Ingrown nail

Ingrown nail

Onychocryptosis (also known as an "Ingrown nail" or "Unguis incarnatus") is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the nail bed.

What is an ingrown nail?

An ingrown nail (onychocryptosis) occurs when part of the nail penetrates the skin, which can often result in an infection. The ingrown nail can also apply pressure in the nail fold area without penetrating the skin - this is not technically an ingrown nail, but can also be painful (a corn/callus is also common down the side of the nail and is a reaction to this pressure, rather than the nail actually penetrating the skin).

What does an ingrown nail (onychocryptosis) look like? 

Usually the side of the nail penetrates deep and it is difficult to see the edge of the nail. The severity of appearance of the nail will vary. Some will just have a nail that appears deeply embedded down the side or sides of the nail. In some the corner or a small spike of nail may penetrate the skin, just like a knife. This can result in an infection and the development of proud flesh (granulation tissue). The toe will then be red, inflamed and painful.

What are the symptoms of an ingrown nail (onychocryptosis)?

Pain is the main symptom of an ingrown nail - usually just starting as some minor discomfort. This may be just the pressure from the side of the nail or it may be because the nail has actually penetrated the skin down the side of the nail. The toe is not necessarily infected, but this can develop after the nail penetrate the skin to become ingrown. The infection can spread, making the toe red and inflamed (paronychia). A collection of pus may also develop.

What causes an ingrown nail (onychocryptosis)?

Poor cutting of the nail is most commonly blamed as being the cause of an ingrown nail, but this is not necessarily the case. The following factors are involved in the cause of ingrown toenails (onychocryptosis):

• the primary risk factor is the shape of the nail - a nail that is more curved from side to side rather than being flat is more likely to become an ingrown nail (incurvated nails). Some nails go down the side into the nail fold area for a relatively large distance. A large portion of the nail is almost vertical rather than being horizontal. The most severe of these types of nail is called a 'pincer nail' in which both side of the nail are very curved. The shape of the nail is usually inherited (congenital), but it can be influenced by trauma and/or shoe pressure. 
• poor cutting of these types of nails can leave a sharp corner (or if worse, a small spike) that will initially cause symptoms by putting pressure on the skin and then later penetrate the skin. Trimming too far down the sides is a common cause of an ingrown toe nail. 
• footwear that is tighter is more likely to increase pressure between the skin in the nail fold and nail, increasing the risk on an ingrown nail. 
• previous trauma to the nail may alter the shape of the nail, making it more prone to becoming an ingrown nail 
• pressure from the toe next to the nail that has ingrown can sometime be a factor 
• a 'chubby' or fleshy toe is more likely to have a nail grow into it. Those whose feet swell are a lot are more prone to having this happen.

Ingrown nail treatment

1. Antibiotics are often used to treat the infected ingrown toenail, but don't forget that the cause of the infected (the ingrown nail) is still there, so there is not a lot of point in treating the infection while the cause remains.

2. An experienced medical doctor can easily remove the corner or spike that has penetrated the skin, often with relatively little discomfort. If the ingrown nail is too painful, a local anesthetic may be needed to do this.

3.Ingrown toe nails have a great tendency to happen again the most common of those reasons is the shape to the nail, in this cases it is advised to perform a minor surgical operation. Minor surgery is a relatively simple procedure and is very successful for long term relief that is permanent.

Role of CO₂ laser in the treatment of Ingrown Toenail 

Laser is used for several years to treat with great success ingrown nail, the advantage of CO₂ Laser over knife surgery are the following:

1. Reduced pain as there is no direct contact of a surgical knife with the painful area.
2. Decrease risk of infection as the Co2 laser kills all bacteria in the area applied.
3. Lower recurrence rate then conventional surgical procedure.
4. Reduce postoperative pain allowing the patient to resume everyday activity quicker then non laser surgery.
5. No or minimal bleeding-Laser seals the small blood vessels of the nail.