What is the treatment for ingrown toenail?

Treatment for Ingrown Toenail

Start with conservative management for mild to moderate cases using warm antiseptic soaks and topical agents, but escalate to surgical intervention if there is no improvement after 2 weeks or if infection is severe. 1, 2

Initial Conservative Management

For uncomplicated ingrown toenails without significant infection, begin with these measures:

• Soak the affected toe in warm, soapy water or dilute antiseptic solution for 10-15 minutes twice daily to reduce inflammation and prevent infection 1
• Apply topical povidone-iodine 2% twice daily as the most evidence-based first-line antiseptic agent 2, 3
• Apply a mid-to-high potency topical corticosteroid ointment to the nail folds twice daily to reduce inflammation and edema, but avoid this if purulent drainage is present 1, 2, 3
• Place cotton wisps or dental floss under the ingrown nail edge to separate it from underlying tissue and provide mechanical relief 2, 4
• Tape the nail fold away from the nail plate to reduce pressure 2

When to Add Antibiotics

If infection develops despite conservative measures, antibiotic therapy is warranted:

• For mild-to-moderate infections, prescribe cephalexin or amoxicillin-clavulanate for 1-2 weeks 2
• For toddlers requiring antibiotics, use amoxicillin-clavulanate (Augmentin) dosed appropriately by weight as the first-line agent 3
• Up to 25% of cases have bacterial or fungal superinfections involving both gram-positive and gram-negative organisms 2
• Continue antibiotics for 1-2 weeks for mild infections, with some requiring an additional 1-2 weeks; for moderate-to-severe infections, 2-4 weeks is usually sufficient 2

Critical pitfall: Do not prescribe clindamycin as first-line therapy 2

Surgical Intervention Criteria

Reassess after 2 weeks of medical management; if no improvement, escalate to surgical intervention 2

Immediate surgical consultation is required for:

• Severe infections with deep abscess, extensive tissue involvement, or substantial necrosis 2
• Recurrent or treatment-refractory cases 2

Surgical approaches are superior to nonsurgical ones for preventing recurrence 4. The most common surgical approach is partial avulsion of the lateral edge of the nail plate, with matrixectomy (chemical, surgical, or electrosurgical) to further prevent recurrence 5, 6, 4

Critical pitfall: Do not delay surgical intervention beyond 2 weeks if medical management fails 2

Footwear and Nail Care Education

Proper preventive measures are essential to avoid recurrence:

• Trim toenails straight across, never rounded at the corners, and avoid cutting them too short 1, 3
• Wear comfortable, well-fitting shoes with adequate toe box space to reduce pressure on the toenail 1, 3
• Apply topical emollients daily to cuticles and periungual tissues to maintain skin barrier function 1

Special Populations

For diabetic patients at risk of foot ulceration with ingrown toenails, provide appropriate treatment by a trained healthcare professional to prevent complications 1. In diabetic patients, ingrown toenail treatment is particularly important as it can help prevent foot ulcers 1

For toddlers with recurrent ingrown toenails despite proper nail care, consider referral to a podiatrist for specialized assessment and preventive correction of nail curvature 3

Post-Procedure Care (After Surgical Intervention)

• Continue antiseptic soaks with dilute vinegar (50:50 dilution) or 2% povidone-iodine for 10-15 minutes twice daily 1
• Apply mid to high potency topical steroid ointment to nail folds twice daily 1
• Avoid trauma to the affected digit and wear protective gloves during activities involving water exposure or chemicals 1