Nail Removal

Definition

Nail removal is a form of treatment that is sometimes necessary following traumatic injuries or recurrent infections in the area of the nail. There are nonsurgical as well as surgical methods of nail removal.

Purpose

Nails are removed only when necessary to allow the skin beneath the nail (the nail bed) to heal or in some cases, to remove a nail that has been partially pulled out in an accident. In the case of toenails, it is occasionally necessary to remove the nail of the large toe due to a chronic condition caused by badly fitted shoes. In general, however, doctors prefer to try other forms of treatment before removing the nail. Depending on the cause, nail disorders are usually treated with oral medications; applying medicated gels or creams directly to the skin around the nail; avoiding substances that irritate the nail folds; surgical lancing of abscesses around the nail; or injecting corticosteroids under the nail fold.

The most common causes of nail disorders include:

• Trauma. The nails can be damaged by nail biting, using the fingernails as tools, and incorrect use of nail files and manicure scissors as well as by accidents and sports injuries.
• Infections. These include fungal infections under the nails, bacterial infections of cuts or breaks in the nail folds, or infections of the nails themselves caused by Candida albicans. Inflammation of the nail folds is called paronychia.
• Exposure to harsh detergents, industrial chemicals, hot water, and other irritants. People who work as dishwashers are especially vulnerable to separation of the nail itself from the nail bed (onycholysis).
• Systemic diseases and disorders. These include psoriasis, anemia, and certain congenital disorders.
• Allergic reactions to nail polish, polish remover, or the glue used to attach false nails.

Precautions

In the case of infections, it is necessary to distinguish between fungal, bacterial, and candidal infections before removing the nail. Cultures can usually be obtained from pus or tissue fluid from the affected nail.

Surgical nail removal

If necessary, the surgeon can remove the nail at its base with an instrument called a needlepoint scalpel. In a few cases, the nail may need to be pulled out (avulsed) from its matrix.

Nonsurgical nail removal

Nails can be removed by applying a mixture of 40% urea, 20% anhydrous lanolin, 5% white wax, 25% white petroleum jelly, and silica gel type H.

Preparation

For nonsurgical nail removal, the nail fold is treated with tincture of benzoin and covered with adhesive tape. The nail itself is thickly coated with the urea mixture, followed by a layer of plastic film and adhesive tape. The mixture is left on the nail for five to 10 days, after which the nail itself can be removed.

Aftercare

Aftercare of surgical removal is similar to the care of any minor surgical procedure. Aftercare of the urea paste method includes applying medication for the specific infection that is being treated.

Risks

Risks from either procedure are minimal.

Normal results

Normal results include the successful removal of the infected or damaged nail.

BOOKS

Baden, Howard P. "Diseases of the Nails." In Conn's Current Therapy, 1996, ed. Robert E. Rakel. Philadelphia: W. B. Saunders Co., 1996.

Berger, Timothy G. "Skin and Appendages." In Current Medical Diagnosis and Treatment, 1996. 35th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1995.

Kilgore, Eugene S., et al. "Hand Surgery." In Current Surgical Diagnosis and Treatment. 10th ed. Ed. Lawrence W. Way. Stamford: Appleton & Lange, 1994.

Rebecca J. Frey

KEY TERMS

Avulse—To pull or tear away forcibly. In some cases, a surgeon must remove a nail by avulsing it from its matrix.

Matrix—The tissue at the base of the nail, from which the nail grows.

Nail bed—The layer of tissue underneath the nail.

Onycholysis—The separation of a nail from its underlying bed. Onycholysis is a common symptom of candidal infections of the nail or of exposure to harsh chemicals and detergents.

Paronychia—Inflammation of the folds of skin that surround a nail.