What are the treatment options for a left grade 2 ingrown toenail with mild redness and mild pain but no prevalent discharge?

Treatment Options for Grade 2 Ingrown Toenail with Mild Inflammation and Pain

For a left grade 2 ingrown toenail with mild redness and mild pain but no prevalent discharge, conservative management should be attempted first, with surgical intervention reserved if conservative measures fail within 2-4 weeks. 1

Assessment of Severity

A grade 2 ingrown toenail is characterized by:

• Moderate pain
• Erythema and edema
• Possible minimal drainage
• No significant granulation tissue

Conservative Management Options

First-line Treatment

1. Warm soaks with antiseptic solution

   • Soak foot in warm, soapy water for 10-15 minutes
   • Frequency: 2-3 times daily 1
   • This helps reduce inflammation and prevents infection

2. Separation techniques

   • Place cotton wisps or dental floss under the ingrown nail edge
   • This lifts the nail from the lateral nail fold, relieving pressure 1, 2
   • Replace daily after soaking when the material is soft

3. Topical treatments

   • Mid- to high-potency topical corticosteroid ointment to reduce inflammation
   • Topical antiseptics to prevent infection 1

4. Proper footwear

   • Wear shoes with adequate toe box width
   • Avoid high heels and pointed shoes 1

Additional Conservative Measures

• Gutter splinting: Applying a small plastic tube or splint along the ingrown edge to separate it from the nail fold 3
• Cotton nail cast: Made from cotton and cyanoacrylate adhesive 3
• Proper nail trimming: Cut nails straight across, not curved at the edges 1, 2

Surgical Interventions

If conservative management fails after 2-4 weeks or if symptoms worsen, consider surgical options:

1. Partial nail avulsion

   • Removal of the ingrown portion of the nail plate
   • Thorough cleaning of the nail bed 1
   • Local anesthesia required

2. Matrixectomy options

   • Chemical matrixectomy with phenol (most effective)
   • Surgical excision of the nail matrix
   • Partial nail avulsion combined with phenolization is more effective than surgical excision alone for preventing recurrence 1, 2

Follow-Up and Monitoring

• Regular follow-up every 2-4 weeks until resolution
• Return immediately if signs of infection develop 1
• Monitor for complications:
  • Secondary infection
  • Permanent nail deformity
  • Permanent onycholysis

Important Considerations

• Antibiotics: Not routinely needed for mild cases without signs of infection 1
• Risk factors to address: Hyperhidrosis, poor foot hygiene, improper nail trimming, and tight footwear 2, 4
• Recurrence prevention: Proper nail care and appropriate footwear are essential 1

Special Populations

• Diabetic patients: Require more vigilant monitoring and earlier intervention due to increased infection risk 1
• Immunocompromised patients: Lower threshold for oral antibiotics and more aggressive treatment 1

Treatment Algorithm

1. Start with conservative measures (warm soaks, cotton wisps, proper footwear)
2. If no improvement in 2-4 weeks or worsening symptoms, proceed to surgical intervention
3. For surgical intervention, partial nail avulsion with phenolization offers the best outcomes for preventing recurrence 1, 2

Conservative management is appropriate for this grade 2 ingrown toenail with mild symptoms, but be prepared to escalate to surgical options if symptoms persist or worsen.