Chronic ingrowth nail

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I would like to have suggestions on this case. My approach would be peartial onicectomy with phenol plus skin reduction through fish mouth incision.
Suggestions?

 

Hi Falconegian

Unless this is a pyogenic granuloma, given the position of the lesion, I would guess that it is the result of a frank sub-ungual exostosis or a hypertrophic distal phalangeal bone tuft. I would suggest that a D/P, oblique and true lateral X-ray would offer the differential diagnosis.

Treatment would depend on the diagnosis, but I would suggest that phenol is superfluous.

All the best

Bill Liggins

 

hi
I have made x-ray and they are negative!
why is phenol for you superflous? this lesion is 1 year inthis way. can only onicectomy and debridment solve the problem?

 

There have been cases reported (sorry, don't have the references to hand) of osteomyelitis following application of phenol to bone. Thus, in my view, if you are carrying out a partial nail ablation and excision of the granuloma via a fish mouth incision, phenol would be contra-indicated.

All the best

Bill Liggins

 

I would tend to agree with everything Bill has said (written...). I too thought it was a P. Granuloma - still might be even without the underlying exostosis and is probably worth treating as such. Hard to tell without actually seeing it.
Best wishes.

 

I feel that you should also consider a melanoma as a differential diagnosis alongside those already mentioned.

Regards.

Footsie 100

 

it does look like pyogenic granuloma to me. If unsure, I suggest you may refer the patient to a dermatologist if necessary. Cheers.

 

Hi Falconegian,

I would be interested in an update on your management of the presenting toe problem.

Thanks.

Footsie 100