Ingrown Nails
No Results
No Results
processing….
Ingrown toenail (onychocryptosis) is a fairly frequent problem resulting from either growth of nail fold inwards into the nail bed or abnormal embedding of the nail plate into the nail groove, causing significant discomfort. Although often thought to be synonymous, the terms ingrown nail and paronychia refer to different conditions. Both can cause significant discomfort. Ingrown toenails may cause pain with ambulation. See the image below.
Retronychia is a rare variant of ingrown nail in which the nail plate is embedded into the proximal nail fold with subsequent inflammation of the proximal nail fold. [1]
Ingrown nails result from an alteration in the proper fit of the nail plate in the usual nail groove. Sharp spicules of the lateral nail margin develop and are gradually driven into the dermis of the nail groove. The nail acts as a foreign body. An inflammatory response occurs in the area of penetration, leading to erythema, edema, purulence, and development of granulation tissue.
The normal distance between the nail groove and the border of the nail is 1 mm. A thin epithelial layer covers the nail groove and protects it from irritation. With an increase in pressure on the nail bed and nail groove, an epidermal breakage occurs, with subsequent inflammation, pain, and infection. [2]
Ingrown nails generally occur as the result of poorly fitted footgear. However, this may be caused by prior trauma to or abnormal shape of the nail margin. [3]
Types of ingrown nail include the following [4] :
Neonatal: Occurs as a result of delayed overgrowth of the free nail margin on the tip of the toe and can be managed conservatively (see the first image below)
Infantile: Congenital form results from malalignment of the big toenail or as a result of hypertrophy of lateral nail fold
Adolescent : Most common cause is a narrow nail bed, resulting in ingrowing distal lateral nail
Adult: Most common cause is pressure that causes sharply bent lateral margin of the nail plate
Distal embedding from a big toe nail that is too short
Retronychia
Pincer nail (see second image below)
The following factors are implicated in the development of ingrown nails:
Trimming toenails improperly: Cutting the toenail rounded, V shape or too short will cause bulging of the soft tissue and the possibility to leave a nail spur that is difficult to remove, resulting in an inflammatory reaction with pressure necrosis. The proper way to trim the toenail is to cut it straight across beyond the nail bed. [5]
Poorly fitting shoes: The nail plate can be forced out of the nail groove by footwear that has a toe box that is too small for the forefoot. The constant pressure on the nail bed and nail groove results in breakage that starts an inflammatory process and eventually results in an ingrown nail.
Nail plate abnormality: Increased curvature of the nail plate, as in pincer nail, may develop into an ingrown nail. [5] Deformities that result from prior trauma or underlying bone pathology may predispose to ingrown nails.
Excessive sweating: It was noted that ingrown nails are common among teenagers and soldiers, in whom excessive sweating is present, which results in softening of the nail fold. With the participation in sports, nail spicules may develop and can easily pierce the adjacent softened nail fold.
Obesity causing deepening of the nail groove
Drugs (eg, antiviral therapy for HIV disease): Indinavir has been reported to have an association with an increased incidence of ingrown nails. [6] Cyclosporine, docetaxel, oral antifungals, and retinoids can cause excess nail fold granulation tissue and eventual ingrown nail development. [7, 8, 9]
Generalized joint hypermobility: Joint hypermobility through changes in foot biomechanics and gate affection increases medial midfoot pressure and loading during walking, and, as the first metatarsophalangeal joint bears the highest pressure, an ingrown toenail in the big toe may develop. [10]
Onychomycosis: This infection may result in brittle nails, which may form nail spicules and pierce the adjacent nail fold.
Heredity: Some people are genetically predisposed to inwardly curved nails, with distortion of one or both nail margins.
Pathological hallux interphalangeal angle (≥14.5): This was correlated with the development of ingrown hallux nail and may act as a predisposing factor. [11]
Paronychia with sporangium formation: This was reported to cause an ingrown nail. [12]
Hematopoietic stem cell transplantation: Children with hematopoietic stem cell transplantation have a higher incidence of ingrown nails and were found to have the aggressive forms, with more than 50% of patients having nail edge and bilateral great toe involvement, as well as recurrence in 37.5%. [13]
Nail consistency: Young male runners who have a hard nail consistency were found to have a higher incidence of ingrown nail. [14]
Diabetes: The prevalence of ingrown nails was found to be higher in diabetic patients, suggesting the role of diabetic vasculopathy in the development and evolution of ingrown nails. [15]
United States
Of all nail problems, this is the most common. Toenails are affected much more commonly than fingernails. The lateral margins of the great toe are most frequently affected.
International
In the United Kingdom, 10,000 cases per year have been reported.
No racial predilection is noted.
Ingrown nail has a reported male-to-female ratio of 3:1. In reported cases of retronychia, a female predominance has been noted. [1]
The condition is observed in people of all ages but is most common in the second decade of life. Ingrown nails become much more common as children begin bearing weight on their feet and wearing shoes, although congenital onychocryptosis has been described, [16, 17] as have cases in infants. [18]
Prognosis is excellent. Complete healing is expected. In general, mortality is not associated with ingrown nails. Morbidity is chiefly the result of infection of the tissues. If neglected, abscess formation (paronychia) may occur or spread and lead to osteomyelitis, systemic infection, sepsis, or amputation.
For patient education resources, see the Foot Care Center and Skin, Hair, and Nails Center, as well as Ingrown Toenails and Paronychia.
Another good patient reference is www.familydoctor.org from the American Academy of Family Physicians.
Zaraa I, Kort R, Mokni M, Ben Osman A. Retronychia: a rare cause of chronic paronychia. Dermatol Online J. 2012 Jun 15. 18(6):9. [Medline].
Tatlican S, Yamangöktürk B, Eren C, Eskioglu F, Adiyaman S. [Comparison of phenol applications of different durations for the cauterization of the germinal matrix: an efficacy and safety study]. Acta Orthop Traumatol Turc. 2009 Aug-Oct. 43(4):298-302. [Medline].
Martinez-Nova A, Sanchez-Rodriguez R, Alonso-Pena D. A new onychocryptosis classification and treatment plan. J Am Podiatr Med Assoc. 2007 Sep-Oct. 97(5):389-93. [Medline].
Haneke E. Controversies in the treatment of ingrown nails. Dermatol Res Pract. 2012. 2012:783924. [Medline]. [Full Text].
Langford DT, Burke C, Robertson K. Risk factors in onychocryptosis. Br J Surg. 1989 Jan. 76(1):45-8. [Medline].
Luther J, Glesby MJ. Dermatologic adverse effects of antiretroviral therapy: recognition and management. Am J Clin Dermatol. 2007. 8(4):221-33. [Medline].
Baran R. Retinoids and the nails. J Dermatol Treat. 1990. 1:151-4.
Nicolopoulos J, Howard A. Docetaxel-induced nail dystrophy. Australas J Dermatol. 2002 Nov. 43(4):293-6. [Medline].
Higgins EM, Hughes JR, Snowden S, Pembroke AC. Cyclosporin-induced periungual granulation tissue. Br J Dermatol. 1995 May. 132(5):829-30. [Medline].
Erdogan FG, Tufan A, Guven M, Goker B, Gurler A. Association of hypermobility and ingrown nails. Clin Rheumatol. 2012 Sep. 31(9):1319-22. [Medline].
Córdoba-Fernández A, Montaño-Jiménez P, Coheña-Jiménez M. Relationship between the presence of abnormal hallux interphalangeal angle and risk of ingrown hallux nail: a case control study. BMC Musculoskelet Disord. 2015 Oct 15. 16:301. [Medline].
Wang CY, Hong CC, Su TF, Chang SC. Paronychia with Sporangium Formation Causing an Ingrown Toenail A Rare Case Report. J Am Podiatr Med Assoc. 2017 Nov 8. [Medline].
Ezekian B, Englum BR, Gilmore BF, Kim J, Leraas HJ, Driscoll TA, et al. Children Receiving Hematopoietic Stem Cell Transplantation are at Increased Risk of Onychocryptosis Requiring Surgical Management. J Pediatr Hematol Oncol. 2017 Oct. 39 (7):e353-e356. [Medline].
Pico AM, Verjano E, Mayordomo R. Relation Between Nail Consistency and Incidence of Ingrown Toenails in Young Male Runners. J Am Podiatr Med Assoc. 2017 Mar. 107 (2):137-143. [Medline].
Vural S, Bostanci S, Koçyigit P, Çaliskan D, Baskal N, Aydin N. Risk Factors and Frequency of Ingrown Nails in Adult Diabetic Patients. J Foot Ankle Surg. 2018 Mar – Apr. 57 (2):289-295. [Medline].
Grassbaugh JA, Mosca VS. Congenital ingrown toenail of the hallux. J Pediatr Orthop. 2007 Dec. 27(8):886-9. [Medline].
Lee JH, Kim SE, Park K, Son SJ. Congenital ingrown toenails successfully treated with simple plastic tube insertion. Int J Dermatol. 2008 Feb. 47(2):209-10. [Medline].
Sarifakioglu E, Yilmaz AE, Gorpelioglu C. Nail alterations in 250 infant patients: a clinical study. J Eur Acad Dermatol Venereol. 2008 Jun. 22(6):741-4. [Medline].
Ozdemir E, Bostanci S, Ekmekci P, Gurgey E. Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrowing toenails. Dermatol Surg. 2004 Jan. 30(1):26-31. [Medline].
Seyfettinoglu F, Sünneli Ö, Dülgeroglu A, Bora OA. A case of ingrown toenail accompanied by extreme soft tissue hypertrophy to the extent of invisible nail. Acta Orthop Traumatol Turc. 2012. 46(5):407-10. [Medline].
Dadaci M, Ince B, Altuntas Z, Kamburoglu HO, Bitik O. Skin bridging secondary to ingrown toenail. Pak J Med Sci. 2014 Nov-Dec. 30 (6):1425-7. [Medline].
Lee KW, Burm JS, Yang WY. Keloid formation on the great toe after chronic paronychia secondary to ingrown nail. Int Wound J. 2013 Apr. 10(2):200-2. [Medline].
Senapati A. Conservative outpatient management of ingrowing toenails. J R Soc Med. 1986 Jun. 79(6):339-40. [Medline]. [Full Text].
Manca D. Practice tips. Taping toes. Effective treatment for ingrown toenails. Can Fam Physician. 1998 Feb. 44:275. [Medline]. [Full Text].
Wallace WA, Milne DD, Andrew T. Gutter treatment for ingrowing toenails. Br Med J. 1979 Jul 21. 2(6183):168-71. [Medline]. [Full Text].
Watabe A, Yamasaki K, Hashimoto A, Aiba S. Retrospective evaluation of conservative treatment for 140 ingrown toenails with a novel taping procedure. Acta Derm Venereol. 2015 Sep. 95 (7):822-5. [Medline].
Ozdil B, Eray IC. New method alternative to surgery for ingrown nail: angle correction technique. Dermatol Surg. 2009 Jun. 35(6):990-2. [Medline].
Woo SH, Kim IH. Surgical pearl: nail edge separation with dental floss for ingrown toenails. J Am Acad Dermatol. 2004 Jun. 50(6):939-40. [Medline].
Moriue T, Yoneda K, Moriue J, Matsuoka Y, Nakai K, Yokoi I, et al. A simple therapeutic strategy with super elastic wire for ingrown toenails. Dermatol Surg. 2008 Dec. 34(12):1729-32. [Medline].
Erdogan FG, Erdogan G. Long-term results of nail brace application in diabetic patients with ingrown nails. Dermatol Surg. 2008 Jan. 34(1):84-6; discussion 86-7. [Medline].
Ince B, Dadaci M, Altuntas Z. Knot technique: a new treatment of ingrown nails. Dermatol Surg. 2015 Feb. 41 (2):250-4. [Medline].
Nishioka K, Katayama I, Kobayashi Y, Takijiri C, Nishioka K. Taping for embedded toenails. Br J Dermatol. 1985 Aug. 113 (2):246-7. [Medline].
Arai H, Arai T, Nakajima H, Haneke E. Formable acrylic treatment for ingrowing nail with gutter splint and sculptured nail. Int J Dermatol. 2004 Oct. 43(10):759-65. [Medline].
Ozan F, Dogar F, Altay T, Ugur SG, Koyuncu S. Partial matricectomy with curettage and electrocautery: a comparison of two surgical methods in the treatment of ingrown toenails. Dermatol Surg. 2014 Oct. 40(10):1132-9. [Medline].
Livingston MH, Coriolano K, Jones SA. Nonrandomized assessment of ingrown toenails treated with excision of skinfold rather than toenail (NAILTEST): An observational study of the Vandenbos procedure. J Pediatr Surg. 2017 May. 52 (5):832-836. [Medline].
Issa MM, Tanner WA. Approach to ingrowing toenails: the wedge resection/segmental phenolization combination treatment. Br J Surg. 1988 Feb. 75(2):181-3. [Medline].
Tatlican S, Yamangöktürk B, Eren C, Eskioglu F, Adiyaman S. [Comparison of phenol applications of different durations for the cauterization of the germinal matrix: an efficacy and safety study]. Acta Orthop Traumatol Turc. 2009 Aug-Oct. 43(4):298-302. [Medline].
Barreiro KN, Moradi M, Merrill T, Losito J, Southerland C, Buckley B. Healing efficacy and participant outcomes of chemical matrixectomies using a hydrogel containing oakin. J Am Podiatr Med Assoc. 2014 Nov. 104 (6):617-21. [Medline].
Bostanci S, Kocyigit P, Gürgey E. Comparison of phenol and sodium hydroxide chemical matricectomies for the treatment of ingrowing toenails. Dermatol Surg. 2007 Jun. 33(6):680-5. [Medline].
Bostancı S, Koçyiğit P, Güngör HK, Parlak N. Complications of sodium hydroxide chemical matrixectomy: nail dystrophy, allodynia, hyperalgesia. J Am Podiatr Med Assoc. 2014 Nov. 104 (6):649-51. [Medline].
Terzi E, Guvenc U, Türsen B, Kaya TI, Erdem T, Türsen Ü. The effectiveness of matrix cauterization with trichloroacetic acid in the treatment of ingrown toenails. Indian Dermatol Online J. 2015 Jan-Feb. 6(1):4-8. [Medline]. [Full Text].
Ozawa T, Nose K, Harada T, Muraoka M, Ishii M. Partial matricectomy with a CO2 laser for ingrown toenail after nail matrix staining. Dermatol Surg. 2005 Mar. 31(3):302-5. [Medline].
Ali SM, Ahmed GS, Tahir SM. Outcome of partial nail plate and matrix removal (Winograd technique) for ingrown toe nail. J Liaquat Uni Med Health Sci. 2013. 12:182-5.
Kim M, Song IG, Kim HJ. Partial Removal of Nail Matrix in the Treatment of Ingrown Nails: Prospective Randomized Control Study Between Curettage and Electrocauterization. Int J Low Extrem Wounds. 2014 Sep 25. [Medline].
Córdoba-Fernández A, Rodríguez-Delgado FJ. Anaesthetic digital block with epinephrine vs. tourniquet in ingrown toenail surgery: a clinical trial on efficacy. J Eur Acad Dermatol Venereol. 2014 Oct 3. [Medline].
Amira M Elbendary, MBBCh, MSc Visiting Dermatopathology Fellow, Ackerman Academy of Dermatopathology; Assistant Lecturer, Department of Dermatology, Kasr Alainy University Hospitals, Cairo University, Egypt
Amira M Elbendary, MBBCh, MSc is a member of the following medical societies: Bloom’s Syndrome Association, Egyptian Medical Syndicate, International Dermoscopy Society, Medical Dermatology Society
Disclosure: Nothing to disclose.
Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi
Disclosure: Nothing to disclose.
William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine
William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology
Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.
Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center
Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association
Disclosure: Nothing to disclose.
Thomas Craig, MD Resident Physician, Department of Emergency Medicine, Naval Medical Center
Disclosure: Nothing to disclose.
Ann G Egland, MD Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center
Ann G Egland, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Military Surgeons of the US, Medical Society of Virginia, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Ingrown Nails
Research & References of Ingrown Nails|A&C Accounting And Tax Services
Source
0 Comments