From the Guidelines
To manage post-avulsion ingrown nail irritation characterized by sensitivity and erythema, gentle skin care and monitoring for change in severity is crucial, with interventions such as topical povidone iodine 2% and topical antibiotics/corticosteroids considered for Grade 1 treatment, as recommended by the ESMO clinical practice guidelines 1.
The management of post-avulsion ingrown nail irritation should prioritize gentle skin care instructions, including wearing comfortable shoes, avoiding biting nails or cutting nails too short, and avoiding repeated friction and trauma/excessive pressure, as outlined in the prevention strategies for paronychia 1. For Grade 1 treatment, which aligns with the symptoms described (sensitivity and erythema), the guidelines suggest continuing with the current management and monitoring for changes in severity, with the option to use topical povidone iodine 2% and topical antibiotics/corticosteroids 1.
Key considerations in managing this condition include:
- Gentle skin care to prevent further irritation
- Monitoring for signs of infection or worsening symptoms
- Use of topical treatments as recommended for Grade 1 paronychia
- Avoidance of activities that may exacerbate the condition, such as repeated trauma or pressure on the affected area
It's essential to reassess the condition after a specified period, typically 2 weeks, and adjust the treatment plan accordingly, considering progression to more severe grades of paronychia or the development of complications such as infection 1. The goal is to manage the symptoms effectively while minimizing the risk of further complications and promoting healing of the affected area.
From the Research
Management of Post-Avulsion Ingrown Nail Irritation
To manage post-avulsion ingrown nail irritation characterized by sensitivity and erythema, several methods can be employed:
- Conservative therapy, which may include correcting inappropriate footwear, managing hyperhidrosis and onychomycosis, soaking the affected toe followed by applying a mid- to high-potency topical steroid, and placing wisps of cotton or dental floss under the ingrown lateral nail edge 2
- Application of a gutter splint to the ingrown nail edge to separate it from the lateral fold, which provides immediate pain relief 2
- Use of a cotton nail cast made from cotton and cyanoacryate adhesive, taping the lateral nail fold, or orthonyxia to alleviate mild to moderate ingrown toenail 2
- Partial nail avulsion, which is a common surgical approach to remove the interaction between the nail plate and the nail fold, eliminating local trauma and inflammatory reaction 2, 3, 4, 5
- Matrixectomy, which can be performed through surgical, chemical, or electrosurgical means, and is superior to nonsurgical approaches for preventing recurrence 2
- Chemical matricectomy using agents such as phenol, sodium hydroxide, trichloroacetic acid, or bichloracetic acid, which can be used after partial nail avulsion to prevent recurrence 6, 3, 4, 5
Reducing Postoperative Complications
To reduce postoperative complications such as pain, discharge, and infection:
- Phenolization after partial nail avulsion can be used, which has been shown to reduce pain, postoperative infection, spike formation, and recurrence 3
- Bichloracetic acid matricectomy can be used, which has been shown to have minimal adverse effects, such as postoperative pain and drainage, and a low recurrence rate 5
- Trichloroacetic acid matricectomy can be used, which has been shown to have a low recurrence rate, minimal side effects, and good cosmetic results 6