To evaluate role of combination peel (15% TCA and 8% Phenol) in superficial nail plate abnormalities

• Author Details:   
• Noopur Jain
• Jeet Gandhi
• Raj Patolia ^*

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Background: Superficial nail abnormalities, including conditions like nail psoriasis, idiopathic trachyonychia, and nail lichen planus, present significant therapeutic challenges leading to cosmetic concerns.
Aims & Objectives: To evaluate the efficacy of medium depth chemical peel, specifically a trichloro-acetic acid (TCA) 15% with phenol 8% combination, to target superficial nail issues, thereby improving the overall appearance and texture as a conservative management strategy.
Materials and Methods: We conducted an open-label uncontrolled prospective study at a tertiary care centre from September 2024 to January 2025. Total 31 subjects meeting the inclusion and exclusion criteria were recruited after obtaining informed consent. The treatment involved applying the chemical peel to affected nails over multiple sessions after protecting cuticle. Objective assessment of severity was conducted using the newly devised Nail Surface Abnormality Index (NSI). Patient-perceived severity was measured using the Visual Analogue Scale (VAS), while physician-assessed severity was determined using Physician's Global Assessment (PGA) scores.
Results: From the 31 patients originally recruited, 28 completed the study and were included in the final analysis. Three patients withdrew prior to completion due to reasons unrelated to the research. The mean NSI score improved significantly from 5.47 at baseline to 2.05 after 12 weeks, while the VAS score decreased from 6.25 to 2.49, indicating a 62.5% improvement in NSI and 60.2% in VAS scores. According to the PGA score, nine patients (46.43%) showed good improvement, while eleven (39.28%) demonstrated moderate improvement. Leukonychia was seen in two patients.
Conclusion: The study demonstrates that medium depth combination chemical peels like 15% TCA & 8% Phenol can effectively improve the appearance of superficial nail abnormalities, providing a non-invasive alternative to traditional therapies.

Keywords: Nail plate abnormalities, Combination peel, Phenol, TCA.