What should I do for a possible ingrown nail in my finger?

Management of Possible Ingrown Fingernail

For your non-infected possible ingrown fingernail, start daily antiseptic soaks with dilute vinegar (50:50 dilution with water) or 2% povidone-iodine for 10-15 minutes twice daily, followed immediately by application of a mid-to-high potency topical steroid ointment to the nail fold twice daily. 1

Immediate Conservative Treatment

Your first-line approach should include:

• Antiseptic soaks twice daily: Use either dilute white vinegar (mix equal parts vinegar and water) or 2% povidone-iodine solution for 10-15 minutes 1, 2
• After each soak: Apply a mid-to-high potency topical steroid ointment (like triamcinolone 0.1% or betamethasone) directly to the inflamed nail fold twice daily to reduce inflammation 1
• Continue this regimen for at least 2 weeks before reassessing 2

Additional Helpful Measures

While doing the above treatment:

• Gently lift the ingrown edge: After soaking when the nail is soft, you can carefully place a small wisp of cotton or dental floss under the ingrown lateral nail edge to separate it from the underlying tissue 1, 3
• Avoid further trauma: Wear comfortable gloves when doing activities that might bump or pressure the finger 1
• Keep nails properly trimmed: Cut straight across, not too short, and avoid rounding the corners 1

When to Escalate Treatment

Reassess after 2 weeks - if you notice any of the following, you need medical evaluation: 2

• Persistent pain or throbbing that isn't improving
• Development of pus or drainage - this requires cultures and oral antibiotics with coverage against Staphylococcus aureus 1
• Increasing redness, swelling, or warmth spreading beyond the immediate nail fold
• Formation of red, fleshy tissue (granulation tissue) at the nail edge - this may require removal with silver nitrate or minor surgical procedure 1

Common Pitfalls to Avoid

• Don't cut the nail too aggressively - this often worsens ingrown nails by creating sharp edges that dig into the skin 1
• Don't ignore signs of infection - up to 25% of paronychia cases develop secondary bacterial infection 2
• Don't use topical steroids if pus develops - infection must be treated first with antibiotics before resuming anti-inflammatory treatment 2
• Don't wait beyond 2-4 weeks if symptoms persist - this may indicate need for surgical intervention 1

Prevention Going Forward

Once resolved, maintain these habits:

• Trim nails straight across, never rounded, and leave them slightly longer than the fingertip 1
• Apply emollients daily to cuticles and periungual tissues to maintain skin barrier function 1
• Wear protective gloves when working with water or chemicals 1
• Avoid cutting or manipulating cuticles 1

The combination of antiseptic soaks and topical steroids is the evidence-based first-line approach recommended by the American Academy of Dermatology for non-infected ingrown nails, with surgical options reserved only for cases that fail conservative management after 2-4 weeks. 1, 2