Therapeutic pearl: Chemical sealing of the nail plate and its gutter for treating lateral nail plate dystrophy of the fingernail

Dear Editor,

Chronic onychodystrophy of the lateral fingernail plate is common. The factors causing onychodystrophy are water (moisture), microorganisms, allergens, irritants, and foreign bodies that are lodged in the gutter. Due to this, the gutter and its lateral nail plate get macerated, infected, and dystrophic as they are not protected by the cuticle and hyponychial fibrous band. Thus, topical treatments and precautions are required for the long term. However, in general, during treatment of the lateral nail dystrophy, we are not sealing the gutter and lateral nail plate to keep the space and nail plate dry, which is the main cause of the nail dystrophy.

Under asepsis, the nail gutter is cleaned with a blunt hypodermic needle. Then the gutter is washed out with Betadine and normal saline for the removal of residual debris. After this, the gutter is mopped to make it dry, and cyanoacrylate glue (1–2 drops) is poured into the nail gutter and lateral nail plate. No other treatment was given. The patient was checked in every 2 weeks, and the glue was applied once a day by the patient for 4–6 months. The patients are allowed to do their routine jobs with general precautions to keep the gutter dry. The dystrophic lateral nail plate is replaced by a healthy nail plate [Figure 1a-d]. There were no local side effects noticed at the site. Thus, the glue is helpful in sealing and protecting the gutter and lateral nail plate from the offending factors.

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Figure 1:

(a-d) The dystrophic lateral nail plate is replaced with a healthy nail plate about 4 month later.

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