Ingrowing toenails in children and adolescents
An ingrown toenail, also known as onychocryptosis, occurs when the nail plate grows into the adjacent periungual skin and acts as a foreign body, causing inflammation and infection. The highest incidence occurs in teenagers and adults aged 11–30 years.
The disease process comprises three stages:
1) inflammation, 2) infection and 3) chronic inflammation and granulation. The treatment is indicated when there is significant pain or infection, or chronic recurrent paronychia. The pain can become so severe that it may be disabling, affecting one’s daily activities, such as school, work and physical activities. Common operative options in children and teenagers include complete or partial nail avulsion alone, or with associated germinal matrix ablation. Common operative options in children and teenagers include complete or partial nail avulsion alone, or with associated germinal matrix ablation.
Various forms of anaesthesia are available, and this determines whether the procedure can be done as an outpatient procedure, day surgery procedure or whether admission to hospital is required.
In the first instance, nonoperative measures are generally recommended for Stages 1 and 2 of the disease, while operative options are recommended for patients with Stage 3 disease.
Sumanth Kumar Gera conducted this study to compare the results of nonoperative treatment for IGTN with that of operative treatment among children and adolescents. This study aimed to compare the results of nonoperative treatment for IGTN with that of operative treatment among children and adolescents.
The patient’s age, symptomology, disease stage and treatment prescribed at presentation, and the time is taken for complete resolution of signs and symptoms were recorded. Among 199 toes, 162 (81.4%) were treated nonoperatively, with nail care advice, topical antibiotics and daily cleansing. Only 37 (18.6%) toes were treated operatively. In the operative group, 23 (62.2%) patients underwent wedge resections, while the remaining 14 (37.8%) had total nail avulsions; for all patients, germinal matrices were preserved. At the six-month follow-up, there were 5 (3.1%) cases of recurrence in the nonoperative group when compared to 3 (8.1%) recurrences in the operative group.
This study recommended that IGTN in children and adolescents should be treated in the first instance by nonoperative methods. Operative options can be considered for resistant cases or in case of recurrence of IGTN.
Authors: Sumanth Kumar Gera, DK Halimatussadiah PG Zaini, Shiyao Wang, Siti Hauzah Binte Abdul Rahaman, Rui Fang Chia, Kevin Boon Leong
Newspaper: Singapore Med J. 2019 Feb; 60(2): 94–96.