Have you ever wondered what non-surgical treatment you could do for your patient with a paronychia?
I have had the pleasure of hearing Hiroko Arai, MD, speak multiple times on the subject at the Council for Nail Disorders and the American Academy of Dermatology Annual Meeting. She is a Japanese dermatologist who has pioneered the gutter splint for ingrown nails (sterilized plastic IV tubing fixed with acrylic resin).1 For details and pictures of this procedure, I highly suggest you read this article.
In this article, she describes using sterilized plastic IV tubing that is split on one side. One would apply the tubing to the entire length of the affected lateral nail margin in order to separate the skin from the nail plate. Then affix the tube to the nail plate by an acrylic resin. Interestingly, she applied this technique to what most of us would consider a raging paronychia (complete with granulation tissue, pain on palpation and an inflamed appearance). The article authors used oral antibiotics as needed.
She relates that with this technique, patients experience pain relief in 24 hours and may see the granulation tissue resolve in seven days. Is this a quick procedure for our fast moving culture? Not at all. Patients would leave the gutter splint on the affected nail border anywhere from weeks to months and they can wear the splint with shoes.
You may be asking why you should consider this? Well, Dr. Arai believes the cause of ingrown nails is improper nail cutting both on the part of the patient and the physician. The application of the gutter splint for weeks to months allows the damage produced by improper nail cutting to be reduced by allowing the nail to grow in “normally.”
One of the things I caution with this technique is the use of the acrylic resin. Recently, I performed a nail banding technique that assists pincer nails to flatten down and uses acrylic resin to keep the nail band in place. The patient developed a severe contact dermatitis to the methyl methacrylate. Prior to attempting the procedure described in this blog, I encourage you to ask the patient if he or she has ever worn acrylic nails and had a reaction. Also do a patch test with the glue to ensure a comfortable patient experience.
1. Arai H, Arai T, Nakajima H, Haneke E. Formable acrylic treatment for in-growing nail with gutter splint and sculptured nail. Int J Derm. 2004; 43(10):759-65.