our aim is to describe the effectiveness of silver nitrate for matrix cauterization after partial onychectomy. Methods A prospective observational study was performed on patients with ingrown toenails stage 2–3 who underwent partial onychectomy with silver nitrate chemical matricectomy during 2018–2019 in our institution. All patients were evaluated in the outpatient clinic on the 7th and 30th post-operative day and a telephone evaluation was performed every 6 months after the surgical procedure to date. Results One hundred and twenty-three patients, who underwent 231 partial onychectomies with silver nitrate chemical matricectomy were included, with a median follow-up of 21 months (interquartile range, 12–29). The procedure had an effectiveness of 95.3%, with only 11 recurrences (4.7%) reported so far on follow-up. Postoperative infections were observed in 4 patients (1.7%). Adverse effects, such as pain and postoperative drainage, were irrelevant in most patients. Conclusions Silver nitrate matricectomy after partial onychectomy is an effective and safe alternative for the treatment of ingrown toenail in children, with scarce postoperative morbidity and low recurrence rate (AU)

Antecedentes Aunque la onicectomía parcial con matricectomía química ha sido descrita como tratamiento de elección en los casos de uñas encarnadas en los dedos de los pies, existe escasa evidencia en la literatura en cuanto al uso de nitrato de plata para matricectomía. Nuestro objetivo es describir la efectividad del nitrato de plata para cauterización de la matriz tras onicectomía parcial. Métodos Se realizó un estudio observacional prospectivo en pacientes con uñas encarnadas en los dedos de los pies estadio 2-3, sometidos a onicectomía parcial con matricectomía con nitrato de plata durante los años 2018 y 2019 en nuestra institución. Se evaluó a todos los pacientes en la clínica ambulatoria el 7.° y 30.° días postoperatorios, realizándose una evaluación telefónica cada 6 meses, a contar desde la fecha de la intervención quirúrgica. Resultados Se incluyó a 123 pacientes, a quienes se realizaron 231 onicectomías parciales con matricectomía química con nitrato de plata, con un seguimiento medio de 21 meses (rango intercuartílico: 12-29). El procedimiento tuvo una efectividad del 95,3%, con solo 11 recidivas (4,7%) reportadas hasta el seguimiento. Se observaron infecciones postoperatorias en 4 pacientes (1,7%). Los efectos adversos, tales como dolor y el flujo postoperatorio, fueron irrelevantes en muchos pacientes. Conclusiones La matricectomía con nitrato de plata tras onicectomía parcial es una alternativa efectiva y segura para el tratamiento de las uñas encarnadas en niños, con escasa morbilidad postoperatoria y baja tasa de recidiva (AU)

[Artículo traducido] Cauterización de la matriz con nitrato de plata para el tratamiento de las uñas encarnadas en los dedos de los pies en niños: estudio piloto / Matrix Cauterization With Silver Nitrate in the Treatment of Ingrown Toenails in Children: Pilot Study

Antecedentes Aunque la onicectomía parcial con matricectomía química ha sido descrita como tratamiento de elección en los casos de uñas encarnadas en los dedos de los pies, existe escasa evidencia en la literatura en cuanto al uso de nitrato de plata para matricectomía. Nuestro objetivo es describir la efectividad del nitrato de plata para cauterización de la matriz tras onicectomía parcial. Métodos Se realizó un estudio observacional prospectivo en pacientes con uñas encarnadas en los dedos de los pies estadio 2-3, sometidos a onicectomía parcial con matricectomía con nitrato de plata durante los años 2018 y 2019 en nuestra institución. Se evaluó a todos los pacientes en la clínica ambulatoria el 7.° y 30.° días postoperatorios, realizándose una evaluación telefónica cada 6 meses, a contar desde la fecha de la intervención quirúrgica. Resultados Se incluyó a 123 pacientes, a quienes se realizaron 231 onicectomías parciales con matricectomía química con nitrato de plata, con un seguimiento medio de 21 meses (rango intercuartílico: 12-29). El procedimiento tuvo una efectividad del 95,3%, con solo 11 recidivas (4,7%) reportadas hasta el seguimiento. Se observaron infecciones postoperatorias en 4 pacientes (1,7%). Los efectos adversos, tales como dolor y el flujo postoperatorio, fueron irrelevantes en muchos pacientes. Conclusiones La matricectomía con nitrato de plata tras onicectomía parcial es una alternativa efectiva y segura para el tratamiento de las uñas encarnadas en niños, con escasa morbilidad postoperatoria y baja tasa de recidiva (AU)

Background Although partial onychectomy with chemical matricectomy has been described as the treatment of choice, there is sparse evidence in the literature regarding the use of silver nitrate for matricectomy. Our aim is to describe the effectiveness of silver nitrate for matrix cauterization after partial onychectomy. Methods A prospective observational study was performed on patients with ingrown toenails stage 2–3 who underwent partial onychectomy with silver nitrate chemical matricectomy during 2018–2019 in our institution. All patients were evaluated in the outpatient clinic on the 7th and 30th post-operative day and a telephone evaluation was performed every 6 months after the surgical procedure to date. Results One hundred and twenty-three patients, who underwent 231 partial onychectomies with silver nitrate chemical matricectomy were included, with a median follow-up of 21 months (interquartile range, 12–29). The procedure had an effectiveness of 95.3%, with only 11 recurrences (4.7%) reported so far on follow-up. Postoperative infections were observed in 4 patients (1.7%). Adverse effects, such as pain and postoperative drainage, were irrelevant in most patients. Conclusions Silver nitrate matricectomy after partial onychectomy is an effective and safe alternative for the treatment of ingrown toenail in children, with scarce postoperative morbidity and low recurrence rate (AU)

Comparative study between nail retraining with gauze bandaging and the nail remodeling with acrylics as a conservative treatment for stage I and IIa onychocryptosis.

OBJECTIVE: Onychocryptosis is one of the most prevalent onychopathies, being a frequent reason for consultation in podiatric clinical practice. Conservative treatments are the first therapeutic choice, with nail remodeling using clotrimazole gel emerging as an alternative, although its medium-term effectiveness is unknown. The objective of this study was therefore to compare the efficacy of the technique of nail retraining using gauze bandaging with that of nail remodeling for the conservative treatment of stage I and IIA onychocryptosis. METHODS: An analytical, randomized clinical trial study was performed following a longitudinal and prospective design. A sample was selected of 20 subjects presenting stage I and IIA onychocryptosis. Of these, 10 cases formed the group of nail retraining using gauze bandaging, and the other 10 the nail remodeling group. The presence of recurrence in a 3-month period was evaluated. RESULTS: Before the intervention, the patients in the retraining group presented pain of 6.7 ± 1.9 vs. 6.8 ± 1.6 in the remodeling group, with no significant difference between the two (p = 0.900). After the 3-month follow-up period, seven of the retraining group patients presented recurrence of onychocryptosis vs. only one in the remodeling group. CONCLUSION: The technique of nail remodeling has a lower recurrence rate than that of nail retraining with gauze bandaging, with the pain, inflammation, and infection reported being less, and with greater patient satisfaction.

Retrospective Evaluation of Ingrown Toenails in a Tertiary Reference Center.

BACKGROUND: We evaluated the clinical characteristics of ingrown toenails in one of the biggest reference centers in Turkey. METHODS: This retrospective cohort study was conducted on patients admitted to Ufuk University Hospital with ingrown toenail between January 1, 2014, and December 31, 2019. Clinical characterstics and demographic features of all of the participants were evaluated, and then the study population was divided into two groups: group 1 (patients ≤20 years old) and group 2 (patients >20 years old). These groups were compared in terms of clinical findings. RESULTS: Disease duration, body mass index, rate of medications for chronic diseases, and rate of joint diseases were significantly higher in group 2. Rates of hyperhidrosis and sudden weight gain were significantly higher in group 1 (P < .05). Severity of ingrown toenail was significantly different between groups (P = .006). Stage 1 was the most common stage in both groups, and rate of stage 3 was higher in group 1. Onycoshisis and was more common in group 1, and nail thickening was more common in group 2 (P < .05). Nail wire and aluminum chloride were the most common treatment modalities in groups 2 and 1, respectively (P < .05). Periungual edema, presence of pus, hypertrophy, and granulation were more common in group 1 (P < .05). Thin nail plate was more common in group 1, and normal and thick nail nail plates were more common in group 2 (P < .05). CONCLUSIONS: Clinical characteristics of ingrown toenail vary between younger and older populations. Thus, an individualized approach is preferred in the management of ingrown toenail for different age groups.

Treatment of retronychia: A systematic review and suggested treatment algorithm.

Retronychia is an inflammatory disorder typical of the great toes characterized by arrested nail growth, ingrowth of the nail plate into the proximal nail fold and paronychia. There is no standardized treatment for retronychia, and its management should be weighed based on the severity stage, treatment modality, and clinical outcome. In this paper, a systematic review of the literature was performed to assess all published data regarding the treatment of retronychia. A total of 231 patients from 24 studies were included in the analysis. Conservative management was adopted in mild-intermediate forms, consisting of medical (topical or intralesional high-potency corticosteroids) and podiatric treatment (taping, clipping back the onycholytic plate, orthosis), leading to a global cure rate of 41.2%, with no reported side effects. Non-conservative management, that is, chemical or surgical avulsion of the nail plate, proved resolutive in 71.2% of cases. Surgical avulsion of the nail plate produced the highest cure rate (78.2%), but was burdened by 9.6% of long-term sequelae, mainly nail dystrophies. A decision-making algorithm was designed to give clinicians treatment indications based on the severity stage of retronychia, treatment invasiveness, and possible clinical outcomes.

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.

[Guideline 'Ingrown toenails']. / Richtlijn 'Ingegroeide teennagel'.

Ingrown toenails (also called unguis incarnatus) are a common problem in the general population. In early 2020, the medical specialists' guideline "Ingrown toenail" was published in which the various treatment options are compared. Conservative treatment can be considered for stage I ingrown toenails. In stage II-III ingrown toenails and failing conservative treatment, operative treatment is recommended consisting of partial nail extraction from the ingrown nail edge in combination with destruction of the corresponding part of the matrix. There doesn't seem to be any reason to deviate from the advice in the case of a recurring ingrown toenail or an ingrown toenail in a patient with expected wound healing problems. A detailed elaboration of the guideline, which also contains a step-by-step operative approach, can be found on the Guidelines database (https://richtlijnendatabase.nl/).

How effective is cryotherapy applied to the nail fold in ingrown toenails?

INTRODUCTION: There are only two publications in Pubmed on the effectiveness of cryotherapy in ingrown toenails, and they present conflicting results. We aimed to clarify the clinical effectiveness of cryotherapy in onychocryptosis. METHODS: This study retrospectively examined the visual analogue scale (VAS), dermatological life quality index (DLQI), other medical records, and photographs taken before each cryotherapy session and 6-month follow-up in 59 adult patients with ingrown toenails that underwent cryotherapy with a 3-week interval. Cryotherapy effectiveness was assessed by the clinicians' decisions, improvements in VAS and DLQI scores, and granulation tissue. Other factors related to effectiveness and recurrence were also investigated. RESULTS: After excluding approximately 20% of patients, for whom the treatment was not effective, this study revealed that recurrence rates in unilateral and bilateral onychocryptosis were 34.2% and 88.9%, respectively, 6 months after treatment. In patients that responded to the treatment, about 75 to 80% had excellent symptomatic responses. Excellent symptomatic responses were maintained in about 80% of patients in remission. We found that foot or toe deformity was associated with treatment ineffectiveness (p = 0.019). Age younger than 20 years and bilateral ingrown toenails were also related to recurrence (p = 0.042 and 0.003, respectively). CONCLUSIONS: Cryotherapy can be used to greatly and consistently improve the DLQI in suitable ingrown toenails.

Onychocryptosis - decrypting the controversies.

Onychocryptosis, or ingrown toenail, is a frequent, painful condition affecting young individuals. Controversies still exist regarding its etiopathogenesis and treatment options, including conservative and surgical techniques. The choice of treatment method depends on the stage of disease as conservative measures are mostly effective in early stages and surgical procedures are required in the later stages. Among surgical techniques, phenol cauterization of lateral nail matrix has been the most effective, safe, and commonly performed method. Other more destructive surgical procedures are rarely done nowadays. In this review, we briefly discuss the etiopathogenesis, clinical features, and different treatment options of ingrown toenail.

Efficacy of Nail Braces for Acute and Chronic Ingrown Toenails: A Prospective Study.

BACKGROUND: Nail braces are an alternative treatment for ingrown toenails. OBJECTIVE: This study aimed to prospectively examine the efficacy of nail braces for treatment of acute inflamed (AI)-type and chronic dystrophic-type ingrown toenails. MATERIALS AND METHODS: The authors conducted a prospective study of patients with ingrown toenails treated at Wan Fang Hospital between January 1, 2017, and July 31, 2018. Evaluation using physician global assessment scores and patient satisfaction questionnaires was performed at 1, 3, and 6 months after the start of treatment and during the final visit. Patient demographics, treatment courses, and outcomes were compared between the 2 types of ingrown toenails. RESULTS: Chronic dystrophic-type and AI-type ingrown toenails were observed in 25 (61 sides) and 28 patients (35 sides), respectively. Of the affected sides, 80.9%, 94.9%, and 100% achieved an excellent or fair result at 1, 3, and 6 months, respectively. Treatment duration and follow-up period were 179.2 ± 96.8 days and 281.6 ± 120.9, respectively. The recurrence rate was 7.4%. The treatment course and response were different between the 2 types of ingrown toenails. CONCLUSION: Ingrown toenails could be effectively treated with nail braces with excellent outcomes, favorable patient satisfaction, and low recurrence rates.

Review of onychocryptosis: epidemiology, pathogenesis, risk factors, diagnosis and treatment.

Ingrown toenail, or onychocryptosis, is a highly prevalent nail condition that occurs when the nail edge grows into the periungual dermis. It most frequently affects the hallux and has a biphasic presentation, being most common in the second and fifth decades. It is often painful and may be debilitating in severe cases. Risk factors include trauma, weight changes, poor nail-cutting technique, and hyperhidrosis. Both conservative and surgical treatments have been described, and choice of therapy is dependent on patient co-morbidities, severity, and associated symptoms. This review covers the epidemiology, risks factors, pathogenesis, evaluation, and staging of ingrown toenails, as well as, treatment options. Although there is an unmet need for clinical trials comparing therapies, current recommendations are to treat conservatively and then proceed to surgical therapies if symptoms persist.

Ingrown Toenail Management.

Ingrown toenails account for approximately 20% of foot problems in primary care. The great toe is most often affected. Ingrown toenails occur most commonly in young men, and nail care habits and footwear are most often contributory factors. No consensus has been reached for the best treatment approach, but ingrown nails may be nonsurgically or surgically treated. Nonsurgical treatments are typically used for mild to moderate ingrown nails, whereas surgical approaches are used in moderate and severe cases. Simple nonsurgical palliative measures include correcting inappropriate footwear, managing hyperhidrosis and onychomycosis, soaking the affected toe followed by applying a mid- to high-potency topical steroid, and placing wisps of cotton or dental floss under the ingrown lateral nail edge. Application of a gutter splint to the ingrown nail edge to separate it from the lateral fold provides immediate pain relief. A cotton nail cast made from cotton and cyanoacrylate adhesive, taping the lateral nail fold, or orthonyxia may also alleviate mild to moderate ingrown toenail. Surgical approaches seek to remove the interaction between the nail plate and the nail fold to eliminate local trauma and inflammatory reaction. These approaches are superior to nonsurgical ones for preventing recurrence. The most common surgical approach is partial avulsion of the lateral edge of the nail plate. Matrixectomy further prevents recurrence and can be performed through surgical, chemical, or electrosurgical means.