Letter: Retrospective comparison of experiences with phenol and sodium hydroxide in the treatment of ingrown nail

Management of ingrowing nail

For decades, there has been debate about the cause of ingrown nail: is the nail plate or the periungual tissue at fault? There is no consensus and management relies on case-by-case analysis followed by tailored treatment. Conservative treatment should be attempted in children when the cause is transient (e.g., poor clipping) or the patient refuses surgery. Surgical treatments rely on two main approaches: either narrowing the nail plate, or debulking the soft tissue. It is up to the surgeon to select the most appropriate approach in each case. All procedures discussed in this chapter have high cure rates as long as they are properly performed. As with all surgical procedures, they are operator-dependent. Chemical cautery is the easiest and most versatile technique that may help in almost all instances for lateral ingrowth. For distal ingrowth and very hypertrophic and exuberant lateral folds, debulking with primary or secondary healing is most effective.

The therapeutic outcomes of one-minute application of sodium hydroxide versus phenol in the chemical cauterization of ingrown toenails

BACKGROUND

Ingrown nails are frequently encountered in dermatology practice. The recurrence tendency of the disorder makes chemical cauterization essential during surgical procedures. In studies comparing nail matrix cauterization with sodium hydroxide (NaOH) versus phenol, phenol's application time was highly variable.

OBJECTIVE

To compare the therapeutic outcomes of matrix cauterization for a standard duration of one minute for NaOH versus phenol in stage II and III ingrown nails MATERIAL AND METHODS: The medical records of patients undergoing matrix cauterization with 10% NaOH or 88% phenol were evaluated. The primary outcome measure was the lack of recurrences on long-term follow-up. The secondary outcome measures were complete healing duration, patient-reported pain scores, and adverse effects related to the procedure.

RESULTS

Enrolled in this study were 62 ingrown toenail sides treated with 10% NaOH and 56 ingrown toenail sides treated with 88% phenol. The mean follow-up duration was 25.17 months. Recurrence was observed in four nail sides of the NaOH group (%6.45) and three nail sides of the phenol group (%5.35). The difference between the recurrence rates did not reach statistical significance. Patients treated with both methods were free of pain on the post-procedural tenth day. The visual analog scale pain scores and complete healing duration were similar between the two groups (p>0.05).

CONCLUSION

In a large group with long-term follow-up results, the short-term and long-term post-operative treatment outcomes were similar between the one-minute applications of 10% NaOH versus 88% phenol groups.

Chemical matricectomy with sodium hydroxide: long-term follow-up results

BACKGROUND

Chemical matricectomy with sodium hydroxide is a method being used successfully in the treatment of ingrown toenail.

OBJECTIVE

In this study, it was aimed to evaluate long-term recurrence rates after chemical matricectomy using sodium hydroxide application of different durations.

MATERIALS AND METHODS

Two hundred two patients with ingrown nail edges were treated with either 1-minute (Group 1) or 2-minute (Group 2) applications of sodium hydroxide matricectomy. All patients were followed for at least 2 years.

RESULTS

Chemical matricectomy with sodium hydroxide was applied to a total of 585 nail edges of 202 cases. The overall recurrence rates in Group 1 and Group 2 were 6.4% and 7.1%, respectively, during the average 7.5-year follow-up period. No statistically significant differences were detected in terms of recurrence between the 2 groups (p = .73).

CONCLUSION

Chemical matricectomy with sodium hydroxide is an easy method in the treatment of ingrown nails, with low morbidity and high success rates. There was no difference between 1-minute and 2-minute applications in terms of recurrence during the long-term follow-up. Chemical matricectomy with 1-minute application of sodium hydroxide showed high success in terms of long-term follow-up results.

Exploring postoperative outcomes for ingrown toenails. NaOH vs wedge resection techniques

BACKGROUND

Ingrown (or ingrowing) toenail is a commonly used term for onychocryptosis, in which the nail becomes inserted into the lateral fold of the toe. The resulting effect on a person's health, well-being, and ability to work suggests the importance of clear treatment guidance, but little consensus exists.

OBJECTIVE

To explore postoperative recovery after surgery for ingrown toenails using chemical (sodium hydroxide (NaOH)) or mechanical (wedge resection) matricectomy and thus contribute to understanding within the field on which to base treatment guidelines.

METHODS

One hundred sixty-one procedures were undertaken, 94 using NaOH and 67 using wedge resection. Four measures of postoperative recovery were recorded: recurrence, infection, time to discharge, and number of postoperative visits.

RESULTS

Patients treated with NaOH had lower rates of recurrence (p = .048) and infection (p = .03) than those treated with wedge resection, and time to discharge was shorter (p = .02), but they had more postoperative visits (p = .003).

CONCLUSION

Low rates of recurrence and infection and short postoperative recovery time were found after both procedures, with a small advantage with treatment with NaOH. The authors argue for the value of clinical intervention using matricectomy in early stages to avoid complications resulting from granulation tissue growth.

Controversies in the treatment of ingrown nails

Ingrown toenails are one of the most frequent nail disorders of young persons. They may negatively influence daily activities, cause discomfort and pain. Since more than 1000 years, many different treatments have been proposed. Today, conservative and surgical methods are available, which, when carried out with expertise, are able to cure the disease. Packing, taping, gutter treatment, and nail braces are options for relatively mild cases whereas surgery is exclusively done by physicians. Phenolisation of the lateral matrix horn is now the safest, simplest, and most commonly performed method with the lowest recurrence rate. Wedge excisions can no longer be recommended.