Using 80% trichloroacetic acid in the treatment of ingrown toenails

NewsBot · Feb 4, 2014

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Using 80% trichloroacetic acid in the treatment of ingrown toenails
Hugo Barreiros, Diogo Matos, João Goulão, Pedro Serrano, Alexandre João, Francisco Menezes Brandão
An. Bras. Dermatol. vol.88 no.6 Rio de Janeiro Nov./Dec. 2013

BACKGROUND:
Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times.

OBJECTIVE:
This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail.

METHODS:
One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery.

RESULTS:
There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery.

CONCLUSION:
It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method.
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Admin2 · Feb 4, 2014

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drdebrule · Feb 7, 2014

This was an interesting study to read and I encourage others to do so. I would have liked it better if the predisposing factors seemed less subjective, a pre-op staging classification system (I like Mozena) was employed, and if there was a control group with phenol or sodium hydroxide technique. These things might be for the next study. The lack of post-operative erythema and low infection rate is encouraging. The 10 second application time seems attractive.

NewsBot · Jan 13, 2015

The effectiveness of matrix cauterization with trichloroacetic acid in the treatment of ingrown toenails
Erdinc Terzi et al
Indian Dermatol Online J 2015;6:4-8

Ingrown toenail is an often painful clinical condition that usually affects the big toe. Chemical matricectomy with phenol has a low recurrence rate and good cosmetic results. However, it produces extensive tissue destruction that can result in drainage and delayed healing. Alternatives such as sodium hydroxide and trichloroacetic acid (TCA) have therefore come into vogue. A total of 39 patients with 56 ingrown toenail edges underwent chemical matricectomy with 90% TCA after partial nail avulsion. In most of the patients, adverse effects such as postoperative pain and drainage were minimal. One patient who underwent matricectomy had recurrence in a single nail edge (1.8%) at 12 months follow-up. No recurrence was observed among 38 patients during the mean follow-up period. This was considered to be statistically significant (P < 0.001). Partial nail avulsion followed by TCA matricectomy is a safe, simple, and effective method with low rates of postoperative morbidity and high rates of success.
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NewsBot · Jun 8, 2018

Treatment of Ingrowing Toenails With Phenol 88% or Trichloroacetic Acid 100%: A Comparative, Prospective, Randomized, Double-Blind Study.
André MS et al
Dermatol Surg. 2018 May;44(5):645-650. doi: 10.1097/DSS.0000000000001499.

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.
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NewsBot · Apr 23, 2019

Controlled trial comparing the effi ontrolled trial comparing the effi cacy of 88% cacy of 88%
phenol versus 100% trichloracetic acid for chemical henol versus 100% trichloracetic acid for chemical
matricectomy in the management of ingrown toenail atricectomy in the management of ingrown toenail
Kaoutar Moustaide et al
Our Dermatol Online. 2019;10(2):116-120.

Background: The ingrown toenail results from a painful conflict between the nail plate and the adjacent soft parts.
Material and methods: We conducted a prospective, comparative trial of the long-term efficacy of two methods:
phenolization (88%) and matricolysis by trichloroacetic acid (TCA) (100%). Adult, consenting patients with ingrown
toenails were alternately allocated into two treatment, to receive either 88% phenol or 100% TCA chemical matricectomy.
The patients as well as the statistician were blinded to the agent being used. Post-procedure follow-up evaluated median
duration of pain, discharge, and healing along with recurrence, if any, in both the groups. The group wise data was
statistically analyzed. Results: On comparing the two groups, pain lasted 9.34 days in the TCA group and 18.62 days
in the phenol group, this difference was not statistically significant (P = 0.202). The tissue condition took 9.30 days
to normalize in the the TCA group, while it took 17.63 days to normalize in the phenol group. This difference was
found to be statistically significant (P < 0.007). The aesthetic result and the cost of the care were similar in the 2
groups. Conclusion: Chemical matricectomy using TCA is as efficacious as phenolisation, with the advantage of faster
tissue normalization.
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NewsBot · Mar 2, 2020

Comparison of Trichloroacetic acid and Phenol application after
partial nail extraction in the treatment of ingrown toe nails
MUHAMMAD FAHIM AHSAN et al
P J M H S Vol. 13, NO. 4, OCT – DEC 2019

Aim: To compare the efficacy of 90% Trichloroacetic acid and 88% phenol in Matrixectomy (extraction of
partial nail) for the management of ingrown toenails.
Methods: This was a single center prospective randomized clinical study, conducted in the General
surgery department of Pakistan Institute of Medical Sciences Hospital, Islamabad, from July 2018 to July
2019. Out of all study participants 50% patients treated with 88% Phenol and the remaining 50% treated
with 90% Trichloroacetic acid. Postoperatively patients were followed for 48 hours, 1, 4, 12 weekly up to 3
months. Efficacy was defined in term of pain wound bleeding, allergic reaction, wound infection and
recurrence. Data was collected on self-designed Proforma.
Results: Total 100 patients of ingrown toenails were selected. Average age of patients was 26.31±8.74
years. Severity of the pain was statistically insignificant among both groups, p-value 0.472. Wound
infection was higher in 88% Phenol group in contrast to 90% Trichloroacetic acid group, while statistically
insignificant, p-value 0.306. Recurrence was only among 2 patients of 90% Trichloroacetic acid group.
Conclusion: Both treatment options are equally effective in treating the ingrown toenails with lower rate of
postoperative pain, complications and recurrences
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NewsBot · Jul 18, 2023

A COMPARATIVE STUDY OF 88% PHENOL VERSUS 90%
TRICHLOROACETIC ACID AS CHEMICAL CAUTERANTS
AFTER PARTIAL NAIL EXTRACTION IN THE TREATMENT OF
INGROWN TOE NAILS.
Nitish Sharma et al
Eur. Chem. Bull. 2023, 12(Special Issue 5), 6172 –6175

Aim: To compare the efficacy and safety of 88% phenol and 90% trichloroacetic acid as chemical cauterants
in lateral nail matricectomy after partial nail avulsion for the management of ingrown toenails.
Methods: This was a prospective randomized clinical study in which 50% of study participants were treated
with 88% Phenol and the remaining 50% were treated with 90% TCA as chemical cauterant after partial nail
avulsion. Postoperatively patients were followed for 48 hours, 1, 4, 12 weekly up to 3 months and 3 monthly
upto one year. Efficacy was defined in term of pain, wound discharge, wound infection, healing and recurrence.
Data was collected on self-designed Proforma.
Results: A total of 50 patients of ingrown toenails were enrolled in the study. Average age of patients was
26.31±8.74 years. Severity of the pain was statistically insignificant among both groups, p-value 0.472. Wound
infection was higher in 88% phenol group in contrast to 90% Trichloroacetic acid group, while statistically
insignificant, p-value 0.306. Recurrence was only seen in 1 patient of 90% Trichloroacetic acid group.
Conclusion:
Both treatment options are equally safe and effective in treating the ingrown toenails with lower rate of
postoperative pain, complications and recurrences.
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