What therapies can smooth the nail bed after toenail removal?

Therapies to Make the Nail Bed Smooth After Toenail Removal

The most effective therapies for smoothing the nail bed after toenail removal include daily application of topical emollients to cuticles and periungual tissues, gentle skin care, and regular nail trimming as the nail regrows. 1

Initial Management After Nail Removal

• Apply topical petrolatum around the nails due to its lubricant and smoothing effects on the skin and nail bed 1
• Keep the affected area clean and dry between treatments to prevent infection and promote proper healing 2
• Avoid friction and pressure on the nail fold as well as picking or manipulating the nail bed to prevent further damage 1
• Use pH5 neutral bath formulations with tepid water for cleaning, as harsh soaps can irritate the healing nail bed 1

Topical Treatments for Nail Bed Smoothing

• Apply hypoallergenic moisturizing creams or ointments once daily to smooth the skin and prevent dryness of the nail bed 1
• For inflammation or edema of the nail bed, mid to high potency topical steroid ointment can be applied to nail folds twice daily 3
• Daily dilute vinegar soaks may help reduce inflammation and promote smoother healing 3
• For cases with fungal involvement, topical antifungals may be beneficial:
  • Amorolfine 5% lacquer applied once or twice weekly after gentle filing of the nail bed 1
  • Ciclopirox 8% lacquer applied once daily for up to 48 weeks for persistent fungal issues 1

Preventive Measures During Healing

• Manicure should be done carefully, cutting nails straight across until they no longer extend over the toes 1
• Wear comfortable well-fitting shoes and cotton socks to prevent pressure on the healing nail bed 1
• Keep hands dry and out of water when possible to promote proper healing 1
• Avoid wearing tight shoes that could cause pressure on the healing nail bed 1

Management of Complications

• If infection is suspected, obtain bacterial cultures and initiate appropriate antibiotics with anti-staphylococcus aureus coverage 3, 2
• For painful hematoma or subungual abscess, drainage is mandatory before proceeding with other therapies 2
• In cases of chronic or recurrent infections, address underlying factors such as immunocompromised status 2

Common Pitfalls to Avoid

• Avoid greasy creams for basic care as they might facilitate the development of folliculitis due to their occlusive properties 1
• Avoid manipulation of the nail bed which increases risk of infection 1
• Do not use topical acne medications on the nail bed as they may irritate and worsen the condition due to their drying effects 1
• Avoid inappropriate use of topical steroids which may cause perioral dermatitis and skin atrophy if used inadequately 1

Follow-up Care

• Regular nail trimming is necessary until the nail plate grows reattached 3, 4
• Reassess after 2 weeks of treatment, and if healing is not progressing well, consider alternative treatments 2
• Monitor for signs of recurrent infection or abnormal nail regrowth 2