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Pediatric Ingrown Toenails: A Practical Treatment Algorithm
Adriana Matter1,2, Nilton Di Chiacchio3, Nilton Gioia Di Chiacchio3,4
1Dermatology Department, Hospital Santa Casa de Curitiba, Curitiba, Brazil.
Insights
Pediatric ingrown toenails require individualized treatment based on severity and age. A new algorithm guides management, favoring conservative options for younger children and surgical interventions for more severe cases to improve outcomes.
Area of Science:
- Pediatric Podiatry
- Dermatology
- Surgical Innovation
Background:
- Ingrown toenails are prevalent in children, posing unique management challenges.
- Anatomical differences and compliance issues complicate treatment decisions in pediatric patients.
- Optimal management strategies for pediatric ingrown toenails lack a clear consensus.
Purpose of the Study:
- To introduce a practical treatment algorithm for pediatric ingrown toenails.
- Stratify treatment recommendations by ingrown toenail severity and patient age.
- Integrate current literature with clinical expertise for evidence-based guidance.
Main Methods:
- Comprehensive literature review on pediatric ingrown toenail treatments.
- Analysis of conservative and surgical intervention efficacy and recurrence rates.
- Synthesis of findings into an age- and severity-stratified clinical algorithm.
Main Results:
- Conservative treatments (taping, bracing) show variable success (5-23% recurrence).
- Surgical options (tissue removal, matricectomy) offer higher long-term efficacy for moderate-to-severe cases.
- Age-specific approaches are crucial; soft tissue procedures are preferred for children under 10.
Conclusions:
- Individualized management of pediatric ingrown toenails is essential, considering severity and age.
- Assessment of foot structure and gait is vital to prevent recurrence and optimize outcomes.
- A structured treatment algorithm can guide effective clinical decision-making.
Background:
Ingrown toenails are common in the pediatric population, particularly among adolescents, and often present unique diagnostic and therapeutic challenges due to anatomical differences, compliance issues, and the impact of anesthesia. Despite a range of conservative and surgical options, there is no clear consensus on optimal management in children.
Objective:
To propose a practical treatment algorithm for pediatric ingrown toenails, stratified by severity and age group, and grounded in current literature and the authors' clinical experience.
Methods:
A comprehensive review of the literature was conducted focusing on conservative and surgical treatments for pediatric ingrown toenails. Treatment efficacy, recurrence rates, and age-related considerations were analyzed and synthesized into a clinical decision-making algorithm.
Results:
Conservative measures (taping, cotton pledgets, and nail bracing) demonstrated variable success, with recurrence rates ranging from 5% to 23%. Surgical approaches, such as hypertrophic tissue removal and chemical matricectomy, demonstrate greater long-term efficacy, particularly in moderate to severe cases. In children younger than 10 years, soft tissue-focused procedures are preferred to avoid permanent narrowing of the plate or nail distortion. Pain control, anesthesia strategy, and patient compliance significantly affect outcomes.
Conclusion:
Management of pediatric ingrown toenails should be individualized based on severity and age. A thorough assessment of the child's foot structure and gait, which may contribute to recurrence or suboptimal outcomes, should be performed as an adjunct procedure.
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