From the Guidelines
To manage post-avulsion ingrown nail irritation characterized by persistent sensitivity and erythema, it is essential to prioritize wound care and prevention of further irritation, as outlined in the most recent and highest quality study 1. The management of post-avulsion ingrown nail irritation involves a combination of wound care, pain management, and prevention of further irritation.
- Soaking the affected toe in warm water with Epsom salt for 15-20 minutes, 2-3 times daily, can help reduce inflammation and promote healing.
- After soaking, gently cleaning the area with mild soap, pat drying, and applying an antibiotic ointment like Neosporin or Polysporin can help prevent infection.
- Covering the area with a clean bandage can protect it from further irritation.
- Taking over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help manage pain and reduce inflammation.
- Wearing loose, comfortable shoes that don't put pressure on the toe can also help reduce irritation. According to the ESMO clinical practice guidelines 1, gentle skin care instructions, including wearing comfortable shoes, wearing gloves while cleaning, and avoiding biting nails or cutting nails too short, can help prevent further irritation. It is also essential to monitor for signs of infection, such as increasing pain, swelling, pus, or red streaks extending from the toe, and seek medical attention if these symptoms occur. The redness and sensitivity are normal inflammatory responses to the procedure, but proper wound care and prevention of further irritation can help promote healing and reduce the risk of complications, as supported by the study 1.
From the Research
Management Options for Post-Avulsion Ingrown Nail Irritation
The management options for post-avulsion ingrown nail irritation characterized by persistent sensitivity and erythema (redness) include:
- Nonsurgical treatments such as 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
- Surgical approaches that remove the interaction between the nail plate and the nail fold to eliminate local trauma and inflammatory reaction, such as partial avulsion of the lateral edge of the nail plate 2
- Matrixectomy, which can be performed through surgical, chemical, or electrosurgical means, to further prevent recurrence 2
- Phenolization after partial nail avulsion, which has been shown to reduce postoperative pain, infection, and recurrence compared to partial nail avulsion alone 3, 4, 5
- Trichloroacetic acid (TCA) matricectomy, which has been shown to have a low recurrence rate with minimal side effects and is easy to perform in an outpatient clinic 6
Comparison of Treatment Options
Some studies have compared the effectiveness of different treatment options, including:
- Partial nail avulsion with phenolization versus partial nail avulsion alone, with the former showing better results in terms of reducing postoperative pain, infection, and recurrence 3
- Partial nail avulsion followed by phenolization versus direct surgical excision of the nail matrix, with both being equally effective in treating ingrown toenails 5
- Partial nail avulsion combined with phenolization versus surgical excision of the nail without phenolization, with the former being more effective at preventing symptomatic recurrence but having a slightly increased risk of postoperative infection 5