Medical Management of Ingrown Nails

Initial Assessment and Conservative Management

The American Academy of Dermatology recommends daily antiseptic soaks with dilute vinegar (50:50 dilution) or 2% povidone-iodine for 10-15 minutes twice daily, and application of mid to high-potency topical steroid ointment to nail folds twice daily for inflammation, for patients with ingrown nails 1, 2
After soaking, apply a mid to high-potency topical steroid ointment to nail folds twice daily to reduce inflammation in patients with ingrown nails 1, 2

If pus is present, obtain cultures and initiate appropriate antibiotics with coverage against Staphylococcus aureus and other gram-positive organisms, as recommended by the American Academy of Dermatology 2
Daily dilute vinegar soaks (50:50 dilution) or 2% povidone-iodine to the nail folds twice daily help reduce inflammation and prevent infection in patients with ingrown nails 1, 2
For granulation tissue formation, options include scoop shave removal with hyfrecation or silver nitrate application, with a strength of evidence rated as moderate by the Journal of the American Academy of Dermatology 3, 2
For recurrent, severe, or treatment-refractory cases, doxycycline at 100 mg twice daily can be used with recommended follow-up after 1 month, as suggested by the Journal of the American Academy of Dermatology 3, 2

In cases requiring splinting, a plastic tube with a lengthwise incision can be placed on the lateral edge of the nail to encapsulate it, as described by the Journal of the American Academy of Dermatology 3, 2
Formable acrylic may be used for fixation of splints and nail prostheses in complex cases, according to the Journal of the American Academy of Dermatology 3
For onychocryptosis (ingrown nail), dental floss insertion under the ingrown nail separates the lateral nail edge from the underlying tissue, as recommended by the Journal of the American Academy of Dermatology 3

Regular nail trimming is necessary, ensuring nails are cut straight across and not too short, to prevent recurrence of ingrown nails, as suggested by the American Academy of Dermatology 1, 3
Daily application of topical emollients to cuticles and periungual tissues to maintain skin barrier function can help prevent recurrence of ingrown nails 1
Avoid repeated trauma to the nail unit by wearing comfortable well-fitting shoes and cotton socks, as recommended by the Journal of the American Academy of Dermatology 3, 1
Wear protective gloves when working with water or chemicals to prevent recurrence of ingrown nails 1
Avoid cutting cuticles or manipulating the nail folds to prevent recurrence of ingrown nails 1
Maintain good hand hygiene to prevent recurrence of ingrown nails 1
Avoid artificial nails and harsh nail products to prevent recurrence of ingrown nails 1

Persistent pain or drainage beyond 2-4 weeks may require surgical intervention, as recommended by the American Academy of Dermatology 1

Continue antiseptic soaks if inflammation persists, as suggested by the American Academy of Dermatology 1
Reassess wound healing at 2 weeks post-procedure to determine if additional interventions are needed, as recommended by the American Academy of Dermatology 1
Monitor for signs of infection including increased pain, redness, swelling, or purulent drainage, as recommended by the American Academy of Dermatology 2

The American Academy of Dermatology recommends applying a mid- to high-potency topical corticosteroid ointment to the affected nail fold twice daily, immediately after antiseptic soaking, for granulation tissue associated with ingrown toenails 4

Mid- to high-potency topical corticosteroid ointment should be used, applied to the nail folds twice daily, immediately after completing 10-15 minute antiseptic soaks with either dilute vinegar or 2% povidone-iodine, with the ointment vehicle preferred over cream for better penetration and occlusion in the periungual area 4

If granulation tissue persists despite topical corticosteroids, consider high-potency topical steroids, and add topical timolol 0.5% gel twice daily under occlusion as adjunctive therapy, with procedural options including scoop shave removal with hyfrecation or silver nitrate chemical cauterization 4, 5
For treatment-refractory cases, consider intralesional triamcinolone acetonide, and stop topical steroids immediately if infection develops, obtaining cultures and initiating appropriate antibiotics targeting common bacteria before resuming steroid therapy 4

For recurrent, severe, or treatment-refractory cases after 2-4 weeks, consider oral doxycycline 100 mg twice daily with follow-up after one month 4