Ingrowing toenails in children and adolescents: is nail avulsion superior to nonoperative treatment?

• Published in: Singapore medical journal Vol. 60; no. 2; pp. 94 - 96
• Main Authors: Gera, Sumanth Kumar, PG Zaini, D K Halimatussadiah, Wang, Shiyao, Abdul Rahaman, Siti Hauzah Binte, Chia, Rui Fang, Lim, Kevin Boon Leong
• Format: Journal Article
• Language: English
• Published: Singapore Singapore Medical Association 01-02-2019
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Child; Female; Hospitals, Pediatric; Humans; Male; Nails; Nails, Ingrown - drug therapy; Nails, Ingrown - surgery; Original; Recurrence; Retrospective Studies; Singapore; Toes; Singapore; nail avulsion; ingrown toenails; adolescents; nail care
• ISSN: 0037-5675
• DOI: 10.11622/smedj.2018106

Ingrowing toenail (IGTN) or onychocryptosis is not uncommon in children and adolescents. However, there is a dearth of evidence in the literature on the management of IGTN in this age group. This study aimed to compare the results of nonoperative treatment for IGTN with that of operative treatment among children and adolescents.
All children and adolescents who were treated for IGTN at our institution between 2010 and 2014 were included for this retrospective study. Demographic data, treatment prescribed and outcome at six months after presentation were analysed.
Overall, 199 patients were recruited. There were 123 (61.8%) boys and 76 (38.2%) girls. Median age was 14 years. 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.
We recommend that IGTN in children and adolescents be treated in the first instance by nonoperative methods. Operative options can be considered for resistant cases or in case of recurrence of IGTN.