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DERMATOLOGY PEARL
Year : 2021  |  Volume : 12  |  Issue : 5  |  Page : 778-779  

An innovative treatment for grade 1 stage of ingrown fingernail


Mukhtar Skin Centre, Katihar Medical College Road, Katihar, Bihar, India

Date of Submission18-Sep-2020
Date of Decision09-Dec-2020
Date of Acceptance02-Feb-2021
Date of Web Publication21-Jun-2021

Correspondence Address:
Muhammed Mukhtar
Katihar Medical College Road, Katihar - 854 105, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_763_20

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How to cite this article:
Mukhtar M. An innovative treatment for grade 1 stage of ingrown fingernail. Indian Dermatol Online J 2021;12:778-9

How to cite this URL:
Mukhtar M. An innovative treatment for grade 1 stage of ingrown fingernail. Indian Dermatol Online J [serial online] 2021 [cited 2021 Oct 24];12:778-9. Available from: https://www.idoj.in/text.asp?2021/12/5/778/318491




   Problem Faced Top


Ingrown fingernail is a rare recurrent entity that presents as distal paronychia and pseudopyogenic granuloma.[1] The incidence of the disease is up to 10%–30% in the patients on epidermal growth factor receptor (EGFR) inhibitors. The spicule of the nail is responsible for pressure and penetrative injury. It acts as a foreign body in the gutter. Currently, timolol lotion is the most preferred drug, though it is not effective in most of the cases.[2] Cotton nail cast for ingrown toenail is good but cumbersome to use for finger nail.[3] Cyanoacrylate glue applied at weekly interval is an effective chemical cast for the toe gutter. Herein, I have described a novel method for treating the ingrown finger nail at Grade 1 stage.


   Solution Proposed Top


The ingrown finger nail at grade 1 stage presents with pain, mild swelling and tenderness [Figure 1]a. This ingrown nail is first trimmed and the nail gutter is cleaned [Figure 1]b. The lateral nail fold is then stretched out a bit and 1 or 2 drop of cyanoacrylate glue is poured in the gutter. After the glue settles down, the site gets sealed and appears dry and firm in about 2-3 minute [Figure 1]c. The pain settles in about 15-30 minute. In next 1-2 days, the finger is no longer tender on touch. The glue is reapplied weekly or whenever it gets dislodged till the nail crosses the gutter which takes about 2-3 weeks [Figure 1]d. Patient can perform regular activities. Cyanoacrylate glue is adhesive, hygroscopic, and antiseptic material and it hardens and splints the gutter. This blunts and immobilizes the lateral nail and its spicule and gives a little uplifts to the nail [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d. The uplift of the glued finger nail from its gutter and hyponychium can be easily compared with normal finger nail. Together, these lead to decrease in penetrative pressure injury of nail to the gutter [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d, [Figure 3]e, [Figure 3]f. This chemical cast protects the gutter from maceration, infection, and associated problems. Thus, the cyanoacrylate glue is a novel, noninvasive option for treating early stage of ingrown fingernail and may be helpful in preventing its progression into grade 2 and 3 stage.
Figure 1: (a) Ingrown fingernail (Grade 1) in right ring finger. (b) Trimmed fingernail and its gutter showing spicule penetration pit cleaned. (c) Nail gutter and its pit chemically splinted with cyanoacrylate glue just after trimming the nail. (d) Ingrown fingernail after 3 week of the chemical splinting

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Figure 2: (a-d) Early changes seen in the nail gutter, lateral nail and hyponychium after 2 to 3 days of cyanoacrylate glue splinting

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Figure 3: (a-f) Nail and glue casts in the nail gutter (a and b), hyponychium (c and d), and after removal of casts outer and inner surfaces (e and f) after 3 weeks

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chang P. Diagnosis using the proximal and lateral nail folds. Dermatol Clin 2015;33:207-41.  Back to cited text no. 1
    
2.
Olamiju B, Bhullar S, Coleman EL, Leventhal JS. Management of paronychia with pseudopyogenic granulomas secondary to epidermal growth factor receptor inhibitors: An assessment of topical timolol and the need of multiple medical and procedural therapies. J Am Acad Dermatol 2020;S0190-9622(20)31070-7.  Back to cited text no. 2
    
3.
Gutierrez-Mendoza D, De Anda Juarez M, Avalos VF, Martinez GR, Dominguez-Cherit J. “Cotton nail cast”: A simple solution for mild and painful lateral and distal nail embedding. Dermatol Surg 2015;41:411-4.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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