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- Presentation
Management of Ingrown Nails: Conservative and Surgical Treatment Options
Description
The talk explains how to manage ingrown nails by choosing between conservative and surgical treatment based on disease severity, symptoms, and patient factors. Ingrown nails are common worldwide and especially concerning in diabetic patients, so clinicians should consider risk factors such as microtrauma, improper nail care, hyperhidrosis, comorbidities, and the patient’s ability to follow postoperative instructions. Mild cases with minimal pain, redness, swelling, and no infection should start with conservative care, which is also appropriate when surgery is not feasible or is risky, such as in uncontrolled diabetes or arterial insufficiency. Conservative options discussed include taping, orthonyxia, and especially a preferred cotton-tube-and-cyanoacrylate nail cast placed correctly under the nail plate, which can relieve pain quickly and remain effective for weeks. Artificial plates and tretinoin may help after nail plate loss, though recurrence can be an issue with some methods. For moderate to severe cases, surgery is recommended after or alongside medical treatment. Techniques mentioned include partial nail avulsion/partial matricectomy with 88% phenol, management of hypertrophic tissue by excision with either secondary healing or suturing, nail apparatus realignment in children with malalignment, and nail bed plasty for cosmetic concerns or transverse overcurvature. In very severe or non-salvageable painful cases, total nail removal may be offered. The main goals are to relieve pain, prevent progression, and restore balance between the nail plate and surrounding tissue, while choosing the approach that best fits the patient’s needs and circumstances.
View moreConclusions
- Mild ingrown nails are best managed conservatively, and most patients respond well to non-surgical care.
- Moderate and severe cases often begin with conservative or medical measures but may require surgery for definitive cure.
- The main goals of treatment are pain relief, prevention of progression, and correction of the imbalance between periungual tissue and the nail plate.
- Patient comorbidities, infection risk, and ability to comply with postoperative care should guide whether conservative treatment or surgery is chosen.
- Among conservative options, the cotton nail cast was presented as the preferred method because it is simple, inexpensive, and provides immediate pain relief.
- Taping and plastic tube splints can work, but their usefulness is limited by issues such as hyperhidrosis, need for daily care, or anesthesia.
- Artificial nail reconstruction with tretinoin can help distal onychocryptosis when the nail plate has been removed, but orthonyxis was considered less reliable because of recurrence.
- For surgical management, phenol 88% partial matricectomy was emphasized as a preferred and effective option with good postoperative outcomes.
- Nail bed plasty is a useful cosmetic surgical choice for transverse overcurvature when patients want better appearance as well as symptom relief.
- In very severe or end-stage cases, more extensive surgery such as total matricectomy can provide good pain control and symptom resolution.
- The optimal treatment for ingrown nails is individualized, because the key decision is the indication rather than the specific technique.
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