By Louise Gagnon
Both 70% glycolic acid and 15% phenol were effective in improving the appearance of nails, according to a prospective, open label, pilot study presented at the annual meeting of the American Academy of Dermatology in San Francisco. Investigators performed a left-right comparison using a standardized scoring tool that measures nail surface abnormalities plus before-and-after photographs to track improvement in nails among 12 participants. They found improvement in the nail score, Visual Analog Scale as measured by patient perception of therapy, and physician assessment. Of 12 patients, nine reported satisfaction with chemical peels.
“They are both equally effective,” says Soni Nanda, MD, a dermatologist at Delhi, India, and a consultant at Max Hospital and Ex. Medical Head Kaya Skin Clinic (North) in Delhi. “Phenol might be a better option for thicker nails because it is a deeper peel, but for nails that are thin or brittle, glycolic acid is a better option.”
Nail splitting was seen more often in nails treated with phenol, suggesting that intervals between phenol peels should be more spaced out than intervals between glycolic acid peel treatments.
The current management of nail abnormalities include the use of intralesional steroids, intralesional methotrexate, and moisturizers, says Nanda, but these treatments can be painful and produce side effects. Ultimately, patients are seeking a cosmetic improvement in their nails, she says. “We may just be able to improve the look of the nail, and that may be all that the patient is looking for,” she says. “Chemical peels are a treatment modality with which clinicians already have familiarity, are inexpensive, and are painless for patients.”
Of note, clinicians applied petrolatum jelly to protect the cuticle from the peel. “You don’t want the peel going in the cuticle because it will burn the cuticle,” says Nanda. Next, Nanda and colleagues plan to conduct a study with 50 patients to further assess the safety and efficacy of chemical peels for nail disorders.
Sandy Tsao, MD, Assistant Professor of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, who moderated the oral presentation session in which the research was presented, described the concept of using chemical peels to treat nail disorders as exciting because it presents another potential treatment option for patients with long-standing nail abnormalities.
“It is very distressing for patients to have long-standing pitting, longitudinal ridges, or any kind of change to the nail surface that appears atypical,” says. Tsao in an interview with Plastic Surgery Practice. “People feel they don’t want to show their hands or shake hands because others will think they have an illness. They don’t need to be treated from a medical perspective, but from a cosmetic perspective, and an emotional perspective, it makes a huge difference in a person’s self-esteem.”
Chemical peels are safe and “it seems very reasonable” that they could be repeated on an ongoing basis, says Tsao. “Chances are that you might have three to six treatments and then undergo maintenance treatment.”.
Comparing the two types of peels studied, Tsao noted that phenol peels are more aggressive, and put forth that other medium depth peels might be considered for superficial abnormalities such as trichloroacetic acid.