Behandeling van ingegroeide teennagels*

Objective

To provide a systematic overview of the effectiveness of conservative and surgical treatments aimed at preventing the regrowth or a recurrence of an ingrown toenail.

Design

Systematic review.

Method

Using various search terms, we looked for randomized controlled trials on ingrown toenails in the following databases: Cochrane Skin Group Specialised Register, Cochrane Library, Medline, Embase, CINAHL and Web of Science. Two authors assessed all articles on inclusion and exclusion criteria and methodological quality.

Results

We found 24 studies with 25 interventions and 2826 participants in total. Five studies concerned conservative treatments, 16 involved surgical treatments and four covered pre- or post-operative treatments. On average, there were 188 patients per study; each study was divided into 2, 3 or more arms. The percentage of patients lost to follow-up ranged from 1 to 42%. For only a small portion of the items in the risk of bias table was a good explanation for the high risk of bias. Surgical treatments were better at preventing recurrence than conservative treatments. The addition of phenol to a surgical treatment reduced the risk of recurrence in one study (14 vs. 41%; RR: 0.34; 95% CI: 0.17-0.69). Post-operative interventions did not lead to fewer post-operative infections, less post-operative pain or shorter recovery times.

Conclusion

Surgical interventions are more effective than non-surgical interventions in preventing the recurrence of an ingrown toenail. The addition of phenol to a surgical intervention reduces the risk of recurrence. Pre- or post-operative treatments are not effective.

Conflict of interest: financial remuneration has been declared (see www.ntvg.nl, search for A5403; click on ‘Belangenverstrengeling’ (‘Conflict of interest’). Financial support for this article: none declared.