Intra-individual Right-left Comparative Study of Medium Depth Peels in Superficial Nail Abnormalities

Superficial nail abnormalities include conditions which produce nail surface changes such as trachyonychia, pitting and ridging. Mostly, this is a neglected area due to the dearth of treatment options. Glycolic acid peeling has been reported to be effective in such cases.

This study aims to assess the safety and efficacy of medium depth peels (70% glycolic acid versus phenol combination peel [8% phenol with 15% trichloroacetic acid]) in patients with superficial nail abnormalities.

A right-left comparative study in patients with superficial nail abnormalities was done. On the right finger or toenails phenol combination peels and on the left side 70% glycolic acid was used in a predefined protocol over 12 weeks. The severity was assessed objectively by a new devised index (Nail Surface abnormality Index (NSI]). Patient's subjective perception of severity was assessed by Visual Analogue Scale (VAS), and that of the physician was assessed by Physician's Global Assessment (PGA) scores.

A total of 17 patients were enrolled, two dropped out and 15 patients were included in the final analysis (mean age 19.2 years, total 120 nails treated). The mean NSI score declined from 7.88 ± 0.45 to 4.02 ± 0.45 on the right side; and from 8.0 ± 0.45 to 4.32 ± 0.44 on left side, at the end of 12 weeks. The VAS declined from 6.57 ± 0.26 to 3.87 ± 0.33 on right side and from 6.32 ± 0.28 to 3.78 ± 0.32 on left side. According to PGA score, five patients showed good improvement, seven showed moderate improvement and three responded poorly.

Both the medium depth peels were found to be safe and equally efficacious modalities for treatment of superficial nail abnormalities.