Treatment of Onychocryptosis (Ingrown Toenail)

Conservative Treatment Approaches

The American Academy of Dermatology recommends taping the nail fold away from the nail plate to separate the ingrown edge from underlying tissue for mild to moderate onychocryptosis 1, 2
Dental floss nail splinting, which involves inserting dental floss under the ingrown nail to separate the lateral nail edge from the underlying tissue, is a recommended conservative treatment approach 1, 2
Flexible tube splinting, where a plastic tube with a lengthwise incision is placed on the lateral edge of the nail to encapsulate it, is another conservative treatment option 1, 2
Antiseptic soaks, such as daily dilute vinegar soaks (50:50 dilution) to nail folds twice daily for 10-15 minutes, are recommended to reduce infection risk 1, 2
Topical povidone-iodine 2% can be applied twice daily to reduce inflammation and prevent infection, as suggested by the American Academy of Dermatology 1, 2, 3
Mid to high-potency topical corticosteroid ointment can be applied to nail folds twice daily to reduce inflammation in cases with edema, pain, or granulation tissue 1, 2
Topical timolol 0.5% gel can be applied twice daily under occlusion for granulation tissue (pyogenic granuloma) 1, 2, 3
Silver nitrate cauterization can be used for chemical cauterization of granulation tissue 1, 2, 3

Surgery is indicated for severe (grade 3), recurrent, or treatment-refractory onychocryptosis, according to the American Academy of Dermatology 1, 2, 3
Scoop shave removal with hyfrecation can be used for granulation tissue removal 1, 2
Acrylic treatment with gutter splint can be used for structural correction 1, 2
Intralesional triamcinolone acetonide can be used for recurrent or severe cases with persistent granulation tissue 1, 2

Reassessing after 2 weeks is crucial, and if reactions worsen or do not improve with conservative treatment, surgical intervention is necessary 3
Avoiding cutting nails too short is essential, as it is a common predisposing factor; nails should be trimmed straight and not too short 3
Wearing comfortable, well-fitting shoes and cotton socks can help prevent recurrence 3
Podiatry referral should be considered for preventive correction of nail curvature in recurrent cases 3