Treatment of Ingrown Toenail with Redness in an 87-Year-Old
Topical mupirocin (Bactroban) applied three times daily is the recommended treatment for an ingrown toenail with surrounding redness in an elderly patient, with daily antiseptic soaks as adjunctive therapy. 1
Initial Assessment and Management
- The redness around the ingrown nail likely represents a bacterial infection, most commonly caused by Staphylococcus aureus, which requires appropriate antimicrobial therapy 2
- Bacterial cultures should be obtained if purulent discharge is present before initiating antibiotic therapy 3
- A small amount of mupirocin ointment should be applied to the affected area three times daily, and the area may be covered with a gauze dressing if desired 1
Adjunctive Therapies
- Daily antiseptic soaks with dilute vinegar (50:50 dilution) or 2% povidone-iodine for 10-15 minutes twice daily help prevent infection and promote healing 3
- For inflammation and edema of the nail fold, mid to high potency topical steroid ointment can be applied twice daily 3
- Keeping the affected area clean and dry between treatments is crucial to prevent worsening of infection 4
Monitoring and Follow-up
- Clinical response should be evident within 3-5 days; if improvement is not seen, the patient should be re-evaluated 1
- Regular nail trimming is necessary, cutting nails straight across until they no longer extend over the toes 4
- Monitor for signs of worsening infection including increased pain, redness, swelling, or purulent drainage 5
Special Considerations for Elderly Patients
- Avoid systemic antibiotics unless there is evidence of spreading infection, as they are often ineffective for localized paronychia 2
- For this 87-year-old patient, be cautious with extensive use of polyethylene glycol-based ointments (like standard mupirocin) if there is moderate to severe renal impairment 1
- Wearing comfortable well-fitting shoes and cotton socks can help prevent pressure on the healing nail bed 4
When to Consider Additional Intervention
- If symptoms persist beyond 2 weeks despite appropriate topical therapy, consider partial nail removal 3
- Persistent pain or drainage may indicate a subungual abscess requiring drainage 4
- If fungal infection is suspected (thickened, discolored nail), obtain cultures and consider appropriate antifungal therapy 3