Dermatologists must become familiar with nail surgery techniques, expert says

October 1, 2010

When faced with a potentially serious nail abnormality, some providers who take a wait-and-see approach may delay diagnosis and treatment because they aren't comfortable performing nail surgery, according to Nathaniel J. Jellinek, M.D., clinical assistant professor, department of dermatology, Brown Medical School, Providence, R.I., and adjunct clinical assistant professor, division of dermatology, University of Massachusetts Medical School, Worcester, Mass.

Key Points

East Greenwich, R.I. - When faced with a potentially serious nail abnormality, some providers who take a wait-and-see approach may delay diagnosis and treatment because they aren't comfortable performing nail surgery, according to Nathaniel J. Jellinek, M.D., clinical assistant professor, department of dermatology, Brown Medical School, Providence, R.I., and adjunct clinical assistant professor, division of dermatology, University of Massachusetts Medical School, Worcester, Mass.

"I think more people need to become comfortable with nail surgery," Dr. Jellinek says. "Sometimes I see patients with clinical presentations that require nail surgery, and the only reason it wasn't done is that many people are uncomfortable with the techniques."

Surgical scrubs are gaining attention in controlling infection. The nail folds and the web spaces harbor large volumes of normal bacterial flora, Dr. Jellinek says. "However, those bacteria can be pathogenic and lead to infections after surgery." Traditionally, surgical preparation procedures for nails have been less effective than in other sites in reducing the bacterial load, leading to a greater incidence of infection, he says.

Research conducted predominantly on toenails suggests that scrubbing patients' nails for 30 seconds or longer with a bristled brush and using antiseptic combinations such as alcohol and chlorhexidine or chlorhexidine and povidone-iodine may help reduce the risk of infection.

"All seem to be more effective at decreasing the bacterial load," he says. "We presume that this is going to decrease the number of infections, and it probably does, but the studies really haven't looked at that as much as looking at the presence and absence of bacteria before and after the scrub and before and after surgery with these different scrub preparations."