What is the treatment for an ingrown toenail infection?

Treatment for Ingrown Toenail Infection

The most effective treatment for an ingrown toenail infection includes warm water soaks, appropriate antibiotic therapy, and surgical intervention for moderate to severe cases.

Initial Assessment and Conservative Management

For mild to moderate ingrown toenail infections:

1. Foot soaking:

   • Soak the affected foot in warm, soapy water 3-4 times daily 1
   • Adding Epsom salt to the water can help reduce inflammation 2

2. Separation technique:

   • After soaking, gently place cotton wisps or dental floss under the ingrown nail edge to separate it from the lateral nail fold 1, 3
   • This helps the nail grow above the skin edge rather than into it

3. Topical treatment:

   • Apply a mid- to high-potency topical steroid to reduce inflammation 3
   • For infected ingrown toenails, topical antibiotics may be used for mild superficial infections 4

4. Gutter splinting:

   • Application of a gutter splint to the ingrown nail edge provides immediate pain relief 3
   • Can be combined with an acrylic nail for better results 1

Antibiotic Therapy for Infection

When infection is present:

1. For mild infections:

   • Narrow-spectrum antibiotics targeting gram-positive cocci (particularly staphylococci) are sufficient 4
   • Duration: 1-2 weeks is usually adequate 4

2. For moderate infections:

   • Oral antibiotics with good bioavailability can be used 4
   • Duration: 2-4 weeks depending on response 4

3. For severe infections:

   • Parenteral (IV) antibiotic therapy is required initially 4
   • Broad-spectrum empirical therapy may be needed pending culture results 4
   • Consider local antibiotic resistance patterns, especially MRSA prevalence 4

Surgical Management

Surgical intervention is indicated for:

• Moderate to severe ingrown toenails
• Cases with significant infection
• Recurrent ingrown toenails

The most effective surgical approaches include:

1. Partial nail avulsion:

   • Removal of the ingrown lateral edge of the nail plate 3
   • Provides immediate relief and allows drainage of any infection

2. Partial nail avulsion with phenolization:

   • More effective than surgical excision alone for preventing recurrence 1
   • Chemical destruction of the lateral nail matrix prevents regrowth of the problematic portion

3. Complete nail excision:

   • Reserved for severe cases with extensive infection or deformity 1

Important Considerations and Pitfalls

1. Diabetic patients require special attention:

   • Provide appropriate treatment for any ingrown toenail to help prevent foot ulcers in diabetic patients at risk of ulceration 4
   • Early intervention is crucial to prevent complications

2. Fungal co-infection:

   • If onychomycosis (fungal nail infection) is present alongside the ingrown toenail, it should be treated appropriately 3
   • For dermatophyte infections, oral terbinafine (250 mg daily for 12-16 weeks for toenails) is the first-line treatment 4

3. Prevention of recurrence:

   • Proper nail trimming technique (straight across, not rounded at corners)
   • Appropriate footwear that doesn't compress the toes
   • Managing hyperhidrosis if present 3

4. Follow-up:

   • Patients with infected wounds require early and careful follow-up to ensure the selected treatment is effective 4
   • If infection fails to respond to antibiotic therapy in a clinically stable patient, consider discontinuing antibiotics and obtaining optimal culture specimens after a few days 4

When to Seek Surgical Consultation

Immediate surgical consultation is warranted for:

• Deep abscess
• Extensive tissue involvement
• Substantial necrosis
• Signs of spreading infection 4

By following this structured approach to treating ingrown toenail infections, most cases can be successfully managed with minimal complications and reduced risk of recurrence.