Abstract
Background
Surface abnormalities of the nail may be due to nail diseases or chemical abuse. So, every nail plate change does not require medical treatment. The aim of our study was to support the benefit of glycolic acid (GA) in both pathological conditions and dry, discolored nails due to cosmetics.
Methods
A prospective single open label uncontrolled study is conducted in our department from January until April 2017. We divided our cases into 2 groups: G1 (consequences of cosmetics) and G2 (pathological conditions). In G1, we used 1–2 coat of GA 50% in 1–2 sitting at weekly intervals, but we needed multiple sittings (6–12 weeks) in G2 with 2–4 coats.
Results
We have collected 20 cases: 12 in G1 and 8 in G2. In G1, 8 patients had good response. In G2, 6 had good response. Adverse effects were tolerable.
Conclusion
Good response in G1 was also noted in the Indian report. The improvement in the chemotherapy side effect led us to widen the sample in order to have more credible results. GA 50% peels can offer aesthetically better looking nails. However, larger studies with a longer follow-up are required to validate the results.
Introduction
Physical appearance, including the nails, is an important part of an individual's overall well-being. The nail tablet can be subject to superficial abnormalities (rough, dull, discolored, and hyperkeratosis). These abnormalities are due either to mechanical aggressions (iterative manicures), chemical aggressions (acetone and others), or pathologies (onychomycosis, lichen planus (LP), psoriasis, and nutrient deficiencies) [1]. The glycolic acid (GA) peel, which is a powerful exfoliant responsible for breaking the disulfide bonds of the keratin in the nail tablet, softens, separates, and causes desquamation of corneocytes. The objective of our study was to evaluate the role of GA both in the treatment of nail surface abnormalities of pathological origin and in dry, striated, and dyschromic nails due to the misuse of cosmetics.
Materials and Methods
We conducted a prospective monocentric study in the dermatology and venereology department of the Ibn Rochd University Hospital of Casablanca, between January 2017 and May 2017. We hired 2 groups of patients: group 1 (G1) includes rough, dull, and discolored nails due to cosmetic and chemical abuse, and group 2 (G2) includes patients with nail surface abnormalities secondary to pathological situations. We have excluded any (bacterial/viral) infection or inflammation of the periungual area, very thin nails, and hypersensitivity to GA. We used 50% GA.
The procedure consisted of 4 steps:
Cleaning the nail with water.
Protection of the cuticle and the periungual area by applying simple Vaseline.
Application of the GA with a cotton-tipped swab on the tablet in 1 to 2 layers for G1 and in 2 to 4 layers for G2.
Finally, rinsing with water or neutralizer after 45 min of application.
The G1 had benefited from 1 to 2 sessions and the G2 from 6 to 12 sessions (depending on the thickness of the nail) at an interval of 1 week. The response was expressed as good, fair, or absent.
Between sessions, we advised our patients to proceed with daily hydration of the nails and the maintenance of the G2 background treatment. Failure was reported after 8 sessions in G2. Informed consent to participate in the study and to take photographs was obtained from all patients.
Results
Twenty patients were collated of which 12 in G1 and 8 in G2 (3 cases of onychomycosis, 3 cases of LP, 1 case of eczema, and 1 case of chromonychia due to chemotherapy). All our patients were female. No patients withdrew from the study. Eight patients from G1 responded well (66.66%) (Fig. 1), 2 had a moderate response (16.66), and 2 did not respond to the peel (16.66). In the G2, we had a good response in all cases of onychomycosis, 2 cases of LP (Fig. 2), and 1 case of chromonychia. On the other hand, we noted an absence of response in 1 case of LP and the case of eczema. The adverse effects reported were periungual irritation (2 cases) and leukonychia (1 case). These effects were minimal and tolerable.
Fig. 1.
Good response after only 1 peeling session in a patient with discoloration of the nail tablet due to chemicals aggressions.
Fig. 2.
Good response after several peeling sessions in a patient with ungual lichen.
Discussion
The originality of our study lies in the fact that it would be the 2nd of its kind that evaluates the effectiveness of nail peeling by GA to improve the appearance of nails altered by situations of systemic disease, dermatological pathology, or by repeated use of cosmetics and chemicals. Indeed, not every modification of the tablet requires medical treatment [2]. Moreover, GA has been used as a keratolytic agent in various skin conditions for a long time due to its low molecular weight, which allows good penetration and controlled keratolysis. It has the additional property of being a humectant [3] and an enhancer to facilitate transungual drug transfer [4]. All these properties refer to its ability to have aesthetically improved nails.
The percentage of good response in cases of onychomycosis and nails, altered by cosmetics and chemicals, is higher in a study conducted in India than the result found in our study (82 vs. 66.6%). This could be explained by the fact that the Indian study evaluated the efficacy of GA at 70% and not 50%. In onychomycosis, alteration of the nail tablet may persist despite mycological healing. Keratolysis would thus improve the penetration of a topical antifungal agent such as amorolfin to accelerate mycological and esthetic healing. The good response in the case of plan lichen has been observed in forms stabilized after corticosteroid therapy. The slight difference in the results of Banga and Patel's study compared to ours would probably be explained by the lower concentration of AG in our series and by the indications we added in G2 as eczema and chromonychia due to chemotherapy.
Conclusion
Nail peeling with 50% or even 70% GA is an effective and well-tolerated esthetic modality for the treatment of nails that are pathological or altered by chemical abuse. However, studies with a larger sample are necessary to validate our results.
Statement of Ethics
This study was carried out in accordance with the principles set out in the Declaration of Helsinki and with local ethical guidelines (Ethics Committee for Biomedical Research, Faculty of Medicine and Pharmacy, Casablanca, Morocco).
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
The authors have no funding sources to declare.
Author Contributions
Soumiya Chiheb: conception of the work. Ibtissam Benslimane Kamal: acquisition, analysis, and interpretation of data. Amal Elfiboumi: acquisition, analysis, and interpretation of data. Fouzia Hali: revinsing critically the work.
References
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