How to treat an ingrown toenail at home?

Home Treatment of Ingrown Toenail

For mild ingrown toenails without significant infection, start with twice-daily warm antiseptic soaks combined with topical corticosteroids and mechanical relief techniques, reserving antibiotics only for clear signs of infection such as purulent drainage or cellulitis extending beyond the nail fold. 1, 2

Initial Assessment

Before starting home treatment, evaluate the severity by checking for:

• Degree of redness, swelling, and pain 1
• Presence of pus, abscess, or purulent drainage 1, 2
• Extent of cellulitis (redness extending beyond the immediate nail fold) 2
• Granulation tissue formation 2

If you have diabetes, seek immediate professional care rather than attempting home treatment, as ingrown toenails can progress to serious foot ulceration. 2, 3

Conservative Home Treatment Protocol

Antiseptic Soaking (Foundation of Treatment)

• Soak the affected toe for 10-15 minutes twice daily using either: 1, 2
  • Dilute vinegar solution (50:50 vinegar to water) 1, 3
  • 2% povidone-iodine solution 1, 2
• Alternatively, Epsom salt soaks can be used 4

Topical Anti-Inflammatory Treatment

• Immediately after each soak, apply a mid- to high-potency topical corticosteroid ointment to the inflamed nail fold twice daily 1, 2, 3
• This reduces local inflammation and swelling 2

Mechanical Relief Techniques

Choose one of these methods to separate the nail from inflamed tissue: 2

• Cotton wisp or dental floss insertion: Place small amounts of cotton or dental floss under the ingrown lateral nail edge to lift it away from the skin 2, 5
• Gutter splinting: Use a plastic tube with a lengthwise incision placed on the lateral nail edge for immediate pain relief 1, 2
• Taping technique: Tape the lateral nail fold away from the nail plate 2

When to Add Antibiotics

Do NOT routinely use antibiotics for mild ingrown toenails. 2 Only add oral antibiotics if you observe:

• Purulent drainage (pus) 2
• Significant cellulitis with redness extending well beyond the nail fold 2

If antibiotics are needed:

• First-line: Cephalexin targeting Staphylococcus aureus and gram-positive organisms 1, 2
• If first-line fails: Switch to sulfamethoxazole-trimethoprim (Bactrim) for broader coverage including MRSA 1
• Be aware that secondary bacterial or fungal infections occur in up to 25% of cases 1

Prevention of Recurrence

To prevent future ingrown toenails: 2, 3

• Trim toenails straight across, never rounded at corners, and avoid cutting too short 2, 3
• Wear comfortable, well-fitting shoes with adequate toe room 1, 2
• Wear cotton socks 1
• Apply topical emollients daily to cuticles and periungual tissues 2, 3
• Avoid manipulating cuticles or using nails as tools 2
• Wear protective gloves when working with water or chemicals 1, 2
• Manage hyperhidrosis (excessive sweating) if present 5

When Home Treatment Fails

Reassess after 2 weeks of conservative management. 2 Seek professional care if:

• Persistent pain or drainage continues beyond 2-4 weeks despite appropriate home treatment 2
• Granulation tissue develops 2
• Pain becomes intolerable 1
• Signs of infection worsen 2

Important Caveats

• For diabetic patients: Do not attempt home treatment; seek immediate professional care as ingrown toenails can lead to serious complications including foot ulceration 2, 3
• Recurrent cases: If this is your second or third episode, home treatment may provide only temporary relief, and you should consider professional evaluation for definitive treatment 3
• The combination of soaking plus corticosteroids plus mechanical relief is more effective than any single intervention alone 2
• Urea-containing products may help soften hyperkeratotic (thickened) skin around the nail if present 6