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The article presents the case study of a 28-year-old woman presented with an enlarging nodule that had been growing under her left great toenail for six months. It mentions that histologic differential diagnosis of patient's lesion included subungual exostosis and osteochondroma. It also reveals subungual exostoses as benign osteocartilaginous tumors.

Background: The impact of nail abnormalities on prognosis in hemodialysis patients is unknown. This study investigated whether toenail opacity as a readout of nail abnormalities predicted prognosis in hemodialysis patients.Methods: In this observational study, 494 eligible hemodialysis patients who received hemodialysis at Oyokyo Kidney Research Institute between September 2010 and December 2015 were included. The presence of nail abnormalities was objectively evaluated by big toenail opacity ratio measurement. Primary endpoint was overall survival, and secondary endpoints were lower limb amputation and determination of risk factors for poor prognosis among patient demographics, comorbidities, blood tests, and big toenail opacity. Overall survival and lower limb survival were evaluated using the Kaplan-Meier method with log-rank test. Multivariate Cox regression analyses assessed predictors for poor prognosis.Results: Big toenail opacity was found in 259 (52%) patients. Patients with big toenail opacity were significantly older, had shorter duration of dialysis, higher prevalence rates of diabetes mellitus (DM), cardiovascular disease (CVD), and higher mortality rates than those without opacity. Presence of big toenail opacity predicted poor prognosis for both overall and lower limb survival. Multivariate Cox regression analyses revealed serum albumin, the presence of DM and big toenail opacity were independent risk factors for both poor overall and lower limb survivals.Conclusion: The prevalence of big toenail opacity was high in hemodialysis patients. Despite the short observation period, our findings indicated that big toenail opacity had significant predictive power for poor overall and lower limb survival. [ABSTRACT FROM AUTHOR]

BACKGROUND Phenol is the gold standard for chemical matricectomy in ingrowing toenail. Recently, trichloroacetic acid (TCA) was used as cauterant. Both agents have high success rates but a postoperative healing time claimed to be faster for TCA rather than phenol. OBJECTIVE Comparing the efficacy, the postoperative oozing time, the inflammatory reaction, and the postoperative pain. MATERIALS AND METHODS Comparative, prospective, randomized, double-blind study. Eighty-four patients with 96 ingrowing toenails were randomized in 2 groups. Forty-six ingrowing toenails were treated with phenol 88% and 50 with TCA 100% within a 4-month period. Patients were observed 4 times for the presence of oozing and for the degree of inflammation. Patients assessed also oozing and pain on a scale basis during 34 days. RESULTS Oozing was observed to be less with phenol treatment, as from the second week. Inflammation was also significantly inferior in the phenol group at Week 4. Patients evaluated the incidence of pain below 2/10 for both cauterants, while oozing was higher with TCA during 34 days. The overall success rates of both groups were similar with 100%. CONCLUSION Phenol and TCA are both effective but TCA does not offer any advantage in terms of postoperative morbidity compared with phenol. [ABSTRACT FROM AUTHOR]

Studies conducted in China linked selenium deficiency to higher risk of esophageal squamous cell carcinoma ( ESCC), but this has not been widely tested outside that selenium-deficient region. The aim of this study was to investigate the association between selenium and other mineral concentrations in toenails and risk of ESCC in a region with high incidence rates. In this nested case-control study, we identified 222 cases of ESCC from the Golestan Cohort Study, Iran, which has followed up 50,045 participants since enrollment (2004-2008). We randomly selected one control for each case matched by age and sex, using incidence density sampling. We used toenail samples collected at baseline to measure the concentration of selenium, zinc, chromium, mercury, and scandium using instrumental neutron activation analysis. Multivariate adjusted logistic regression models were used to estimate odds ratios ( OR) and 95% confidence intervals. Median nail selenium, zinc, chromium, and mercury levels were 1.01, 74.59, 0.77, and 0.018 μg/g in cases and 1.02, 75.71, 0.71, and 0.023 μg/g in controls, respectively. The adjusted odds ratios comparing each fourth quartile of mineral status versus the first quartile were as follows: selenium = 0.78 (95% CI, 0.41-1.49); zinc=0.80 (95% CI, 0.42-1.53); chromium = 0.91 (95% CI, 0.46-1.80); and mercury=0.61 (95% CI, 0.27-1.38), and all trend tests were non-significant. The nail selenium concentration in our controls reflects relatively high selenium status. No evidence of association between selenium or chromium concentrations in toenails and the risk of ESCC was detected in this population. [ABSTRACT FROM AUTHOR]

Recurrence rates are high for onychomycosis, with prophylactic topical antifungal use proposed to counter recurrence. Although this is a reasonable action for many clinicians, few studies have been conducted on the efficacy of topical prophylaxis. A retrospective chart review (2010-2015) was conducted in patients receiving oral terbinafine or itraconazole for toenail onychomycosis. Following complete cure, a topical antifungal (amorolfine, bifonazole, ciclopirox olamine, or terbinafine spray) was used weekly as prophylaxis. Recurrence was recorded along with patient characteristics including demographics and concomitant medical conditions. Data from 320 patients were collected. Recurrence was significantly lower in patients receiving topical antifungal prophylaxis than in no prophylactic treatment following oral terbinafine ( p < .001), but not itraconazole ( p = .185). Regardless of oral treatment, the use of topical antifungals as prophylaxis ( p < .001) decreased, and the number of affected toenails ( p = .048) and family history of fungal infections ( p < .001) increased the likelihood that recurrence would occur. This study supports the use of topical antifungal medications as prophylactic treatment to help prevent recurrence of toenail onychomycosis and suggests that those with a family history of fungal infections should be closely monitored. [ABSTRACT FROM AUTHOR]

BACKGROUND Chemical matricectomy is performed mainly by 2 agents, phenol and sodium hydroxide. Chemical matricectomy with phenol has a low recurrence rate and good cosmetic results, but it produces extensive tissue destruction and can result in drainage and a delayed healing time. These adverse effects havebrought forward the use of chemical agents such as sodium hydroxide and trichloroacetic acid for matricectomy. OBJECTIVE This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 90% bichloracetic acid (BCA) in the treatment of the ingrown nails. MATERIALS AND METHODS A total of 30 patients with 58 ingrown toenail edges were included in this study. All of the patients underwent chemical matricectomy with 90% BCA after partial nail avulsion. Adverse effects such as postoperative pain and drainage were minimal in most of the patients. RESULTS One patient who underwent matricectomy had recurrence in a single nail edge (1.8%) at the 12th month of the follow-up. No recurrence was observed in 29 patients during mean follow-up period. This was considered to be statistically significant (p < .001). CONCLUSION This is the first study to use BCA for the treatment of ingrown toenail. Partial nail avulsion followed by BCA matricectomy is a safe, simple, and effective method with low rates of postoperative morbidity and high rates of success. Therefore, partial nail avulsion and BCA matricectomy can be used as an alternative treatment method for the treatment of ingrown toenails. [ABSTRACT FROM AUTHOR]

The article presents case study of a 17-year-old woman who was presented to a hospital for examination of her thickening fingernails and toenails since early infancy, resulting to painful plantar keratoderma, oral leukokeratosis, cysts and follicular hyperkeratosis. The patient then underwent treatment for its keratoderma and diagnose with pachyonychia congenita. The article also discusses the features of pachyonychia congenita and KRT6A mutations.

Onychomycosis is one of the most common dermatological diseases, primarily caused by dermatophytes, and sometimes, also by yeast and moulds. This study aims to clarify the frequency of isolated pathogens from mycotic toenails in the reference centre of the central Alpine mountain region of South Tyrol, northern Italy. Age and gender differences, types of pathogens and initial therapy used were also investigated. This is a retrospective study from 2004 to 2013 on the files of all patients with suspected onychomycosis in whom a cultural pathogen detection was performed. A total of 1565 patients were studied (943 women; 622 men), with a median age of 55 years. Fungal pathogens could be detected by culture in 49.5%. Significantly more pathogens could be grown in men (63.8%) than in women (39.9%, P < 0.0001). The most common pathogens grown were dermatophytes (53.3%), especially T. rubrum and T. interdigitale, followed by moulds (24.7%) and yeast (22%). Therapies prescribed were topical in 64.2% and systemic in 35.8% of the cases. Topical treatment was more frequent in older patients ( P < 0.05). In northern Italy, dermatophytes are the most common causative agents for onychomycosis. Fungal pathogens were more commonly found in men than in women and topical treatment was more frequent in older patients. [ABSTRACT FROM AUTHOR]

Background: The current definition of complete cure is considered too stringent to reflect the true benefit of onychomycosis treatment seen in general practice and may limit the use of newer topical agents in mild-to-moderate disease. In addition, outcomes reported in clinical trials do not consistently report secondary endpoints, making data comparison difficult. Methods: The authors review the clinical data reported on two new topical antifungals, efinaconazole and tavaborole, in light of the latest thinking of more practical approaches to assess improvement and treatment success. Results: Almost 20 percent (19.7%) of patients treated with efinaconazole had absence of clinical signs, and almost a third (31.6%) had ≤10 percent affected toenail and mycologic cure at Week 52. Cure rates for tavaborole (<10% affected toenail and mycologic cure) were 15.3 percent and 17.9 percent at week 52. With both topical treatments, cure rates were higher when only negative culture was considered. Conclusion: These clinical cure rates likely better reflect the efficacy we see in practice. It is probable that efficacy would be further improved with longer treatment courses and/or longer follow-up periods and appropriate prophylactic strategies. This clinical judgment is predicated by any risk of nonadherence or disease recurrence. [ABSTRACT FROM AUTHOR]

IntroductionNovel treatment regimens are being developed to improve drug penetration through the nail plate. This study investigated the efficacy of nail drilling regimens for the treatment of onychomycosis.MethodsParticipants were assigned to holes with combination (oral plus topical terbinafine) therapy (Group 1), holes with topical terbinafine (Group 2) or topical terbinafine only (Group 3). Measurement of clear nail and mycology was performed at baseline and at weeks 4, 10, 16, 22 and 28. Mixed linear models were used to compare mean percent clear nail. Mycological cure rates were also tabulated for each group. Tolerability and adverse events were documented.ResultsNinety-eight participants were enrolled (106 nails). Both groups with holes had significantly higher percentage of clear nail compared with topical terbinafine alone. Although no significant difference between the two groups where holes were drilled in the nail plate, Group 1 demonstrated improvement over Group 3 earlier than Group 2 (visit 2 versus visit 4). Group 1 also had the highest mycological cure rates.ConclusionTreatment with holes plus topical terbinafine produces significantly greater improvement in toenails’ appearance and higher mycological cure rates compared to treating the dorsal aspect of the nail plate with topical terbinafine alone. [ABSTRACT FROM AUTHOR]

Background Onychomycosis is difficult to treat and a concern for many patients. Prevalence estimates of onychomycosis in North American clinic samples have been higher than what has been reported for general populations. Objective A large, multicentre study was conducted to estimate the prevalence of toenail onychomycosis in the Canadian population. Methods Patients were recruited from the offices of three dermatologists and one family physician in Ontario, Canada. Nail samples for mycological testing were obtained from normal and abnormal-looking nails. This sample of 32 193 patients includes our previous published study of 15 000 patients. Results Abnormal nails were observed in 4350 patients. Of these, the prevalence of culture-confirmed toenail onychomycosis was estimated to be 6.7% (95% CI, 6.41-6.96%). Following sex and age adjustments for the general population, the estimated prevalence of toenail onychomycosis in Canada was 6.4% (95% CI, 6.12%-6.65%). The distribution of fungal organisms in culture-confirmed onychomycosis was 71.9% dermatophytes, 20.4% non-dermatophyte moulds and 7.6% yeasts. Toenail onychomycosis was four times more prevalent in those over the age of 60 years than below the age of 60 years. Conclusion The present data highlights that onychomycosis may be a growing medical concern among ageing patients. [ABSTRACT FROM AUTHOR]

Topical antifungal management of toenail onychomycosis has been fraught with several therapeutic challenges including difficulty gaining access to the site of infection and the need for prolonged durations of therapy. In addition, there has been a marked lack of information on the impact of toenail polish application on drug penetration after application. This article reviews available data from studies evaluating the effect of nail polish on antifungal drag penetration using ex vivo laboratory models with cadaver fingernail plates with both tavaborole 5% solution and efinaconazole 10% solution. In addition, changes in nail polish appearance and color transfer to applicators are also discussed, with changes noted with topical efinaconazole. Importantly, there are no data on whether or not nail polish application alters the efficacy of these topical agents. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the case study of a 45 years old female who has undergone physical examination due to contact dermatitis on left arm and her big and second toenails was diagnosed as pincer nails.

The element contents in toenail clippings of healthy Korean young adults were measured using an instrumental neutron activation analysis. The average contents of elements such as Na, K, Cl, Ca, Fe, Se, and Zn are 449, 474, 1024, 1677, 66, 0.7 and 94 mg/kg in men, whereas those contents in women respectively 332, 476, 836, 1097, 66, 0.8 and 104 mg/kg. The correlation analysis of toenail elements with chronic disease risks showed positive associations between Na and serum HDL-cholesterol, blood pressure, and negative associations between Se and Hs-CRP, between Zn and hemoglobin level. [ABSTRACT FROM AUTHOR]

Topical treatment for toenail onychomycosis has been fraught with a long-standing reputation of poor efficaey, primarily due to physical properties of the nail unit that impede drug penetration. Newer topical agents have been formulated as Solution, which appear to provide better therapeutic response in properly selected patients. It is important to recognize the impact the effects that mitigating and concomitant factors can have on efficaey. These factors include disease severity, gender, presence of tinea pedis, and diabetes. This article reviews results achieved in Phase 3 pivotal studies with topical efinaconazole 10% Solution applied once daily for 48 weeks with a focus on how the aforementioned factors influenced therapeutic outcomes. It is important for clinicians treating patients for onychomycosis to evaluate severity, treat concomitant tinea pedis, address control of diabetes if present by encouraging involvement of the patient's primary care physician, and consider longer treatment courses when clinically relevant. [ABSTRACT FROM AUTHOR]

BACKGROUND Pincer nail is a deformity characterized by excessive transverse curvature of the nail plate that increases distally for which many conservative and surgical corrective modalities have been recommended. OBJECTIVE The purpose of this study is to investigate the outcomes and safety of modified double Z-plasty in the management of symptomatic pincer nail. MATERIALS AND METHODS Modified double Z-plasty has been performed on 20 great toes in 12 patients from January 2008 to December 2013. The mean age of patients was 43 (range: 20-65) years. Three men and 9 women were enrolled. Visual analogue scale (VAS) score for pain, transverse angle, and width indices were investigated at the initial and the last follow-up. The average follow-up period was 2.4 years. RESULTS All parameters showed significant improvement after surgery. Between the initial and last followup, the mean VAS score fell from 7.4 to 0.3, the mean transverse angle improved from 50 to 166°, and the mean width index improved from 65.4% to 97%. In all patients, the deformity was successfully eliminated with no recurrences. No complications were identified. CONCLUSION Modified double Z-plasty provides a long-standing effective treatment for pincer nail deformity with an excellent esthetic result. [ABSTRACT FROM AUTHOR]

Background: The changes in psoriatic nails can closely resemble an onychomycosis. Therefore, the fungal infection may be underdiagnosed. It was investigated the frequency of mycosis in fingernails and toenails in 150 patients with psoriasis in a dermatology department. Methods: The clinical data suggestive of onychomycosis were investigated. Nail scales were obtained and cultured on Sabouraud dextrose agar with and without antibiotic. A direct examination with KOH was also performed. Results: Out of 150 patients, 67 (45 %) had healthy nails; 42 (28 %) presented onychomycosis and 41 (27 %) showed nail changes without infection. Fingernail changes were more associated with psoriatic ony-chopathy (82.5 %), unlike toenail changes that were more frequently caused by fungal infection (26.4 % vs. 9.45 % in psoriasis). Out of 20 positive cultures, 22 fungi were isolated, of which 11 belonged to Candida spp. (50 %). As risk factor to develope an onychomycosis, only the psoriasis evolution time showed a significant difference (p = 0.033). Conclusion: In patients with psoriasis, fingernail disorders are mainly due to the own disease, while toenail disorders changes can be associated with onychomycosis. The main etiological agents were yeasts from the genus Candida. The only factor associated with a higher incidence of onychomycosis in these patients was a long lasting psoriasis. [ABSTRACT FROM AUTHOR]

Onycholysis - the separation of the nail plate from the nail bed occurs in fingers and toenails. It is diagnosed by the whitish appearance of the separated nail plate from the nail bed. In fingers, the majority is caused by trauma, manicuring, occupational or self-induced behavior. The most common disease producing fingernail onycholysis is psoriasis and pustular psoriasis. Phototoxic dermatitis, due to drugs can also produce finger onycholysis. Once the separation occurs, the environmental flora sets up temporary colonization in the available space. Finger onycholysis is most common in women. Candida albicans is often recovered from the onycholytic space. Many reports, want to associate the yeast as cause and effect, but the data are lacking and the treatment of the candida does not improve finger onycholysis. A reasonable explanation for the frequent isolation of Candida and Pseudomonas in fingernail onycholysis in women, is the close proximity the fingers have to the vaginal and gastrointestinal tract. Fifty per cent of humans harbour C. albicans in the GI tract and it is frequently carried to the vagina during hygienic practices. Finger onycholysis is best treated by drying the nail 'lytic' area with a hair blower, since all colonizing biota are moisture loving and perish in a dry environment. Toenail onycholysis has a very different etiology. It is mechanical, the result of pressure on the toes from the closed shoes, while walking, because of the ubiquitous uneven flat feet producing an asymmetric gait with more pressure on the foot with the flatter sole. [ABSTRACT FROM AUTHOR]

Background Clinical studies regarding complete cure rate of onychomycosis using oral Terbinafine have a very broad range (14-90%) based solely on response to treatment on the big toenail. Objective To evaluate the efficacy of Terbinafine in all affected onychomycotic toenails and, furthermore, to evaluate differences in mycological, clinical and complete cure rate between affected onychomycotic toenails. Patients and methods Inclusion criteria are as follows: distolateralsubungual onychomycotic involvement of the hallux and additional involvement of at least two more toenails of the same foot. Exclusion criteria are as follows: patients with nail traumata and hypersensitivity to Terbinafine. Patients were treated with oral Terbinafine 250 mg/day for 16 weeks. Mycological analysis was performed using direct microscopy and culture. Clinical improvement was assessed using digital photography. Results Statistically significant difference was found in clinical improvement between the great toenail and all other involved toenails. The rate of complete cure (100% clinical cure and mycological cure) of the big toenail was lower (23%) as compared to the second (65%), third (51%) and the fourth toenail (67%). Limitations This is a case series study that was based on a single-centre cohort. Conclusions Our results support findings that efficacy of Terbinafine should be based on all involved onychomycotic toenails; the big toenail is not superior in response compared to other affected toenails. [ABSTRACT FROM AUTHOR]

The article discusses the treatment of ingrown toenails which includes surgery and patients quality of life.

The article presents a case study of 70-year old man with nail lesion which includes dermatoscopy based diagnosis and patient's quality of life.

For treatment of ingrown toenails, a phenolization approach is often chosen. Many reports describe a lavage of the wound with alcohol to neutralize any residual phenol; however, it remains uncertain if there is a more effective solution for use in the lavage step. The aim of our study was to analyze the suitability and effectiveness of 0.1% polihexanide solution compared with isopropyl alcohol in the removal of excess phenol after treatment for ingrown toenails. We performed an in vitro study using human matrix and a diffusion cell apparatus to measure the amount of phenol remaining after two lavage washes. The effect of phenol evaporation was also examined.When phenol was irrigated with alcohol alone, 27.43 ± 4.10 mg (57.74%) of the initial amount of phenol was recovered. If irrigated with 0.1% polihexanide, 35.98 ± 2.93 mg (75.74%) of phenol was recovered. These results indicate that a polihexanide lavage step has significantly higher efficiency for removing excess phenol relative to alcohol. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the benefits of efinaconazole topical solution, 10% on quality of life in onychomycosis patients. Methods: An analysis of 1,655 patients, aged 18 to 70 years, randomized to receive efinaconazole topical solution, 10%, or vehicle from two identical multicenter, double-blind, vehicle-controlled, 48-week studies evaluating safety and efficacy. The primary endpoint was complete cure rate (0% clinical involvement of target toenail, and both negative potassium hydroxide examination and fungal culture); clinical improvement defined as ≤10-percent improvement in nail involvement both at Week 52. Quality of life was assessed using a validated OnyCOE-t™ questionnaire. Improvement in quality of life was compared in those patients clinically and not clinically improved. Results: Efinaconazole topical solution, 10%, was significantly more effective than vehicle irrespective of QoL domain. Greatest improvement in mean score was seen in those domains with the lowest baseline scores. All mean scores in the group considered to have clinically improved with efinaconazole exceeded 80.0 at Week 52. Mean treatment satisfaction scores with efinaconazole in those patients who were clinically improved increased from 79.9 (Week 24) to 89.2 (Week 52), compared to a corresponding drop in those patients considered not improved from 65.3 to 58.0. The correlation between change in percent affected nail and change in mean domain scores was significant with efinaconazole for all domains. Limitations: A period of 52 weeks may be too brief to evaluate improvement in quality of life in onychomycosis patients. Some of the questions in the OnyCOE-t questionnaire may be more relevant than others to the study population and the onychomycosis population as a whole. Conclusion: Once-daily efinaconazole topical solution, 10%, provided statistically greater improvement in all aspects of quality of life compared to vehicle. Improvement was most marked in those patients considered clinically improved and correlated with a change in percent affected nail. [ABSTRACT FROM AUTHOR]

As immunologists, we are frequently asked to evaluate patients with recurrent infections. These infections can provide us with clues regarding what pathways might be aberrant in a given patient, e.g., specific pyogenic bacteria with Toll-like receptor problems, atypical mycobacteria with interferon gamma receptor autoantibodies, and Candida/staphylococcal infections with cellular immune abnormalities. We present a 55-year-old man who presented to our immunology clinic with onychodystrophy of the toenails and fingernails and recurrent oral-esophageal candidiasis. The differential diagnosis for recurrent yeast infections is complex and includes usual suspects as well as some that are not as straightforward. [ABSTRACT FROM AUTHOR]

Onychomycosis is a common disease seen in dermatology practice. Most patients with onychomycosis opt for treatment due to the social stigma attached to the unsightly appearance, as well as the pain that can at times make walking difficult. However, in many cases, onychomycosis is resistant to oral antifungal medication, which is the first-line therapy for this disease. In recent years, we have attempted a new treatment method using a long-pulsed 1,064nm Nd:YAG laser(Cutera Inc., Brisbane, CA, USA)in refractory cases with onychomycosis. Using 1)a laser beam with a spot size of 5.0 mm and 2)sequential irradiation at low fluence, we 3)applied the laser to the infected lesions in a motion similar to showering, while maintaining a distance of several centimeters from the skin(Laser Genesis™). Treatment efficacy was assessed using nail turbidity scores on a five-point scale. Improvement in onychomycosis was noted in more than 68.8% of all cases, thus demonstrating the high efficacy of this method. No major adverse reactions were observed during the treatment period. Since its mechanism of action clearly differs from that of antifungal agents, it can be considered a useful treatment option for cases with onychomycosis resistant to antifungal therapy. Future studies should examine "combined therapy" with oral/topical antifungal agents and this laser treatment, which may provide a significant improvement in the level of satisfaction among patients with onychomycosis. [ABSTRACT FROM AUTHOR]

Ingrowing nail also known as onychocryptosis is a common health problem. This disease mostly affects young people, often carrying a considerable amount of socio-economic implications. It's foot problem that usually manifests as inflammation of tissue along the side of a toenail. The aim of the study was to asses and to compare effectiveness of electrocautery and phenol application in partial matrixectomy after partial nail extraction in the treatment of ingrown toenails. Material and methods. The group of 60 patients with ingrowing toenail which was randomized into two groups underwent partial matrixectomy in surgical outpatient clinic between 2009-2013. This group of patients was under surgical observation for 100 days in outpatient clinic. Results. In all operated patients we obtained surgical success however we had 13 recurrences during the follow up period, 5 in the phenolization group and 8 in the electrocoagulation group. Conclusions. There was statistically significant difference between these two techniques, which indicated that matrix phenolization is connected with shortened healing time vs the matrix electrocoagulation. [ABSTRACT FROM AUTHOR]

Photodynamic therapy ( PDT) is a medical modality that uses a combination of visible light and a photosensitive compound in the presence of oxygen. It is widely used to treat non-melanoma skin cancer; other indications are being investigated, especially onychomycosis. Eighty patients with toenail onychomycosis were enrolled and completed this randomized, parallel, placebo-controlled study. For 24 weeks, 40 patients (Group A) were treated with one placebo capsule per week and sessions of 2% methylene blue aqueous solution irradiated with light emission diode device ( MBLED/ PDT) with 18 J/cm2; and another 40 patients (Group B) were treated with 300 mg oral fluconazole per week and sessions of placebo PDT (haematoxylin-diluted 1 : 10). The use of MBLED/ PDT consisted of sessions with an interval of 15 days between each session for 6 months. Microbiological and clinical cure was assessed at 1 and 12 months posttreatment. Group A ( MBLED/ PDT) patients showed a significant response ( p < 0.002) compared with Group B (fluconazole), especially in patients who required nail abrasion ( p < 0.001). The MBLED/ PDT is safe, effective, and well tolerated; it promotes a favorable outcome with good patient adherence and may be considered as a practical and feasible treatment option for toenail onychomycosis. [ABSTRACT FROM AUTHOR]

Background: Limited data exist on the contribution of dietary sources of arsenic to an individual's total exposure, particularly in populations with exposure via drinking water. Here, the association between diet and toenail arsenic concentrations (a long-term biomarker of exposure) was evaluated for individuals with measured household tap water arsenic. Foods known to be high in arsenic, including rice and seafood, were of particular interest. Methods: Associations between toenail arsenic and consumption of 120 individual diet items were quantified using general linear models that also accounted for household tap water arsenic and potentially confounding factors (e.g., age, caloric intake, sex, smoking) (n = 852). As part of the analysis, we assessed whether associations between log-transformed toenail arsenic and each diet item differed between subjects with household drinking water arsenic concentrations <1 µg/L versus =1 µg/L. Results: As expected, toenail arsenic concentrations increased with household water arsenic concentrations. Among the foods known to be high in arsenic, no clear relationship between toenail arsenic and rice consumption was detected, but there was a positive association with consumption of dark meat fish, a category that includes tuna steaks, mackerel, salmon, sardines, bluefish, and swordfish. Positive associations between toenail arsenic and consumption of white wine, beer, and Brussels sprouts were also observed; these and most other associations were not modified by exposure via water. However, consumption of two foods cooked in water, beans/lentils and cooked oatmeal, was more strongly related to toenail arsenic among those with arsenic-containing drinking water (=1 µg/L). Conclusions: This study suggests that diet can be an important contributor to total arsenic exposure in U.S. populations regardless of arsenic concentrations in drinking water. Thus, dietary exposure to arsenic in the US warrants consideration as a potential health risk. [ABSTRACT FROM AUTHOR]

Abstract: Background: Acral lentiginous melanoma (ALM) accounts for <10% of all melanomas in Caucasians. Although the involvement of KIT, NRAS and BRAF mutations is well known in ALM, the impact of these mutations on clinicopathological features has not been established. Objective: To define the KIT, NRAS, BRAF and PTEN mutation frequencies in Swedish patients with ALM and to evaluate the impact of mutation status on patient and tumor characteristics. Methods: Tumor cells were microdissected from 88 primary ALMs and 16 paired metastases and analyzed for KIT, NRAS and BRAF mutations. A subset of 25 ALMs was also evaluated for PTEN mutations. Results: BRAF mutations were identified in 17% of the primary ALMs. Both NRAS and KIT mutations were found at a similar frequency of 15%. Only one of the ALMs that were screened for PTEN harbored a mutation (4%). The KIT, NRAS and BRAF mutation status in paired primary and metastatic ALMs was identical. Patients with BRAF mutated tumors were significantly younger (57 years) than those with BRAF wild-type tumors (73 years, p =0.028). BRAF mutations were significantly more common in females (p =0.011) and more often found in tumors located on the feet (p =0.039). Anatomical site was an independent prognostic factor for overall survival; patients with ALMs on the hands or under fingernails had a better prognosis than those with tumors on the feet or under toenails (p =0.025). Conclusion: Our results confirm the presence of KIT, NRAS and BRAF mutations in ALM and provide evidence that mutations in these genes occur at similar frequencies. Our results also show that PTEN is mutated in a small subset of ALM tumors. [Copyright &y& Elsevier]

Onychomycosis is a common, chronic fungal nail infection that can have a significant negative impact on patients' physical and social functioning and emotional well-being. This study was undertaken to assess health-related quality of life ( HRQoL) in patients with toenail onychomycosis. The Onychomycosis QoL questionnaire ( ONYCHO), as a disease-specific instrument, and the Short Form 36 Health Survey ( SF-36) as a generic instrument, were applied in 140 consecutive patients affected by onychomycosis. Women and patients who were experiencing toenail onychomycosis for more than 2 years were reporting worse disease-specific HRQoL. The patients working in blue-collar occupations and patients with greater involvement of individual nails were more affected by onychomycosis regarding symptoms. The results of this study confirm that although onychomycosis is not a life-threatening disease, it can significantly reduce patients' QoL. [ABSTRACT FROM AUTHOR]

Hereditary Ectodermal Dysplasia is an inherited disorder commonly involving skin, teeth, hair, and nails. We have observed ectodermal dysplasia (EDs) in 11 individuals over two generations in one family. Smooth, dry, thin skin was seen in most affected individuals. All had fine, slowgrowing scalp hair and body hair and some had sparse eyebrows and short eyelashes. Nearly all showed decrease in sweating. Severe teeth abnormalities were seen in all patients and fingernail abnormalities were not so severe but toenail abnormalities were seen in all patients. No other abnormalities were seen in affected individuals in this family. It is very rare to find such a large family having ectodermal dysplasia. [ABSTRACT FROM AUTHOR]

Onychomycosis constitutes up to 50% of all nail disorders. Toenails are generally affected, mostly due to dermatophytes. Terbinafine is the most potent antifungal agent in vitro against dermatophytes. There are few randomised controlled trials using a non-continuous dose of terbinafine. The aim of this open-label pilot study was to reduce the total drug amount, the collateral effects and, specially, the costs; albeit maintaining the same efficacy of the standard regimens. Compare the outcomes of two different intermittent regimens with the same total amount of the medication (42 tablets in 6 months). Forty-one patients were divided into the following groups: terbinafine 250 mg day−1, for 7 days, monthly or terbinafine 500 mg day−1, once daily, for 7 days, every 2 months, both plus nail abrasion during 6 months. The efficacy was evaluated at months 6, 12 and 18 using the disease free nail criteria. Total cure = group I: eight patients (44.4%) and group II: eight patients (44.4%). Partial cure = group I: five patients (27.8%) and group II: four patients (22.2%). Treatment failure = group I: five patients (27.8%) and group II: three patients (16.7%). Recurrence = group I: zero patients (0.0%) and group II: three patients (16.7%). Two intermittent dosing regimens of terbinafine plus nail abrasion proved to be an alternative statistically effective, safe and with reduced drug costs for dermatophytes toenail onychomycosis. [ABSTRACT FROM AUTHOR]

Background Distal subungual onychomycosis and traumatic onycholysis are the most common causes of toenail abnormalities, and differential diagnosis is often impossible without mycology. Objectives To identify and describe dermoscopic signs specific for distal subungual onychomycosis that could facilitate its diagnosis and differentiation from traumatic mycologically negative onycholysis and to determine the sensitivity and specificity of these dermoscopic features. Methods We performed a retrospective study at the Outpatient Consultation for Nail Diseases of the Department of Dermatology of the University of Bologna. Dermoscopic digital images of 57 consecutive patients who underwent global photography, videodermoscopy and mycological examination for onycholysis of a single toenail between 1 December, 2010 and 30 June, 2011, were evaluated and compared. Digital dermoscopic images of onycholysis of the great toenail were evaluated for the presence of peculiar dermoscopic features. The presumptive dermoscopic diagnosis was compared with results of mycology. Results Evaluation of videodermoscopic images allowed us to identify three recurring peculiar dermoscopic features, two of which were present only in distal subungual onychomycosis (jagged proximal edge with spikes of the onycholytic area and longitudinal striae) and one only in traumatic onycholysis (linear edge - without spikes - of the onycholytic area). Conclusions We found distinctive dermoscopic signs that are exclusive to distal subungual onychomycosis and to traumatic onycholysis. Detection of these signs is simple and can, in selected cases, help to avoid mycology. [ABSTRACT FROM AUTHOR]

Background Ingrown toenail is a common disease that causes pain and discomfort. There are conservative and surgical treatments, but many have the drawbacks of recurrence and long recovery time. Objective To analyze for the first time the results of a technique called nail splinting using a flexible tube secured using a suture ( FTSS) performed on a series of patients with ingrown toenails. Methods and Materials A retrospective descriptive study of 71 pediatric patients operated on using the FTSS technique between 2001 and 2009 was performed. The data were collected using medical record review or telephone survey. The main outcomes were high percentage of success and shorter recovery time than with partial matrix excision. Results Sixty-two patients (87.3%) were cured using a single procedure, with an average follow-up of 13.1 months. Recurrence occurred in nine patients (12.6%); three required the classic technique with resection of the matrix and nail bed plastic surgery, and in 6, FTSS was repeated with good results. Conclusion Flexible tube secured using a suture has a lower recurrence rate than matricectomy. Additional advantages are the speed with which complaints can be monitored and quick return to school because recovery may be as short as 48 hours. [ABSTRACT FROM AUTHOR]

As the most frequently used systemic antifungal agents for onychomycosis, terbinafine and itraconazole have both proved to have the conditions of recurrence in various degrees during follow-up period after end of therapy; very little is known about their comparative recurrences after long-term follow-up. We conducted a meta-analysis of available trials to compare the long-term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole. Meta-analysis was performed by the Review Manager version 5.0.25. Risk ratio and 95% confidence intervals were calculated by the fixed effect model. Five trials and total 251 eligible patients were included in this meta-analysis. The combined risk ratio of the meta-analysis comparing terbinafine with itraconazole for mycological recurrence rate was 0.44 (95% CI 0.29-0.66), which suggests that itraconazole therapy is more likely to produce mycological recurrence compared with terbinafine therapy. [ABSTRACT FROM AUTHOR]

This is a randomized, double-blind study enrolling 70 patients with onychomycosis of the finger and toenails. Clinical and mycological efficacies as well as measures of safety were assessed monthly for a maximum of 6 months of treatment. The treatment regimens were: fluconazole 1% and fluconazole 1% with urea 40%. These results indicated topical treatment of onychomycosis with a combination of fluconazole 1% and urea 40% was more effective (82.8%) than fluconazole 1% (62.8%) nail lacquer alone in treatment of dermatophytic onychomycosis. Fluconazole was well tolerated and side effects were negligible. At the end of therapy and the end of the 6-month follow-up, fluconazole 1% and urea 40% demonstrated statistically significant superiority in clinical and mycological responses compared with fluconazole 1% alone. [ABSTRACT FROM AUTHOR]

The article presents a study that evaluates the long-term efficacy of proximolateral matrix partial excision and matrix phenolization in treating ingrown toenail. It states that 348 proximolateral matricectomies and phenol ablations in 225 patients with stage 2 or 3 ingrown toenail were conducted to assess the long -term efficacy of the intervention. Results of the study highlight the importance of the intervention in treating ingrown toenail, with higher success rate and lower morbidity.

Background Phenol cauterization is a chemical equivalent often chosen for treatment of ingrown toenails. Many reports describe intraoperative irrigation, or lavage, of the wound with various types of alcohol to neutralize any remaining phenol. There are conflicting reports in the literature as to whether true neutralization or merely effective removal of excess phenol is needed. Objective The aim of our study was to analyze the suitability and effectiveness of ethyl alcohol versus sterile saline when used in a lavage step after phenol application in the treatment of ingrown toenails. Methods We performed an in vitro study using human skin and a diffusion cell apparatus to measure the amount of phenol recovered after lavage with ethyl alcohol or sterile saline. Results When the wound was irrigated with ethyl alcohol, the total phenol recovered after two irrigation washes was 55.7% of the original amount initially used in treatment, compared with 80.4% when sterile saline solution was used for irrigation. Conclusion Alcohol and sterile saline solution do not neutralize phenol but dilute it and aid in its removal. We found that saline solution recovered more phenol than when washing with alcohol and recommend its use instead of alcohol for irrigation purposes after chemical matrixectomy. [ABSTRACT FROM AUTHOR]

Onychocryptosis or ingrown toenail is a very common pathology of the toenail unit, chiefly affecting adolescents and young adults. The ingrown toenail is responsible for disabling complaints like pain and difficulty in walking. It is associated with significant morbidity, hampering the quality of life as it interferes with sporting activities, school, or work. It principally occurs in the hallux. It is ascribed to poor trimming of the nails in combination with local pressure due to ill-fitting footwear, hyperhidrosis, poor foot hygiene and nail abnormalities. Pain, swelling and discharge are the main clinical features. Four stages of the condition have been described. Diagnosis is usually evident, but it should be differentiated from subungual exostosis and tumors of the nail bed. The current standard of care focuses on conservative treatment like the gutter splint technique in the initial stages, and in cases that are resistant to medical management or recurrent, surgical correction is the treatment of choice. There are various surgical techniques that are described in literature. Although there is no ideal technique, lateral nail plate avulsion with lateral matricectomy by phenol is commonly used and reported to be more effective in reducing recurrences. The aim of this review article is to focus on this common pathology of the nail, the various techniques employed in management and aid in the selection of treatment according to the stage and severity of the disease. [ABSTRACT FROM AUTHOR]

Summary Background Onychomycosis accounts for up to 50% of all onychopathies. Objectives To evaluate the efficacy of four posaconazole regimens compared with placebo in the treatment of toenail onychomycosis, to assess the safety and tolerability of posaconazole, and to estimate the relative efficacy of posaconazole against terbinafine. Methods A phase 2B, randomized, placebo- and active-controlled, parallel-group, multicentre, investigator-blinded (double blind for placebo) study (ClinicalTrials.gov identifier: NCT00491764). Onychomycosis patients aged 18-75 years ( n = 218) were randomized equally to one of six treatment regimens: posaconazole (oral suspension) 100, 200 or 400 mg once daily (24 weeks); posaconazole 400 mg once daily (12 weeks); terbinafine (tablets) 250 mg once daily (12 weeks); or placebo (24 weeks). The primary efficacy variable was complete cure (negative mycology and 0% nail involvement) at week 48. Results All posaconazole treatment arms had a significantly ( P ≤ 0·012) greater proportion of patients with complete cure at week 48 compared with placebo. The proportions of patients with complete cure were numerically higher for posaconazole 200 mg/24 weeks (54·1%) and 400 mg/24 weeks (45·5%), but lower for 400 mg/12 weeks (20%) compared with terbinafine (37%; differences were not statistically significant). Posaconazole was well tolerated. Seven patients receiving posaconazole withdrew because of asymptomatic liver enzyme increases, as mandated by protocol discontinuation criteria. Conclusions The efficacy and favourable safety profile of posaconazole suggest a potential new treatment for onychomycosis. The availability of low-cost generic terbinafine may limit posaconazole use to second-line treatment of infections refractory to, or patients intolerant of, terbinafine, or nondermatophyte mould infections. [ABSTRACT FROM AUTHOR]

For treatment of ingrown toenails, a phenolization is often chosen. Many reports describe an intra-operative irrigation or lavage of the wound with various types of alcohol to neutralize any residual phenol from this treatment. There are conflicting reports in the literature as to whether a true neutralization is required or merely effective removal of excess phenol. The aim of our study was to analyse the suitability and effectiveness of the alcohol lavage step during the treatment of ingrown toenails with a phenolization procedure. We performed an in vitro study using human skin and a diffusion cell apparatus to measure the amount of phenol remaining after various lavage washes. The effect of phenol evaporation was also examined. There was no measurable amount of phenol collected after each experiment, suggesting that diffusion of phenol through the skin does not exist. The open compartment test had significantly less phenol recovered compared with the occluded compartment test, indicating phenol evaporation. None. An alcohol lavage step after the phenolization procedure can be a suitable and effective means of diluting and removing any excess or residual phenol from the exposed area. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

Witkop tooth and nail syndrome is a rare autosomal dominant ectodermal dysplasia manifested by hypodontia and nail dysplasia. Tooth shape may vary, and conical and narrow crowns are common. Mandibular incisors, second molars, and maxillary canines are the most frequently missing teeth. Nail dysplasia affects the fingernails and especially the toenails and is often more severe in childhood. Nails may be spoon-shaped, ridged, slow-growing, and easily broken. We examined an Eastern Mediterranean family in which three siblings (two girls, one boy) had this syndrome. The severity of finger and toenail anomalies varied. The children's mother had no Witkop-related abnormalities, but their father was reported to have dental and nail anomalies. Early intervention is recommended to manage orofacial disfigurement and avoid negative social consequences for these children. [ABSTRACT FROM AUTHOR]

Ingrowing toenail is one of the most common nail complaints. Although many surgical treatments are described for complicated nails, frequent recurrence of pain and postoperative disability necessitate finding an appropriate treatment. In a clinical trial, we compared the Winograd and sleeve (gutter) surgical methods to find a simple, painless, and practical alternative. Of 100 patients (mean 27.8) included in the study, 50 underwent Winograd surgery and the rest the sleeve method. Postoperative infection occurred in four (8%) patients in the sleeve and three (6%) in the Winograd group. The condition reoccurred in five (10%) patients who underwent sleeve surgery and six (12%) who underwent Winograd. Recurrence rate was higher in female patients, although the difference was not statistically significant. Mean surgery duration for Winograd and sleeve methods was 15.7 minutes and 9.4 minutes, respectively, and postoperative work day loss was 2.0 weeks and 1.1 weeks, respectively. The sleeve method seems to be more practical and appropriate for patients planning to go back to work sooner and better fulfills the main characteristics for the primary treatment of choice. The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

Painful feet and lower limb dysfunction are risk factors for falling. Toenail deformities are common disorders in elderly people, but the relationship between nail deformities and lower limb function remains unclear. The aims of the present study were to assess the impairment of lower limb function in patients with deformities of the great toe and to determine whether foot care treatment is beneficial in reducing the risk of falling. Functional tests of the lower extremities were performed in 263 adults, including patients with any of hallux valgus, ingrown nail, or pachyonychia, and volunteers. Fifty-five subjects with nail disorders of the great toe received medical foot care treatment. The presence of ingrown nail, pachyonychia, or tenderness of the great toe was significantly correlated with impaired postural performance and reduced muscular strength as assessed by functional tests. Medical foot care markedly reduced pain levels in the great toe and improved scores on functional tests of the lower extremities. Toenail disorders of the great toe cause dysfunction of the lower extremities and are likely to increase the risk of falling in daily life. Foot care management of toenail disorders has the potential to improve functional abilities in daily life, particularly in elderly individuals. [ABSTRACT FROM AUTHOR]

Background Suspected toenail onychomycosis is a frequent problem. Clinical diagnosis has been considered inadequate. Objectives To assess the diagnostic accuracy of clinical findings for detecting fungi in toenails, and to develop and validate a clinical diagnostic rule aimed at improving dermatologists' diagnosis of onychomycosis. Methods A cross-sectional diagnostic study was performed including a total of 277 patients seen by 12 dermatologists. The gold standard was the presence of dermatophytes on culture or a positive nail plate biopsy. For each sign we described prevalence, sensitivity, specificity, positive and negative predictive values, and likelihood ratios for positive and negative results. We developed a diagnostic clinical rule and validated it in a subsample. Results Helpful findings to predict the presence of fungi are: previous diagnosis of fungal disease; abnormal plantar desquamation (affecting > 25% of the sole); onychomycosis considered the most probable diagnosis by a dermatologist; and presence of interdigital tinea. When dermatologists considered onychomycosis the most probable diagnosis and plantar desquamation was present (13% of patients), the positive predictive value for presence of fungi was 81%. When both signs were absent (34% of patients), the positive predictive value for absence of fungi was 71%. In other situations, clinical diagnosis might not give enough information to decide on therapy. Conclusions In 13% of the patients (a large number in absolute terms), when dermatologists consider onychomycosis the most probable diagnosis and plantar desquamation is present, therapy should be started without any further test, as clinical diagnosis is at least as accurate as laboratory tests. In other situations, an optimal management strategy should be defined. [ABSTRACT FROM AUTHOR]

BACKGROUND Several options for the treatment of ingrowing toenails are available, ranging from simple conservative approaches to extensive surgical procedures. OBJECTIVE To evaluate in a long-term follow-up (36 months) the efficacy of chemical matricectomy with phenol for the treatment of ingrowing toenails. METHODS AND MATERIALS A total of 197 phenol ablations were performed in 139 patients with stage 2 and 3 disease. Each patient was examined weekly until full wound healing was achieved and was followed for 36 months to assess the long-term efficacy of the treatment. The healing period after surgery ranged from 2 to 4 weeks; few postoperative complications were seen. RESULTS Only three recurrences were observed (after 2, 4, and 11 months). Short-term results were excellent. No severe complications occurred during the 36-month follow-up period. Cosmetic results were remarkable. The success rate was 98.5%. CONCLUSIONS Phenol cauterization is an excellent surgical method for the treatment of ingrowing toenails, being simple and associated with low morbidity and a high success rate, even over the long term (36 months). The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

BACKGROUND Ingrown toenails have a tendency for recurrence. Operative interventions can be successful, and several procedures are in use. OBJECTIVE Retrospective evaluation, to reveal differences in postoperative pain, time to recovery, and satisfaction with the cosmetic outcome in patients treated with a phenol (PCM) or surgical matricectomy (SM). MATERIALS & METHODS All matricectomy patients at the Dermatology Department of the Ludwigshafen City Hospital between 2004 and 2008 were interviewed over the telephone. Of 72 evaluable patients with a total of 112 ingrown nail sides, 33 were treated with PCM and 39 with SM. The patient group consisted of 40.3% women, the median age was 31. RESULTS Patients after PCM indicated two points less postoperative pain on an analogue scale from 0 to 10 ( p<.001). In the PCM group, more patients recovered from the operation in less than 1 week ( p=.007). Patient evaluation of cosmetic outcome was not different between the groups ( p=.76), but recurrence rates were significantly higher in the PCM group (31.5%, vs 6.9% in the SM group, p=.006) CONCLUSION Both matricectomies have advantages and disadvantages. We should discuss these issues with our patients to help them decide on the kind of matricectomy. The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

Background: Ingrown toenail, or onychocryptosis, is a common source of morbidity worldwide. The current standard of care focuses on the nail as the causative agent, and, in cases that are resistant to medical management, surgical correction via nail avulsion and phenol matrix ablation is used. Unfortunately, this treatment leads to poor cosmetic results, high rates of recurrence and low patient satisfaction. Methods: We retrospectively reviewed a case series of 124 consecutive patients who underwent surgical correction of ingrown toenails from 1988 to 2004. We recorded the operative technique and postoperative wound healing via photographs. We assessed outcomes and patient satisfaction using self-reports and 7-point Likert scale questionnaires. Results: Our surgical approach involved the excision of excessive nail-fold granulation tissue with preservation of the nail and its matrix. In total, 72.5% of patients were under the age of 29 (69.4% men). Before surgical intervention, 78.8% of patients scored their pain as severe, 69.9% had difficulty wearing normal footwear and 64.3% had difficulty with normal activities because of their ingrown toenails. A total of 212 surgical sites were analyzed, with a median follow-up of 8 years. No recurrences were identified in any patients (100%, n = 124). Overall, 94.3% (n = 116) stated that they were highly satisfied with the procedure. Only 1.6% (n = 2) reported a loss of sensation at the surgical site. Conclusion: Surgical correction of ingrown toenails via soft-tissue excision of the nail folds, coupled with preservation of the nail and its matrix, [ABSTRACT FROM AUTHOR]