Dermatology - diseases of the skin

Ingrown toenail

Ingrown toenail is ingrown inner or outer edge of the nail plate 1 toe nail in the platen. This is a fairly common disease, occurs in childhood and adulthood. It affects mainly the outer edge of the nail bed.

Causes of ingrown nail

Allocate 2 main causes of ingrown nail plate:

Improper cutting of the nail
If an incorrect technique of cutting nails too far toward the base cut the lateral edge of the nail plate, which leads to improper growth of the ingrown nail and the soft tissue of the finger;

Wearing narrow shoes
The second reason is wearing uncomfortable tight and narrow shoes, especially pointy toe. In this case the nail plate, under the pressure of the walls of the Shoe were forced to cut into the nail wall, permanently injuring him. The result is a festering sore, grow pathological granulation (so-called “wild meat”).

Ingrown nail plate as possible:

• for flat feet;
• for fungal nails, which causes distortion, thickening of the nail, promoting the ingrowth of the soft tissue of the finger;
• after the trauma of the nail.

Symptoms of ingrown toenail

The main symptom of an ingrown toenail is a constant pain in the nail fold, increasing walking and wearing shoes. When viewed in the beginning of the disease, you can see the small size of the sore in a place where there is a constant trauma to the nail fold. Upon accession of infection (which happens quite quickly) may appear scanty purulent discharge. Then there is the growth of abnormal granulation is excessive growth of tissue in the wound area of the nail fold in response to injury and infection. Such granulation are the color of raw meat, for which he received the name of “wild meat”. From their appearance, the disease becomes chronic, essentially making it harder to walk.

Examination of ingrown nail

Upon detection of these symptoms should consult a surgeon’s clinic. Specific tests are not required, you should have a blood test to evaluate the severity of the inflammatory process; to evaluate the blood sugar is necessary to exclude the presence of diabetes.

With the development of complications, which will be discussed later, will need to perform radiography of the bones of the foot, as the possible transition of purulent process on a bone.

If you suspect a fungal infection will require treatment from a dermatologist, because without addressing the causes of the disease it is pointless to treat its consequences.

Treatment for ingrown nail

Treatment for ingrown nailTreatment in the absence of complications performed on an outpatient basis in the clinic. At the beginning of the disease when the infection and abnormal granulation is not expressed, is conducted conservative treatment, which is used for preparation for surgical treatment. It is necessary to exclude mechanical effect on the nail plate. This is achieved by wearing loose fitting shoes with a wide nose, even better to walk for a while barefoot or in shoes with open front part (sandals, flip flops). It is necessary to abandon short trimming of the nail, which enhances its ingrowth.

Self-treatment ingrown toenail

Twice a day you must perform a warm bath with salt water, it helps soften the skin and nail plate. To reduce the degree of inflammation in parallel, you must follow the bath with a weak solution of potassium permanganate (potassium permanganate) or baking soda. Effectively laying between the nail and skin roller gauze strips soaked in 0.5% aqueous-alcoholic solution of chlorhexidine, which as they dry re-moisten, reaching the constant presence of an antiseptic solution to the wound area. Besides laying gauze strips reduces the mechanical stresses on the nail cushion that helps to reduce pain and faster healing of the wound.

Previously used the mapping between the nail and skin roller narrow strips of x-ray film is also eliminated mechanical injury factor, in addition led to a gradual straightening of the deformed nail plate. Currently, there are special tools in the form of springs, plates, brackets, perform the same function. An example is shown in the photo.

Due to their miniature size, they do not prevent the wearing of shoes. Lifting the edge of the nail, they help to reduce pressure on the nail roll, reduce pain and correct the shape of the nail.

The appearance of abnormal granulation tissue and purulent discharge said about the neglect of the process and the need for surgical treatment.

Surgical treatment of ingrown nail

There are several types of surgery performed for the correction of ingrown nail. Performed under local anesthesia with 2% lidocaine or 0.5 – 1% solution of novocaine. It is necessary to remember about possible allergic reactions to these drugs up to anaphylactic shock. So be sure to check with your doctor the name of the drug, which he will carry out the epidural and let me know if you have had an allergic reaction to this drug.

The simplest method of treatment of ingrown nail is the removal of part or the entire nail plate. The nail will grow within 3 months, at this time, the nail bed will not be protected, and any mechanical action on it will cause pain, at least for the first week.

The positive results of the simple removal of part or the entire nail plate is not high. Very often the nail re-grows. This is due to increased due to inflammation of the periungual cushion. Therefore, to improve the efficiency of operations in parallel with the removal of the nail plate, scraping and removal of abnormal granulation produce plastic around the cushion.

Plastic nail fold is performed as follows: an oval incision on the lateral surface of a finger removes part of the skin and stitch the edges of the resulting wound with interrupted sutures. The result is strain around the platen roll and ceases to contact with the nail plate. This allows to achieve a stable remission of the disease.

Currently for the treatment of ingrown toenail and apply modern technology. The least traumatic method of surgical treatment of this disease laser correction. Under the action of high temperatures of the laser beam to evaporate the ingrown part and the edge of the growth zone of the nail. At the same time eliminate pathological granulation and foci of infection. The laser is also used for fungal nail plate, using it to sterilize all the subungual space from the fungal spores.

Complications of ingrown toenail

The most often complications arise during the chronic ingrown toenail. To contribute to development of complications:

• diabetes mellitus;
• obliterating atherosclerosis of vessels of lower extremities.

Complications of ingrown toenailIn these diseases the blood circulation of the soft tissues of the finger, which reduces their ability to regenerate and resistance to infection.

As a result develops the following pathological conditions.

• Lymphangitis and lymphadenitis – the infection spreads through the lymph vessels, causing inflammation (lymphangitis) to the nearest lymph nodes (popliteal and inguinal lymph nodes), where delayed, causing them and increase pain syndrome (lymphadenitis).
• Abscess of toe – purulent inflammation of the soft tissues of the finger, accompanied by swelling and redness of the whole nail phalanx, requires surgery.
• Osteomyelitis of the nail phalanx of a finger – transition purulent infection in the bone, is difficult to treat, may require amputation of the phalanx of a finger. Diagnosed by the results of x-ray studies of the bones of the finger.
• Gangrene of toe – irreversible necrosis of the soft tissues of the foot, accompanied by blackening of the skin. The only treatment is amputation of the ungual phalanx or the entire toe.

Prevention of ingrown toenails.

One should follow some simple rules.

• Wearing loose shoes.
• Treatment of orthopedic diseases (flat feet).
• Personal hygiene.
• Timely treatment of infection by a specialist dermatologist.
• Proper techniques of trimming nails. The nail should be cut in a straight line, not passing below the top of the finger, sharp straight nail scissors. The edge of the nail need nail file to file the corners so they were smooth and not hurt the skin.

At occurrence of first signs of disease you should consult a surgeon. In the early stages of the disease can be cured without surgery!

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