From the Guidelines
For an infected ingrown toenail, the most effective treatment option is to partially remove the nail and prescribe oral antibiotics, as this approach addresses both the infection and the physical obstruction caused by the ingrown nail. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of addressing the underlying cause of the infection and taking a comprehensive approach to treatment 1.
Treatment Options
- Soaking the foot in warm water with Epsom salt for 15-20 minutes, 3-4 times daily, can help reduce pain and inflammation.
- Applying an antibiotic ointment like Neosporin or Polysporin and covering with a clean bandage can help prevent further infection.
- Taking over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) as needed for pain can help manage symptoms.
- Gently lifting the ingrown edge of the nail using a clean cotton wisp or dental floss, placing it under the nail edge to help it grow above the skin, can help alleviate pressure.
- Wearing open-toed shoes or sandals can reduce pressure on the toe.
When to Seek Medical Attention
- If you notice increasing redness, swelling, pus, red streaks extending from the toe, or have diabetes, seek medical attention promptly.
- A healthcare provider may need to partially remove the nail and prescribe oral antibiotics like cephalexin (500mg four times daily for 7-10 days) or clindamycin (300mg four times daily for 7-10 days) to treat the infection effectively 1.
Importance of Addressing Underlying Cause
- Infections occur because the broken skin barrier allows bacteria, typically Staphylococcus aureus, to enter and multiply in the warm, moist environment around your toenail.
- Addressing the underlying cause of the infection, such as the ingrown nail, is crucial for effective treatment and prevention of further complications 1.
From the Research
Treatment Options for Infected Ingrown Toenail (Onychocryptosis)
The treatment options for an infected ingrown toenail can be categorized into nonsurgical and surgical approaches.
- Nonsurgical treatments are typically used for mild to moderate ingrown nails and include:
- Correcting inappropriate footwear
- Managing hyperhidrosis and onychomycosis
- Soaking the affected toe followed by applying a mid- to high-potency topical steroid
- Placing wisps of cotton or dental floss under the ingrown lateral nail edge
- Application of a gutter splint to the ingrown nail edge to separate it from the lateral fold
- A cotton nail cast made from cotton and cyanoacrylate adhesive, taping the lateral nail fold, or orthonyxia 2
- Surgical approaches are used in moderate and severe cases and include:
- Partial avulsion of the lateral edge of the nail plate
- Matrixectomy, which can be performed through surgical, chemical, or electrosurgical means 2
- Chemocautery with phenol or a surgical partial matricectomy 3
- Various surgical techniques such as the Winograd technique, Vandenbos procedure, chemical matricectomy, radiofrequency ablation, bipolar diathermy, carbon dioxide laser ablation, Zadik's procedure, Howard-Dubois procedure, Super U procedure, Noël's procedure, knot technique, and toenail paronychium flap 4
- Partial nail avulsion or complete nail excision with or without phenolization
- Electrocautery, radiofrequency, and carbon dioxide laser ablation of the nail matrix 5
Considerations for Treatment
The choice of treatment depends on the severity and recurrence of the ingrown toenail, as well as the presence of infection 4, 5.
- Oral antibiotics before or after phenolization do not improve outcomes 5
- Partial nail avulsion followed by either phenolization or direct surgical excision of the nail matrix are equally effective in the treatment of ingrown toenails 5
- Compared with surgical excision of the nail without phenolization, partial nail avulsion combined with phenolization is more effective at preventing symptomatic recurrence of ingrowing toenails, but has a slightly increased risk of postoperative infection 5