CHRONIC MYCOTIC-ASSOCIATED SURGICAL NAIL PATHOLOGY COMPLICATED WITH INGROWN NAIL (NAIL INCARNATION): THE ANALYSES OF CLINICAL CASES AND COMPLEX TREATMENT
DOI:
https://doi.org/10.11603/ijmmr.2413-6077.2017.1.7291Keywords:
destructive onychomycosis, secondary recurrent ingrown nail, antimycotic therapy, surgical nail removal.Abstract
Background. Conservative treatment of secondary recurrent unguis incarnatus are not very effective and Dupuytren’s method, Emmert-Schmiden surgeries etc. are very traumatic, disfigure nail bone, distort anatomic and functional unity of a nail.
Objective. The aim of our research was the optimal sequence of holiatry, surgical moving away from nails, local and system therapy after excision of the staggered nails in case of destructive onychomycosis complicated by secondary ingrown nail for some patients with complicated mycotic defeat of nails. Clinical options of surgical treatment were clarified; morphologic changes were studied; causes of unsatisfactory outcomes of chronic pathology complex treatment were analyzed for prospective approaches to preventing of relapses.
Methods. The analysis justifies the feasibility of establishing of predictive relationships between clinical variants of chronic purulent necrotic infections and combined comorbidity. System therapy by itraconazole before operative treatment (basic onychial defeats sanation) and in a postoperative period was carried out. Types of operative treatment applied may be divided into five statistic groups.
Results. Over a five-year period (2010-2015) 436 unguis incarnates diagnosis (325 cases of incarnated onychomycosis) in 259 men and 177 women aged 12-67 were performed, 38 of them with incarnated onychogryphosis had diabetes mellitus and 24 had metabolic syndrome. Analysis of subonychial scraping allowed stating the prevalence of red trichophytia in 31% of cases with the bacterial flora. Patients with combined pathology got 4-5 five-day system ‘pulses’ of 400 mg/day itraconazole therapy. In patients with primary advantage of providing low-impact methods of nail excision with access via onycholisation structure a nail extirpation and marginal matricectomy was carried out; dermatophytoms and stratification on a nail bed were deleted.
Conclusions. Type of onychectomy wound cytograms in the study group on the 10th day was defined as regenerative-inflammatory in 24.81%, regeneratory in 75.19% (p=0.031). The methods of surgical treatment of mycotical recurrent nail incarnation have been improved considering patho- and morphogenetic properties of destructive onychomycosis.
References
Adamski Z, Kaszuba A. Dermatology for cosmetologists. Wroclaw: Elsevier Urban & Partner; 2011;186.
Baran R, Feuithade M, Datry A. A randomized trial of amorolfine 5% nail lacquer combined with oral terbinafine compared with terbinafine alone in the treatment of dermatophytic toenail onychomycoses affecting the matrix region. Br J Dermatol. 200;142:1177–83.
Blaszczyk-Kostanecka M, Wolska H. Dermatology in practice. Warsaw: Medical Publishing House PZWL; 2009;230.
Brillowska-Dabrowska A, Saunte DM, Arendrup MC. Five hour diagnosis of dermatophytenail infections with specific detection of Trichophyton rubrum. J Clin Microbiol. 2007;45(4):1200–1204.
Brotzman SB, Wilk EC. Orthopedic Rehabilitation. Wroclaw: Elsevier Urban & Partner; 2007;2(1):120.
Chang Р. Onychogryphosis. Our Dermatol Online. 2011;2(4):227–28.
Chang P, Meaux T. Onychogryphosis: A Report of Ten Cases. Skinmed. 2015;13(5):355–59.
Chapeskie H, Kovac JR. Case Series: soft-tissue nail-fold excision: a definitive treatment for ingrown toenails. Can J Surg. 2010;53:282–86.
Demirseren DD, Emre S, Akoglu G, et al. Relationship between skin diseases and extracutaneous complications of diabetes mellitus: clinical analysis of 750 patients. Am J Clin Dermatol. 2014;15:65–70.
Gamboa A, Shibao C, Diedrich A, et al. Contribution of endothelial nitric oxide to blood pressure in humans. Hypertension. 2007;49(1):170–77.
Gupta AK, Baran R. Ciclopirox nail lacquer solution 8% in the 21st century. J Am Acad Dermatol. 2000;43(4l):96–102.
Gupta AK, Gregurek-Novak T. Efficacy of itraconasole, terbinafine, fluconazole, griseofulvin, and ketoconazole in the treatment of Scopulariopsis brevicaulis causing onychomycosis of the toes. Dermatology. 2001;202:235–38.
Gupta AK, Schouten JR, Lynch LE. Ciclopirox Nail Lacquer 8% for the Treatment of Onychomycosis: A Canadian Perspective. Skin Therapy Letter. 2005;10(7):1–3.
Havu V, Heikkila H, Kuokkanen K, et al. А double-blind, randomized study to compare the efficacy and safety of terbinafine (Lamisil®) with fluconazole (Diflucan®) in the treatment of onychomycosis. Br J Dermatol. 2000;142:97–102.
Khunger N, Kandhari R. Ingrown toenails. J Dermatol Venereol Leprol. 2012;78:279–89.
Lesher JL. Recent developments in antifungal therapy. Dermatol Clin. 2010;14(1):163–69.
Peyvandi H, Robati RM, Yegane RA, et al. Comparison of two surgical methods (winograd and sleeve method) in the treatment of ingrown toenail. Dermatol Surg. 2011;37:331–35.
Ragunatha S, Anitha B, Inamadar AC, et al. Cutaneous disorders in 500 diabetic patients attending diabetic clinic. Indian J Dermatol. 2011;56:160–64.
Shemer A. Update: medical treatment of onychomycosis. Dermatologic Therapy. 2012;25:582–93.
Tatlican S, Eren C, Yamangokturk B, et al. Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrown toenails in people with diabetes. Dermatol Surg. 2010;36:219–22.
Thomas J, Jacobson GA, Narkowicz CK. Toenail onychomycosis: an important global disease burden. Journal of Clinical Pharmacy and Therapeutics. 2010;35:497–519.
Vergun AR. Multivitamin failure in patients with complicated destructive nail mycosis; analysis of clinical observations. 7 th Lviv-Lublin conference of Experimental and Clinical Biochemistry. Abstract book. Lviv. 2013. p. 176-77.
Welsh O. Vera-Cabrera L, Welsh E. Onychomycosis. Clinics in dermatology. 2010;28:151–59.
Yang KC, Li YT. Treatment of recurrent ingrown great toenail associated with granulation tissue by partial nail avulsion followed by matricectomy with sharpulse carbon dioxide laser. Dermatol Surg. 2002;28(5):419–21.
Yin Z, Xu J, Luo D. A metaanalysis comparing long term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole. J Dermatol Treat. 2012;23(6):449–52.
Downloads
Published
How to Cite
Issue
Section
License
Authors who sent their manuscript to International Journal of Medicine and Medical Research agree to the following terms:
1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC-BY-NC that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
2. Authors able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
