Nail Surgery & Methotrexate

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We are considering a PNA with phenolisation.
The challenge? The pt has RhA, and takes 2x10g Methotrexate once a week.
Common practice appears to be......avoid nail surgery for these pts...healing difficulties, immunosuppressed.... .
However, in terms of risk management.. the recurrent cryptosis is also undesirable.
2 previous wedge ressections with no matrixectomy healed in 3 months.
Nail regrowth, hypertrophied sulcus ("chubby toe") ,active lifestyle and failing conservative measures are inspiring us to pursue alternatives...
[Circulation & Sensation within normal limits - non-diabetic - 55yo male- orchardist]
Thoughts from the realm appreciated.

 

Liggins in the thread of August 28, 2009 refers to Goodman and Gillman as the authoritative opinion. I don't mean to be offensive, but who are they, and on what do they base their opinion?
And yes, we can approach a general surgeon for an excisional wedge ressection - refused in the past - but would like to develop a well-informed opinion before going down that track.

 

Hello Metropod

Goodman and Gillman are the editors of "The Pharmacological Basis of Therapeutics" ISBN 0-02-344781-8. The book is generally considered to be the 'world renowned textbook of pharmacology, toxicology and therapeutics'. Amongst other comments "phenol is absorbed by all routes of administration and can reach the circulation 'even when applied to the intact skin'". "Aqueous solutions stronger than 2% should not be applied to the surface of the body"

This all sounds very damning but used with care as we use it, it is a useful and effective treatment. As mentioned in my previous posting I think that liaison with the rheumatologist treating her would be the best approach reserving incisional alternatives to a podiatric surgeon colleague.

ll the best

Bill

 

Thank you for that detail. It gives me a logical next move. Embarrassingly, it wasn't the Rheumatologist who was on my radar!