An ingrown nail is very common and represents a foreign body reaction of the periungual skin to the edge of the nail. The more the skin inflames, the more the area swells, leading to more pressure by the nail. Secondary infection is common.
The nail gets driven into the tissue which then swells causing a viscous cycle. Young people and the big toe are most commonly affected. Trauma, improper nail cutting and anatomic abnormalities of the nail may predispose.
Various approaches may be used including eliminating shoes that cause direct pressure, reducing exercise that contributes to trauma, warm soaks and oral antibiotics. Some have recommended using tape to pull the tissue back, away from the nail. The patient should be educated on correct nail clipping.
The application BID of a potent topical steroid for a week may help. The steroid should be applied immediately after water-soaking to increase penetration.
If these conservative measures fail, the lateral 1/3 of the nail on that side may be avulsed. If permanent cure is desired and the patient accepts the consequence of permanent nail dystrophy, the nail matrix may be ablated as well.
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