From the Research
Retronychia is a nail condition that typically requires surgical management, with nail avulsion being the most effective treatment option, as evidenced by a systematic review and suggested treatment algorithm 1. Retronychia is characterized by the ingrowth of the proximal nail plate into the proximal nail fold, leading to inflammation, pain, and sometimes infection. It commonly affects the great toes, especially in young females, due to recurrent trauma and footwear-related issues. Symptoms include persistent pain, swelling, and granulation tissue formation at the nail fold.
Treatment Options
- For mild cases, conservative measures like soaking the affected toe in warm water with Epsom salt and applying topical antibiotics like mupirocin may help manage symptoms temporarily.
- However, definitive treatment almost always requires nail avulsion (removal) under local anesthesia, as it produces the highest cure rate of 78.2% 1.
- After nail removal, patients should keep the area clean and dry, apply prescribed antibiotic ointment, and wear loose-fitting shoes until healing occurs.
Prevention
- The condition can recur, especially with continued trauma to the nail, so proper footwear and avoiding activities that put pressure on the toenails are important preventive measures.
- Unlike ingrown toenails which affect the sides of the nail, retronychia involves the entire nail plate being pushed backward into the nail matrix. A recent study published in 2022 in the Journal of cutaneous and aesthetic surgery highlights the diagnostic and therapeutic approach to retronychia, emphasizing the importance of surgical management 2. Another study published in 2020 in Skin appendage disorders also supports the use of total nail plate avulsion as the most efficient treatment option 3. Overall, the evidence suggests that surgical management, specifically nail avulsion, is the most effective treatment for retronychia, with a high cure rate and relatively low risk of long-term sequelae.