Management of Ingrown Toenail
Initial Assessment and Classification
- Evaluate severity based on parameters including redness, edema, discharge, and granulation tissue 1
- Check for presence of pus or abscess formation which would require drainage 1
Conservative Management
- Implement warm antiseptic soaks with dilute vinegar (50:50 dilution) or povidone-iodine for 10-15 minutes twice daily 1
- Apply topical 2% povidone-iodine twice daily to the affected area 1
- Use mid to high-potency topical steroid ointment to nail folds twice daily to reduce inflammation 1
- Consider gutter splinting with a plastic tube placed on the lateral edge of the nail to provide immediate pain relief 2
Antimicrobial Therapy
- For infected ingrown toenails, oral antibiotics should be selected based on likely pathogens 1, 3
- Start with cephalexin as first-line therapy 3
- If initial treatment fails, consider switching to sulfamethoxazole-trimethoprim (Bactrim) for broader coverage including MRSA 3
- Be aware that secondary bacterial or mycological superinfections are present in up to 25% of cases 1, 3
Special Considerations
- For pyogenic granuloma formation, consider scoop shave removal with hyfrecation or silver nitrate application 1, 2
- For recurrent, severe, or treatment-refractory cases, consider intralesional triamcinolone acetonide 1, 2
- Topical timolol 0.5% gel twice daily under occlusion has shown benefit in some cases 1
Prevention of Recurrence
- Proper nail trimming technique: cut nails straight across, not too short 1, 4
- Avoid repeated friction, trauma, and excessive pressure 1, 4
- Wear comfortable well-fitting shoes and cotton socks 1, 4
- Use protective gloves during activities involving water or chemicals 1, 3
- Regular application of emollients to cuticles and periungual tissues 1, 4
Follow-up
- Reassess after 2 weeks of treatment 1, 3
- If no improvement is seen, consider referral to dermatology or podiatry for further evaluation 1, 3