Nobuhiko HIGASHI, M.D., Shigetoshi SANO, M.D. and Akihiro KUME, M.D.

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Transcription:

Nobuhiko HIGASHI, M.D., Shigetoshi SANO, M.D. and Akihiro KUME, M.D.

Fig. 1 Interaction of the Nail Plate and Toe A: The distal corner of the nail plate is beyond the tip of toe. This situation shows never to produce ingrown toenail, because there is not the soft tissue around the distal corner of the nail plate. B: The distal corner of the nail plate and the tip of toe is of the same length. In this situation, ingrown toenail is not developed, too. C: The distal corner of the nail plate is present on the way to the tip of toe (arrow head). In this situation, ingrown toenail is easily developed by upward pressure forces to the flexural aspect of bigtoe (arrow).

Fig. 2 Numbers of Patients with Ingrowing Toenail Fig. 3 Affected Bigtoes of Ingrowing Toenail

Table 1 Clinical Stage of Ingrown Toenail Stage I pain, redness, slight swelling, hyperhidrosis of the area involved. Stage II sharp pain, hyperhidrosis, and the formation of granulation tissue. A constant seroplurent exudation is present. fetid odor. Stage III The granulation tissue over the nail plate is covered on its surface by epidermis. Table 2 Matrials of Sculptured Artificial Nail Power: Methacrylate polymer Benzoyl peroxide (initiator) Liquid: Methacrylate monomer N, N-dimethyl-p-toluidine (stabilizer) Application of acrylic monomer-polymer mixture to produce sculputured artificial nail. Fig. 4 Pretreatment with Topical Steroid and Systemic Antibiotics A: Oozing granulation tissues (arrow) at first visit. B: Oozing granulations were dried and reduced in volume by pretreatment with topical steroid and systemic antibiotics one week later.

Fig. 5 Insertion of Roentgen Film A: Ingrown toenail with granulation tissue. B: A piece of bended roentgen film was inserted the lateral nail groove and under the lateral nail plate under local anesthesia. Then roentgen film was fixed with plaster.

Fig. 6 How to Make a Sculptured Nail A: Dip a brush in acrylic liquid, and touch the acrylic liquid contained brush to a acrylic powder. The liquid and powder are mixed together. B: Apply the mixture on the nail and film. C: Sculptured nail is formed after roentgen film is removed. D: Sculptured nail is arranged in a beautiful shape with grinder.

Fig. 7 @ Results of Treatment Fig. 8 @ Result of the Treatment with Sculptured Nail

Fig. 9 @ The Course of Treatment with Sculptured Nail A: Before treatment of ingrown toenail, stage III B: Sculptured nail is formed after topical steroid and systemic antibiotic therapy for 2 weeks. C: 4 months later, ingrown toenail is much improved.

Table 3 Comparison of sculptured nail treatment with surgical treatment for the ingrowing toenail

14. Palmer BV, Jones A: Ingrowing toenails: the results of treatment, Br J Surg, 66: 575-576, 1979 15. Murry WR: Onychocryptosis, Principles of non-operative and operative care, Cli Orthop 142: 96-102, 1979 16. Cameron PF: Ingrowing toenails: an evaluation of two treatments, Br Med J, 283: 821-822, 1981 17. Issa MM, Tanner WA: Approach to ingrowing toenails: the wedge resection/segmental phenolization combination treatment, Br J Surg, 75: 181-183, 1988 18. Langford DT, Burke C, Robertson K: Risk factors in onychocryptosis Br J Surg, 76: 45-48, 1989 2. Lloyd-Davies RW and Brill GC: The aetiology 19. Robb JE: Surgical treatment of ingrowing toenails and out-patient management of ingrowing toenails, in infancy and childhood, Z Kinderchir, Brit J Surg, 50: 592-597, 1963 36: 63-65, 1982 20. Connolly B & Fitzgerald RJ: Pledgets in ingrow- toenails, ing Arch Dis Child, 63: 71-72, 1988 4. Heifetz CJ: Ingrown toenail, Am J Surg, 38: 298 15, 1937 3 5. Zaias N: The nail in health and disease. New York, Sp Medical and Scientific Books, 1980 24. Jemec B, Andersson JE: Surgical treatment of paronychia granulomatosa hallucis, Acta Derma.- tovener, 55: 319-320, 1975

25. Murray WR, Robb JE: Soft-tissue resection for ingrowing toenails, J Dermatol Surg Oncol 157-158, 1981 26. Dixon GL Jr: Treatment of ingrown toenail Foot Ankle, 3: 254-260, 1983, 7:, 36. Byrne DS, Caldwell D: Phenol cauterization for ingrowing toenails: a review of five years' expe- rience, Br J Surg, 76: 598-599, 1989 of segmental chemical ablation, BJCP, 44: 562-563, 1990 ing toenails with liquid nitrogen spray cryothe- rapy, Br Med J, 291: 173-175, 1985 34. Rinaldi R, Sabia M, Gross J: The treatment and prevention of infection in phenol alcohol matricectomies, J Amer Podiatry Med Assoc, 72: 453-457, 1982 35. Young MRA, Rutherford WH: Re-operation rate for ingrowing toe nail treated by phenolization: # year followe up, Br J Surg, 74: 202-203, 1987 37. Gem MA, Sykes P: Ingrowing toenails: studies 38. Vanderham AC, Hackeng CA, Yo TI: The treat- ment of ingrowing toenails, a randomised compa- rison of wedge excision and phenol cauterisation, J Bone Joint Surg, 72-B: 507-509, 1990 39. Sonnex TS, Dawber RPR: Treatment of ingrow- 41. Marks JG, Bishop ME, Willis WF: Allergic contact dermatitis to sculptured nails, Arch Dermatol, 115: 100, 1979

Treatment for Ingrown Toenail with Sculptured Nail Nobuhiko Higashi, Shigetoshi Sano and Akihiro Kume Department of Dermatology, Sakai Municipal Hospital 2-1-1, Shukuin-Nishi, Sakai Osaka 590 Key words: sculptured nail-ingrown toenail-etiologic therapy We believe the etiology of ingrown toenail is primarily sever cutting back of the edges of lateral nail plate. Therefore, an etiologic therapy of ingrown toenail is the method thformthe nail plate longer than the tip of the great toe. Sculptured artificial nail is the bestmaterial to form the nail plate. Seventy five patients were applied sculptured nail to ingrown toenails under local anesthesia. Success was achieved in 19 (73%) of the 26 patients with stage 111, in 30 (77%) of the 39 with stage II and in 10 (100%) with stage I followed up for one years. 16 patients lost for follow up. To avoid recurrence, this treatment must be continued until the nail is completely grown beyond the edge of the flesh. The treatment with sculptured nail for ingrown toenail is the first choice of treatment in all clinical stages of ingrown toenail.

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