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Hi was wondering whether anyone could help,

I need to do nail surgery on a patient who is taking methotrexate and was wondering if he needs to stop taking it before surgery or are there any contra indications if use phenol,

as have asked my boss and even he is unsure.

hope someone can help

many thanks

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Methotrexate is a folic acid analogue and is (amongst other features) a potent inhibitor of some types of immune response.

It is not a contra-indication to nail surgery per se, but because of the healing period following phenolisation, you should consider an incisional technique. I cannot do better than to quote from Goodman & Gillman:

"It is imperative that a skilled medical team and sophisticated facilities, particularly abundant platelet transfusions and measures for preventing and combating infections, be available to provide the intense supportive therapy necessary to control the severe toxic manifestations that may result when intensive dosage schedules are used"

In other words, much depends on the current situation, the current health of the patient, and it would most certainly be wise to have a chat to the consultant in charge of the case, or better still outline your concerns in a letter.

All the best

Bill Liggins

Related threads:
Is Phenol cautery contraindicated in Pregnancy?
Other threads tagged with ingrown toenail

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