Onychocryptosis, commonly known as an ingrown toenail, occurs when the edge of the nail plate grows into the surrounding soft flesh. This penetration causes local irritation, pain, and inflammation in the toe’s nail fold. The body’s reaction often leads to swelling, tenderness, and significant discomfort. While many mild cases can be managed at home, persistent pain often necessitates professional medical attention.
Understanding Ingrown Toenails and Initial Care
Ingrown toenails typically arise from improper nail trimming; cutting the nail too short or rounding the corners encourages the nail to grow into the skin. Wearing tight-fitting or restrictive footwear can also compress the toes, forcing the nail edges into the flesh. Trauma to the toe, such as stubbing it, or having a natural, highly curved nail shape can predispose a person to the condition.
Initial symptoms include localized pain, redness (erythema), and swelling (edema) along the side of the nail. For immediate, non-professional relief, soaking the affected foot in warm, soapy water or a diluted Epsom salt solution for 15 to 20 minutes can reduce inflammation. After soaking, one can attempt to gently lift the offending nail edge and insert a tiny piece of cotton or waxed dental floss beneath it, which helps separate the nail from the skin. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can also be taken to manage the discomfort until professional help is sought.
When to Consult a Dermatologist
A dermatologist, specializing in conditions of the skin, hair, and nails, is equipped to treat ingrown toenails, particularly when the condition has progressed beyond a simple irritation. While podiatrists are often the primary specialists for foot and ankle issues, dermatologists are typically consulted when the problem involves significant skin pathology or chronic infection. Their expertise becomes valuable when the ingrown nail has led to the formation of pyogenic granuloma, which is a rapidly growing, red, vascular growth of tissue around the nail bed.
The dermatologist’s assessment is focused on the health of the entire nail unit and the surrounding skin, especially in complex cases. This expertise is particularly important for patients with underlying systemic conditions like diabetes or peripheral vascular disease, where a seemingly minor toe infection can quickly escalate due to compromised circulation. These high-risk feet require a physician with knowledge of wound healing and skin integrity to prevent serious complications. If the ingrown toenail is recurrent or does not respond to initial treatments, the dermatologist can also evaluate for other contributing skin or nail disorders.
Professional Treatment Methods
When conservative home care methods fail to resolve the ingrown toenail, a medical professional must intervene. The most common in-office procedure is a partial nail plate excision, often referred to as a wedge resection, performed under local anesthetic. During this procedure, the toe is numbed with an injection, and the small, offending portion of the nail that is digging into the skin is carefully trimmed and removed.
To prevent the nail from growing back, the procedure is frequently followed by a chemical matrix ablation. A chemical agent, such as phenol or trichloroacetic acid, is applied to the exposed nail matrix—the tissue where the nail grows from—to permanently destroy the cells in that specific section. This targeted destruction ensures that the problematic nail edge will not regrow, leading to a narrower, permanent nail plate.
In rare, severe, or highly recurrent cases, a more extensive surgical matrixectomy may be performed. This involves the surgical removal of a portion of the nail matrix tissue. While the procedures are highly effective, patients can expect a healing period of several weeks, during which they will need to keep the area clean and bandaged to ensure proper recovery and prevent infection.