A literature review of the use of phenol for nail matrix ablation on pregnant and breastfeeding patients: implications for safe use

Background Nail surgery using phenol to chemically ablate the nail matrix is a technique that has been performed for many years.  The phenolic technique of nail surgery has been refined and established as a safe and effective procedure.  Although it is used in small quantities podiatrically, phenol is readily absorbed through multiple routes such as ingestion, dermal absorption, and inhalation - the latter two being the most likely in podiatric practice.  However, given its pervasiveness as a caustic agent in nail surgery, there is a paradoxically small narrative on the safety aspects of phenol's use in pregnant and breastfeeding patients.  This paper reviews the available literature to provide a narrative response to this concern. Method A literature search to identify research evidence from electronic databases and reference lists was performed.  Evidence was also sought using Google Scholar free text keywords.  A narrative review of the literature was then performed, with agreement from all authors. Discussion Although patient safety concerns have been raised for the clinical use of a range of phenols, humans are environmentally exposed to such compounds in food, cosmetics, plastics, and resins.  For the general population, cigarette smoke and smoked food products are the most common sources of phenol exposure.  The data on phenol exposure during nail surgery and potential health consequences to the foetus are discussed. Conclusion Following calculations for the potential absorption of phenol via an EZ swab, the authors suggest that the purported risks associated with the podiatric use of phenol are overly cautious given that there is no clear association between occupational exposure to phenol and adverse pregnancy outcomes.  Although phenols are ubiquitous in the environment, these exposures have previously not been compared to those of phenol matricectomy.  Future research in this area would be highly beneficial, for example, the urinalysis of phenol before and after nail surgery in non-pregnant females.