What topical antibiotic is recommended for an ingrown toenail?

Topical Antibiotic Treatment for Ingrown Toenails

For ingrown toenails, a combination of topical povidone-iodine 2% and topical antibiotics with corticosteroids is recommended as the first-line topical antibiotic treatment 1.

Initial Treatment Approach

• Apply topical 2% povidone-iodine to the affected area to provide antimicrobial coverage 1
• Use daily dilute vinegar soaks (50:50 dilution) to the nail folds twice daily for 10-15 minutes to reduce bacterial load 1
• Apply mid to high-potency topical steroid ointment combined with topical antibiotics to the nail folds twice daily to reduce inflammation and prevent infection 1
• If pus is present, obtain a culture before initiating antibiotic therapy to ensure appropriate coverage 1

Management Based on Severity

Mild Cases (minimal inflammation)

• Topical povidone-iodine 2% application is sufficient for initial treatment 1
• Avoid cutting the nail too short, which can worsen the condition 1
• Separate the lateral nail edge from the underlying tissue using dental floss or cotton wisps under the ingrown nail edge 1, 2

Moderate Cases (with pain and inflammation)

• Continue topical povidone-iodine 2% application 1
• Add topical antibiotics with corticosteroids to reduce inflammation and prevent secondary infection 1
• Consider taping the nail fold away from the nail plate to reduce pressure and pain 1
• Gutter splinting with a flexible tube can provide immediate pain relief 2

Severe Cases (with infection)

• Oral antibiotics may be necessary in addition to topical treatments 1
• Mupirocin ointment can be effective for superficial infections, with clinical efficacy rates of 71-93% 3
• Consider partial nail avulsion if conservative measures fail 2, 4

Mechanical Interventions

• Proper nail trimming technique is essential - cut straight across, not too short 1, 4
• For onychocryptosis (ingrown nail), use dental floss or cotton to separate the nail edge from the lateral fold 1, 4
• Splinting with a flexible tube can provide immediate relief by separating the nail from the inflamed tissue 1, 2
• Cotton wick saturated with iodine tincture inserted into the affected sulcus can be effective in over 80% of cases 5

Treatment of Complications

• For granulation tissue, apply silver nitrate chemical cauterization 5
• If secondary fungal infection is present, consider topical antifungals such as amorolfine 5% lacquer or ciclopirox 8% lacquer 1, 6
• For recurrent or severe cases that don't respond to conservative treatment, surgical approaches may be necessary 2, 4

Important Considerations

• Avoid using topical steroids if infection is suspected, as they can worsen the condition 1
• Preventive measures include wearing comfortable shoes, avoiding cutting nails too short, and maintaining good foot hygiene 1, 7
• Patients with diabetes or peripheral vascular disease require more aggressive treatment and closer monitoring 2
• Partial nail avulsion combined with phenolization is more effective at preventing recurrence than surgical excision alone, but carries a slightly increased risk of postoperative infection 4