From the Guidelines
To remove a deceased nail due to onychomycosis or onychodystrophy, it is recommended to soak the affected area in warm water mixed with Epsom salt for about 15-20 minutes to soften the nail, followed by gentle trimming with sterile nail clippers or scissors, as this approach prioritizes minimizing morbidity and promoting quality of life. When dealing with a deceased nail, the primary concern is to prevent infection and promote a healthy environment for the new nail to grow. According to the British Association of Dermatologists' guidelines for the management of onychomycosis 1, the goal of antifungal therapy is to achieve fungal-free nails, which is crucial for preventing recurrence and promoting healthy nail growth.
Some key considerations for removing a deceased nail include:
- Soaking the nail in warm water mixed with Epsom salt to soften it, making it easier to trim without causing injury to the surrounding skin.
- Using sterile nail clippers or scissors to prevent infection.
- Trimming small pieces of the nail at a time to avoid pushing the nail back and causing further damage.
- Applying antibiotic ointment around the nail after trimming to prevent infection.
- Keeping the area clean and dry, applying antibiotic ointment daily until the new nail grows in.
It's essential to note that onychomycosis is a deep-seated fungal infection, and its treatment depends on the newly grown-out nail plate being fungus-free 1. Therefore, any approach to removing a deceased nail should prioritize preventing reinfection and promoting a healthy environment for the new nail to grow. If there's any sign of infection, such as redness, swelling, or pus, it's crucial to consult a healthcare professional immediately.
From the Research
Removal of Onychectomy
There are no direct research papers that provide guidance on removing an onychectomy (nail removal) of a deceased nail due to onychomycosis (fungal infection of the nail) or onychodystrophy (nail dystrophy). However, some studies provide information on nail disorders and surgical techniques for nail removal.
Nail Disorders
- Onychomycosis is a common nail disorder, affecting around 10% of the overall population, with a point prevalence of around 15% 2
- Nail disorders can be caused by infectious, inflammatory, or metabolic conditions, and can be assessed through clinical inspection, dermatoscopy, diagnostic imaging, microbiological testing, and histopathological examination 2
Surgical Techniques
- A new surgical modification of nail avulsion using an 11 no. surgical blade instead of nail clippers has been proposed, which can lead to less trauma to the nail bed and better post-procedure outcomes 3
- A case report describes a new method to remove a tibial intramedullary nail through the original suprapatellar incision, which can avoid surgical complications 4
Treatment of Nail Disorders
- Treatment of nail psoriasis should balance consideration of the extent of skin disease, psoriatic arthritis, and severity of nail disease with concomitant impairment of quality of life 5
- Treatment options for nail psoriasis include high-potency topical corticosteroids, calcipotriol, adalimumab, etanercept, intralesional corticosteroids, ustekinumab, methotrexate sodium, and acitretin 5