What is the treatment for a 7-year-old girl with an ingrown toenail?

Treatment of Ingrown Toenail in a 7-Year-Old Girl

The first-line treatment for a 7-year-old girl with an ingrown toenail includes warm soaks, topical povidone-iodine 2% twice daily, and for mild to moderate inflammation, high-potency topical corticosteroids alone or combined with topical antibiotics. 1

Initial Conservative Management

For mild to moderate ingrown toenails without abscess formation:

1. Warm soaks

   • Soak the affected foot in lukewarm water for 15-20 minutes daily
   • Can add Epsom salt to the water to reduce inflammation 2

2. Topical treatments

   • Apply povidone-iodine 2% solution twice daily to prevent infection 1
   • For inflammation: High-potency topical corticosteroids are recommended by the American Academy of Dermatology 1
   • Consider combination of topical steroid with antibiotic if signs of infection are present

3. Mechanical relief techniques

   • Gently place wisps of cotton or dental floss under the ingrown lateral nail edge to separate it from the nail fold 3
   • A gutter splint applied to the ingrown nail edge can provide immediate pain relief 3

Preventive Measures

Educate the child and parents on:

• Proper nail trimming technique: Cut nails straight across, not too short 1
• Appropriate footwear: Ensure shoes have adequate toe box and aren't too tight 1
• Keep feet clean and dry 1
• Avoid trauma to the affected area 1

When to Consider Surgical Management

If conservative treatment fails or if there is:

• Abscess formation (surgical incision and drainage is mandatory) 1
• Severe pain or infection
• Recurrent ingrown toenails

Surgical options include:

• Partial nail avulsion of the lateral edge 3
• Matrixectomy (chemical, surgical, or electrosurgical) for recurrent cases 3

Special Considerations for Children

• Children may be more anxious about procedures - provide appropriate reassurance
• Surgical approaches should be reserved for cases that don't respond to conservative management
• Follow-up within 1-2 weeks to ensure proper healing 1
• Return sooner (48-72 hours) if signs of infection develop 1

Common Pitfalls to Avoid

1. Improper nail trimming: Cutting the nail too short or rounding the corners can promote ingrowth
2. Inadequate treatment of infection: Monitor for signs of worsening infection
3. Overlooking fungal superinfection: Present in up to 25% of cases 1
4. Delayed referral: If not improving with conservative measures within 1-2 weeks, consider referral to a podiatrist or dermatologist

The use of topical steroids is indeed appropriate for managing the inflammation associated with ingrown toenails, as recommended by the American Academy of Dermatology guidelines 1. They help reduce pain, swelling, and redness, making them a valuable component of conservative management.