Dermatológia pre prax 1/2015

Combined therapy of unguis incarnatus by applying gutter split onychoplastic and laser

Aim: To achieve successful healing without matrixectomy to restore natural growing process of the nail plate. Case: A 47-year-old female patient with a posttraumatical appearance of a long-lasting in-growing toenail. It had been progressing for the period of three years and finally resulted into a huge granuloma inflammated tissue infected by Staphylococcus aureus and with a regional lymphoedema causing a difficult and painful walking. Despite standard recommendations she was treated by applying gutter split onychoplastic combined with excochleation of hypergranulomatous mass together with administration of antibiotics, which lasted for ten days. The patient was instructed about homly care. Regular check-ups went on in one-week intervals at the beginning and one- -month intervals at the end the treatment process. There was a necessity of repeated treatment of the granuloma tissue in the second, sixth and eighth week because of its relapsing. There was applied fractional CO2, laser (10 600 nm), power capacity 0.8 - 3 W in continual mode. The cure of the lateral part was finished after 18 weeks and the entire healing process lasted for 27 weeks altogether. Even two years later the halux is healthy. Discussion: The non-standard procedure of the treatment of an ingrown nail is based on the objective assessment. Combination of the physician’s experience and the patient’s cooperation to reach a successful cure is inevitable.

Keywords: unguis incarnatus, granuloma, gutter split onychoplasty, laser, trauma.