Overview
Nail infections and injuries encompass a range of conditions affecting the nail plate, matrix, and surrounding tissues, often requiring prompt management to prevent functional and aesthetic sequelae 2.Diagnosis
Clinical Presentation: Subungual hematoma, avulsion, and dystrophic changes are common 2.
Physical Examination: Assess for deformities, color changes, and involvement of adjacent structures 2.
Imaging: Not typically required unless bone involvement is suspected 2.Management
First-Line Treatments:
- Nail Bed Injuries: Surgical repair with sedation (e.g., ketamine) in pediatric settings can be safe and effective 1.
- Dressing: Replacing avulsed nails with "Superglue" as a splint provides effective coverage 5.
Adjunctive Treatments:
- Infections: Specific antibiotic therapy based on culture and sensitivity results (details not provided in abstracts).
- Dystrophic Nails: Address underlying causes such as psoriasis or alopecia areata; specific treatments vary by etiology 7.Special Populations
Pediatrics: Ketamine sedation for nail bed repairs is safe and well-tolerated, with high parental satisfaction 1.
Elderly: Nail growth slows with age, potentially affecting healing times and treatment outcomes 6.Key Recommendations
Utilize ketamine sedation for nail bed repairs in pediatric patients to ensure safety and parental satisfaction (Evidence: Moderate 1).
Consider replacing avulsed nails with adhesive (e.g., "Superglue") as an effective and practical dressing method (Evidence: Weak 5).
Monitor nail growth rates, noting potential deceleration with aging, which may influence treatment timelines and expectations (Evidence: Expert opinion 6).References
1 Stewart C, Bradley A, Faulkner J, Jatan A. The Use of Ketamine Sedation for the Treatment of Nail Bed Repairs in the Pediatric Emergency Department. Pediatric emergency care 2023. link
2 Martínez Núñez P, Ruiz Alonso E, Maya González JA, Pérez González M. [Nail trauma, what is it? and how to treat it?]. Semergen 2020. link
3 Alli N, Dogan S. Short-term isotretinoin-induced elkonyxis and median nail dystrophy. Cutaneous and ocular toxicology 2016. link
4 Heikkilä H, Stubb S, Kiistala U. Nail growth measurement employing nail indentation--an experimental follow-up study of nail growth in situ. Clinical and experimental dermatology 1996. link
5 Henderson HP. The best dressing for a nail bed is the nail itself. Journal of hand surgery (Edinburgh, Scotland) 1984. link
6 Bean WB. Nail growth. Thirty-five years of observation. Archives of internal medicine 1980. link
7 Samman PD. Trachyonychia (rough nails). The British journal of dermatology 1979. link