What are the management options for an ingrown fingernail?

Management of Ingrown Fingernails

The most effective management for ingrown fingernails includes conservative measures such as warm soaks, proper nail trimming techniques, and separation of the nail from the lateral fold using cotton wisps or dental floss, with surgical intervention reserved for cases with abscess formation or failure of conservative treatment. 1

Initial Conservative Management

First-Line Approaches

• Warm water soaks: Soak the affected finger in warm, soapy water for 10-15 minutes, 2-3 times daily 1
• Vinegar soaks: 50:50 dilution of vinegar applied to nail folds twice daily 2
• Separation techniques:
  • Insert cotton wisps or dental floss under the ingrown nail edge to separate it from the lateral fold 1, 3
  • Gutter splinting using a flexible tube placed on the lateral edge of the nail 2
  • Taping the nail fold away from the nail plate 2

Topical Treatments

• For inflammation without infection:
  • Mid to high-potency topical corticosteroid ointment applied to nail folds twice daily 2, 1
  • Topical antiseptics such as 2% povidone-iodine applied twice daily 2, 1
• For mild infection:
  • Topical antibiotics with or without topical steroids 1

Management of Moderate to Severe Cases

For Abscess Formation

• Surgical drainage is mandatory if an abscess is present 1
• Drainage options include:
  • Using a hypodermic needle to lift the nail fold
  • Wide incision with a scalpel
  • Partial nail avulsion for severe cases 1

For Granulation Tissue

• Scoop shave removal with hyfrecation 2
• Silver nitrate application 2
• High-potency topical steroids 2
• Topical timolol 0.5% gel twice daily under occlusion 2

For Recurrent or Treatment-Resistant Cases

• Intralesional triamcinolone acetonide injection 2
• Partial nail avulsion with phenolization (most effective for preventing recurrence) 1, 3
• Oral antibiotics if signs of spreading infection are present 1

Surgical Approaches

Indications for Surgical Intervention

• Failure of conservative treatment
• Recurrent infections
• Severe pain and inflammation
• Presence of abscess

Surgical Options

• Partial nail avulsion: Removal of the ingrown portion of the nail 3, 4
• Partial nail avulsion with phenolization: Most effective at preventing recurrence 1, 3
• Complete nail excision: Reserved for severe cases 3

Prevention Strategies

• Proper nail trimming: Cut nails straight across, not too short 1
• Avoid trauma: Minimize repetitive friction and pressure to the nail area 1
• Keep hands dry: Avoid prolonged soaking in water 1
• Apply emollients: Daily application to cuticles and periungual tissues 1
• Appropriate glove use: Wear gloves while cleaning or doing wet work 1

Special Considerations

• Diabetic patients: Require more vigilant monitoring and earlier intervention due to increased infection risk 1
• Immunocompromised patients: Should be especially cautious about infection risk 1
• Follow-up: Regular monitoring every 2-4 weeks until resolution for chronic cases 1

When to Seek Medical Evaluation

• Abscess formation
• Signs of spreading infection
• Systemic symptoms (fever)
• Immunocompromised status
• Failure to improve with home treatment 1

Common Pitfalls to Avoid

• Cutting the nail too short or rounding the corners, which increases the risk of ingrowth
• Delaying treatment of infection, which can lead to more severe complications
• Using topical steroids in the presence of untreated infection
• Failing to address underlying causes such as improper footwear or nail care habits

The management approach should follow a stepwise algorithm, beginning with conservative measures and progressing to more invasive interventions only when necessary, always with the goal of relieving pain, resolving infection, and preventing recurrence.