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SUMMARY
Ingrown nail, also called onychocryptosis, is one of the most common nail disorders, typically affecting the toenails.
Various predisposing factors have been associated with ingrown toenails.
There are three forms of ingrown nails (lateral, anterior, and proximal), with different treatment approaches.
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TIPS FOR DIAGNOSIS
Always examine all the toenails and the two feet to look at predisposing factors.
Diagnosis is clinical, with the presence of inflammation, erythema, pyogenic granuloma, and referred pain.
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DON’T FORGET
The disease has a negative impact on the quality of life.
On the basis of the type and severity of ingrowing, different approaches are possible.
Recurrences can occur.
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PITFALLS AND CAUTIONS
If possible, predisposing factors should be corrected.
Surgery should be performed in adults, while in children and adolescents conservative treatment should be preferred.
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EXPERT PEARLS
In the second and third stages of a lateral ingrowing nail, the best approach is to remove the pyogenic granuloma or hypertrophic epithelium, together with the chemical matricectomy.
Retronychia is more rare, and intralesional injection of steroid can be useful in order to avoid nail avulsion.
Patients should be followed up for 6 to 12 months, in order to monitor the nail plate growth and possible recurrences.
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PATIENT EDUCATION POINTS
Predisposing factors include poorly fitting footwear, improper cutting of the toenails, hyperhidrosis and trauma.
In mild stages, surgery may not be necessary.
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An ingrown nail, also called onychocryptosis, is one of the most common nail disorders that may have a negative impact on the quality of life. It typically affects toenails, with the first toenail usually more commonly involved. The pathogenesis is described by the penetration of the nail plate into the soft tissue that can be lateral, proximal, or anterior, with inflammatory reaction and possible development of pyogenic granuloma. Many predisposing or precipitating factors are involved in the disease. Diagnosis is usually clinical, and treatments are different on the basis of the degree of the inflammation.
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Nail ingrowing is a frequent disease, occurring at any age, but is more prevalent in young males,1 while the proximal form (retronychia) is observed more often in young female patients.2,3
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The great toe is most often affected.
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The pathophysiology of the disease is described as a soft-tissue inflammation caused by continuous injury by the nail plate. Various predisposing factors have been associated with ingrown toenails, including poorly fitting footwear, improper cutting of the toenails, hyperhidrosis, trauma, and comorbidities such as obesity, diabetes mellitus, and cardiac and renal diseases.4
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Many anatomic alterations can favor nail inglowing, such as ...