From the Guidelines
Recurrent toenail avulsions are a sign of underlying issues, such as fungal infections, trauma, or systemic diseases, which require prompt attention to prevent complications and improve quality of life. The most recent and highest quality study 1 provides guidance on the prevention and management of dermatological toxicities, including paronychia, which can lead to toenail avulsions. According to this study, gentle skin care, proper footwear, and avoidance of trauma can help prevent toenail avulsions.
Causes of Recurrent Toenail Avulsions
- Fungal infections (onychomycosis), which can be treated with oral antifungals like terbinafine or topical solutions like ciclopirox nail lacquer 1
- Trauma from ill-fitting shoes or repetitive pressure, necessitating proper footwear with adequate toe box space
- Ingrown toenails, which may require partial nail plate removal with phenolization to prevent recurrence
- Underlying peripheral vascular disease or diabetes, which can compromise circulation and healing, requiring medical management of these conditions
Management of Recurrent Toenail Avulsions
- Proper nail care, including keeping nails trimmed straight across, avoiding cutting too short, wearing appropriate footwear, and maintaining good foot hygiene
- Topical treatments, such as povidone iodine 2% or topical antibiotics and corticosteroids, for mild cases of paronychia 1
- Oral antibiotics or surgical intervention for more severe cases of paronychia or toenail avulsions
- Consultation with a podiatrist or dermatologist for prompt evaluation and treatment to prevent complications and address the root cause effectively.
From the Research
Recurrent Toenail Avulsions
Recurrent toenail avulsions can be a sign of underlying issues, including:
- Viral infections
- Autoimmune disorders
- Drug side effects
- Physical trauma 2
- Onychomycosis, a fungal infection of the toenails, which can cause pain and discomfort 3
- Ingrown toenails, which can be associated with granulation tissue and may require surgical treatment 4, 5
Possible Causes
Some possible causes of recurrent toenail avulsions include:
- Microtrauma associated with footwear 2
- Poor nail care or hygiene
- Abnormal nail growth or shape
- Systemic diseases, such as diabetes or peripheral artery disease
Treatment Options
Treatment options for recurrent toenail avulsions may include:
- Topical creams or ointments, such as urea 40% cream 2
- Oral antifungal medications for onychomycosis 3
- Surgical procedures, such as partial nail avulsion or matricectomy 4, 5
- Nonoperative treatment, such as nail care advice and topical antibiotics, which may be recommended for children and adolescents 6